Pregnancy and Eating Disorders

Dr. David Herzog was the first Endowed Professor of Psychiatry in the Field of Eating Disorders at Harvard Medical School. He is board certified in pediatrics, child and adolescent psychiatry and general psychiatry and has treated over 3,000 individuals with anorexia nervosa, bulimia nervosa, and associated diagnoses. Dr. Herzog founded and directed the Harvard Eating Disorders Center, which later became the Harris Center for Education and Advocacy in Eating Disorders at Massachusetts General Hospital. 

In 1987, Dr Herzog initiated his National Institute of Mental Health-funded Longitudinal Study of Anorexia and Bulimia Nervosa, mapping the course and outcome in 246 women followed at frequent intervals. The Longitudinal Study – the largest and most extensive of its kind – has provided a better understanding of how anorexia and bulimia progress, including rates of recovery and relapse, medical consequences, associated psychiatric illnesses, the quality of patients’ relationships, and functioning at school or at work.

As part of the Longitudinal Study, Dr. Herzog and his team examined the course of pregnancy and neonatal status for babies born to women with eating disorders. Forty-nine live births were included.  The participants were interviewed by trained assistants and completed a brief self-report questionnaire that assessed both birth statistics and birth-related complications. Medical records and/or self-report data describing the babies’ birth status were obtained.

The researchers found that women with eating disorders who regain their health prior to conception and remain nutritionally stable throughout pregnancy are not more prone to obstetrical problems than those who have never had an eating disorder. However, engaging in abnormal weight control behaviors during pregnancy can increase the risk of complications such as miscarriage, premature delivery, Cesarean delivery, low-birth-weight babies, and postpartum depression.

The results of this study emphasized the importance of viewing pregnant women with past or current eating disorders as high risk and monitoring them closely both during and after pregnancy to optimize maternal and fetal outcomes.

Drug Abuse in Women with Eating Disorders

Dr. David Herzog, Emeritus Professor of Psychiatry at Harvard Medical School, founded and directed the Harvard Eating Disorders Center, which later became the Harris Center for Education and Advocacy in Eating Disorders at Massachusetts General Hospital.  Dr. Herzog’s Longitudinal Study of Anorexia and Bulimia Nervosa is internationally recognized as the largest and most extensive of its kind. Beginning in 1987, he and his staff followed 246 women with anorexia and bulimia to gain a better understanding of what happens to patients over time. They collected data by interviewing participants every 6-12 months about their eating behaviors, physical and emotional health, work and relationships. The study provided valuable information about the relationship between drug use disorder and eating disorders.

Forty-two (17.1%) of the 246 Longitudinal Study participants reported a lifetime history of drug use disorder. Of these 42 women, 22 (52.3%) had anorexia nervosa at intake and 20 (47.7%) had bulimia at intake. Of the 22 women with anorexia with a lifetime history of drug use disorder, 17 had a history of drug use disorder at entry into the study and of these, 4 had a prospective onset during the study. Five participants with anorexia developed a first episode of drug use disorder over the course of the study. Of the 20 participants with bulimia with a lifetime diagnosis of drug use disorder, 14 had a history of drug use disorder at intake into the study, and of these, 4 had a prospective onset during the course of the study, whereas 6 developed a new onset during the study. 

Dr. Herzog and his staff examined the degree to which participants who had a prospective onset of drug use disorder during the study also carried a diagnosis of affective disorder or alcohol use disorder during that same period. The data indicated that 12 of 19 participants (63.2%) had a co-occurring major depressive disorder episode and 6 of 19 participants (31.6%) had a diagnosis of hypomania during the drug use disorder episode. Seven of 19 participants (36.8%) had a co-occurring diagnosis of alcohol use disorder. 

The most commonly abused illicit drugs were amphetamines and cocaine (both of which have appetite suppressant effects) and marijuana.  Rates of drug use disorder did not differ between intake diagnoses of anorexia and bulimia. The finding that 5 of 22 participants with anorexia and 6 of 20 participants with bulimia were diagnosed with drug use disorder for the first time over the 9-year course of the study suggests that the risk for drug use disorder in women with eating disorders continues over time.

Dr. Herzog and his staff concluded from the study that drug abuse in women with eating disorders is an area of clinical concern and should be monitored routinely throughout the treatment process.