Impact of pregnancy on bulimia nervosa

Background Bulimia nervosa affects women at a peak age of reproductive func tioning, but few studies have examined the impact of pregnancy on bulimia. Aim To examine the impact of pregnancy on symptoms of bulimia nervosa and a ssociated psychopathology Method Women actively suffering from bulimia nervosa during pregnancy (n=94 ) were interviewed using the eating disorder examination (12th edn) and str uctured clinical interview for DSM-III-R, with additional structured questi ons. Behaviours were recorded at conception, each trimester and postnatally . Relative risks were calculated for prognostic factors. Results Bulimic symptoms improved throughout pregnancy. After delivery, 57% had worse symptoms than pre-pregnancy, but 34% were no longer bulimic. Rel apse was predicted by behavioural severity and persistence, previous anorex ia nervosa ('Type II' bulimia), gestational diabetes and 'unplanned' pregna ncy. Unplanned pregnancies were the norm, usually resulting from mistaken b eliefs about fertility. 'Postnatal depression' was suggested in one-third o f the sample, and in two-thirds of those with 'Type II' bulimia, and was pr edicted by alcohol misuse, symptom severity and persistence. Conclusions Postnataltreatment intervention should focus on women 'at risk' of relapse, but all women with bulimia should be assessed for postnatal de pression. Declaration of interest None.