“Comprehensive treatment must incorporate the medical and psychiatric elements of an eating disorder and extend to the joys, hopes, and anxieties related to the developing life, while also addressing the physical health of both mother and baby,” says Lynnette Peoples, MSN, PMHCNS-BC, APN, Director of Princeton Center for Eating Disorders. “In this special circumstance, the care plan should be both interdisciplinary and interdepartmental, which is a distinct advantage of our hospital-based setting.”
Medical Concerns
In addition to health problems for the patient, each type of eating disorder can present different risks for a developing baby, according to Jose Vazquez, MD, Medical Director of Psychiatric Services at Princeton Medical Center. In general, issues that can affect the fetus include electrolyte imbalances, mineral or folic acid depletion, low blood sugar, dehydration, and cardiac arrythmias in the mother, as well as inadequate weight gain.
“The first three months of pregnancy are critical to a baby’s development, so if a patient is struggling with an eating disorder, early treatment and education during pregnancy is very important,” says Dr. Vazquez. “Counseling a patient about gaining weight can be challenging, but inadequate weight gain and maternal complications during pregnancy can lead to low birthweight, prematurity, and lifelong effects for the baby, including learning, neurological, and cardiac problems.”
With education a key component of care, pregnant patients tend to be more compliant and understanding of their role in creating a healthy baby once they are in a structured inpatient setting, according to Dr. Vazquez. Likewise, medical issues can be controlled via monitoring, testing, medications, and care from on-site specialists such as endocrinologists and cardiologists. Princeton Medical Center also offers an engaged, comprehensive service line for obstetrics/gynecology and maternal health.
Therapy Considerations
In some cases, a patient’s desire for her baby to be healthy supersedes anxiety about her own body, and she may be willing to tolerate the physical changes of pregnancy in the interest of the baby. In other situations, pregnancy can worsen anxiety, fear, or the lack of perceived control, causing internal conflict and even resentment.
A focus of therapy is to address these factors within the whole constellation of issues a patient may be experiencing, according to Allison Lansky, EdS, LMFT, CEDS, NCC, Lead Senior Primary Therapist at Princeton Center for Eating Disorders.
“We work with patients to pinpoint fears, recognize motivations, and identify healthy forms of control,” says Lansky. “It’s important to understand that sometimes even asking for help can be empowering.”
“We also help them look at the pregnancy from a logical standpoint, including the risk factors of not eating, as well as from a reflective perspective,” she adds. “It can be therapeutic to explore questions like the parenting values they want to have and the kind of parent they hope to be.”
Obstetric Advantages of a Hospital-Based Setting
Because we are in a hospital setting, we are able to coordinate all aspects of a pregnant patient’s care, enabling them to get the services they need in the quickest, easiest way possible,” says Jennifer Hollander, RN, MSN, Director of Patient Care Services at Princeton Center for Eating Disorders.
During treatment for an eating disorder, an obstetrician/gynecologist at Princeton Medical Center is fully involved in each pregnant patient’s care. The on-site Maternal/Fetal Medicine Department conducts prenatal tests such as ultrasounds and fetal stress tests, and can provide diagnostic and treatment services for any special pregnancy-related needs. In addition, nurses from the Labor and Delivery Unit often meet with patients to provide education and support.
“From the obstetrics perspective, one of our biggest concerns is the growth of the baby,” says Jeffrey Hofman, MD, Division Chief of Obstetrics at Princeton Health, who provides obstetrical care for pregnant patients receiving inpatient care. “Because low birthweight is a risk that can have a variety of implications for the baby, we work together to closely monitor pregnancy parameters. In some cases, this may mean additional ultrasounds and lab tests.”
In addition to in-house collaboration, Dr. Hofman and the obstetrical team ensure ongoing communication with each patient’s regular outpatient obstetrician, so care is seamless upon discharge. Providing insight to the baby’s pediatrician, if one has been identified, is also a critical part of care continuity.