Bulimia and anorexia pose one more problem for women wishing to bear children: several studies have shown that women with these eating disorders tend to have higher rates of miscarriage than the norm. For example, psychiatrist Nadia Micali, at King's College in London, followed a group of more than 10,000 pregnant women in the Avon region of the UK. Of these women, 199 had a history of bulimia, 171 had a history of anorexia, and 82 had both anorexia and bulimia. These women had a significantly higher rate of miscarriage compared to women with no eating disorders.
After further analysis, Micali found that miscarriage occurred more frequently with women with bulimia: they were 1.4 times more likely to have two or more miscarriages than women without eating disorders, even those who had other psychiatric illnesses such as depression. No one knows why the babies conceived by women with a history of an eating disorder are less likely to make it to term. The logical conclusion would be that starving, bingeing, and purging while pregnant harms a growing fetus. But it may not be that simple.
Researchers have been unable to show a clear, consistent link between severity of symptoms and likelihood of miscarriage. There are women with severe symptoms who do not miscarry, and women with no symptoms at conception or during pregnancy who do miscarry.
Thus, simply cutting down on the bingeing and purging while pregnant does not ensure carrying a baby to term or having a healthy baby. A woman also has her own health history to consider - how ill she was before she conceived and what damage she had done to her body's systems, for example. And, ultimately, there are many complicating factors here that doctors simply do not understand. Doctors say the best advice for a woman with a history of eating disorder who wants to become pregnant is to work with a therapist to stop her symptoms and work through the psychological issues before trying to conceive. And, for those with erratic periods, be sure to use birth control, particularly condoms.
Binge eating disorder does not show up often in the medical literature in relation to pregnancy. However, most patients with the disorder, characterized by regular bingeing without purging, are overweight or obese, and obesity does have known negative consequences upon fertility. Research shows that early obesity leads not only to earlier menstruation but also to greater rates of infertility. This seems contradictory, given that anorexia and weight loss also cause a woman's monthly periods to become irregular or cease altogether. But too much weight tends to flood a woman's body with reproductive hormones, just as too little weight dries up the system.
The key to all this is fat. Hormones such as estrogen, in the potent form of estradiol, are normally stored in fat cells or produced by the ovaries after stimulation. At the same time, fat cells can produce a variant of estrogen, called estrone, from a weak male sex hormone. An obese woman, then, can produce too much estrogen, the equivalent of taking birth control pills, which also add estrogen to normal levels in a woman's body. Another reason for infertility in relation to obesity is polycystic ovarian syndrome (PCOS). This condition, marked by numerous cysts in the ovary, also causes the ovaries to alter their production of sex hormones, making PCOS the cause in up to 20 percent of infertility cases. Researchers estimate that anywhere from 30 to 75 percent of the cases of PCOS occur in obese women, although physicians are not sure of the exact reasons for the link.
Women who are obese also tend to make too much insulin. Not only does this lead to insulin resistance, the precursor to diabetes, but excess insulin also worsens infertility problems by overstimulating the ovaries, forcing them to shift their balance of hormone production. Doctors can sometimes successfully treat infertility in these cases with specific combinations of oral contraceptives. But the treatment is complicated and controversial because oral contraceptives can also worsen problems with insulin resistance and create other risks for diabetes.
At the same time, even with fertility treatment, overweight and obese women will have a tougher time conceiving. In a study of 3,586 Australian women who sought fertility treatment, researchers found that obese women were 60 percent less likely to get pregnant during treatment than women with moderate weights. The study also found that the rate of infertility for obese women paralleled that of women who weighed too little. In short, binge eating disorder, reproductively, represents the mirror image of anorexia nervosa: both cause infertility.
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