(PO-193) (PO-193) The challenges of managing pregnant women with anorexia nervosa during prolonged obstetrical hospitalizations: a case report

Background: The prevalence of anorexia nervosa (AN) increases in women of childbearing age and relapse may be triggered during pregnancy. Women with AN are at an increased risk of complications for mother and child including pre-eclampsia, preterm birth, growth restriction, postpartum depression and perinatal mortality. Early identification of AN in pregnancy may be difficult as many women do not disclose this history to their obstetrician which may make inpatient stabilization outside of a specialized unit difficult (Kimmel 2016; Arnold 2019).

Case: Mrs. F is a 37 year old G3P2 at 28w4d with AN, restrictive and purging type, with a BMI < 14 who presented for complete placenta previa, accreta, and worsening AN. She had limited prenatal care due to amenorrhea and ultrasound revealed intrauterine growth restriction. Staff observed her vomiting with concerns for purging prompting a 1:1 sitter. Calorie counts and vitamin repletion was initiated as well. Due to her poor nutritional status, Mrs. F was offered nasal gastric tube feeds but declined although agreeing to total parenteral nutrition. During an interdisciplinary meeting, staff expressed fears due to unfamiliarity working with patients with anorexia. She underwent emergent caesarian hysterectomy at 30w1d for significant vaginal bleeding requiring a prolonged stay. After stabilization, she was offered transition to an eating disorder program however she declined and was discharged home with outpatient follow up.

Discussion: American College of Obstetrics and Gynecology recommends a team approach that is multidisciplinary including providers from Ob/Gyn, psychiatry and neonatology (ACOG 2018). Usual care for AN is often siloed within structured specialty psychiatric clinics and, if severe, specialized medical inpatient settings. With this case, the usual care model to specialty inpatient medical services with Ob/Gyn and intensive care presented new challenges. There are limited guidelines on management of pregnant women with AN during prolonged medical hospitalizations (Wolfe 2016; Dinas 2008).



Conclusion: Further guidelines on the management of pregnant patients with AN during prolonged obstetrical stays is needed outside of a specialized eating disordered unit. While early identification of AN in pregnancy would be ideal, this is often not screened during routine perinatal visits and may be missed until complications already arise.

ACOG Committee Opinion No. 740: Gynecologic Care for Adolescents and Young Women With Eating Disorders. Obstet Gynecol. 2018;131(6):e205-e213.

Arnold C et al. The effects of eating disorders in pregnancy on mother and baby: a review. Psychiatr Danub. 2019;31(Suppl 3):615-618.

Dinas K et al. Anorexia nervosa in pregnancy: a case report and review of the literature. Obstetric Medicine. 2008;1(2):97-98.

Kimmel MC et al. Obstetric and gynecologic problems associated with eating disorders. Int J Eat Disord. 2016;49(3):260-275.

Wolfe BE, Dunne JP, Kells MR. Nursing Care Considerations for the Hospitalized Patient with an Eating Disorder. Nurs Clin North Am. 2016;51(2):213-235.