Anorexia nervosa and bulimia nervosa: chronic conditions affecting pregnancy

Anorexia nervosa and bulimia nervosa primarily affect women who are in the childbearing years. While many anorectic patients are unable to ovulate second to the disruptions of normal body function associated with anorexia, there are still women who will ovulate and become pregnant. Bulimia nervosa may also disrupt the normal menstrual cycle if the disease is very severe. However, many bulimic patients will become pregnant. Both of these disease states cause a decrease in circulating plasma volume, fluid and electrolyte shifts, and other alterations that may increase the risk to a pregnancy and developing fetus. Severe disease states are associated with intrauterine fetal growth retardation (IUGR). The nursing care of the anorectic or bulimic patient who becomes pregnant is specialized and requires coordination between nursing, perinatology, and the psychiatric team, as well as support services including nutritionists. The nursing care of anorectic patients is difficult and requires an understanding of the complex psychological and physical pathophysiology of the disease. Bulimia nervosa also requires a complete understanding of the psychological and pathophysiology of the disease process. This article provides a review of the syndromes, risk factors, definitions of the disease states, and the nursing management of those patients experiencing a pregnancy complicated by the predisposing factors of anorexia nervosa, and/or bulimia nervosa.