Eating disorders are associated with adverse obstetric and perinatal outcomes: a systematic review

Objective: To systematically review the literature focusing on obstetric and perinatal outcomes in women with previous or current eating disorders (EDs) and on the consequences of maternal EDs for the offspring. Methods: The study was performed following the systematic review and meta-analysis (PRISMA) statement. PubMed, SciELO, and Cochrane databases were searched for non-interventional studies published in English or Portuguese from January 1980 to December 2020. Risk of bias was assessed using the Methods guide for effectiveness and comparative effectiveness reviews (American Agency for Healthcare Research and Quality). Results: The search yielded 441 records, and 30 articles were included. The psychiatric outcome associated with EDs in women was mainly perinatal depression. The most prevalent obstetric outcomes observed in women with EDs were vomiting, hyperemesis, bleeding, and anemia. Most studies found maternal anorexia nervosa and bulimia nervosa to be associated with low birth weight and slow fetal growth. Women with binge EDs delivered children with increased birth weight. Of the 30 studies included, methodological quality was good in seven, fair in eight, and poor in 15 studies. Conclusion: A considerable body of evidence was reviewed to assess obstetric and perinatal outcomes in EDs. Acute and lifetime EDs, especially if severe, correlated with poor perinatal, obstetric, and neonatal outcomes. Obstetricians and general practitioners should be vigilant and screen for EDs during pregnancy.

Eating disorders are associated with adverse obstetric and perinatal outcomes: a systematic review.

OBJECTIVE: To systematically review the literature focusing on obstetric and perinatal outcomes in women with previous or current eating disorders (EDs) and on the consequences of maternal EDs for the offspring. METHODS: The study was performed following the systematic review and meta-analysis (PRISMA) statement. PubMed, SciELO, and Cochrane databases were searched for non-interventional studies published in English or Portuguese from January 1980 to December 2020. Risk of bias was assessed using the Methods guide for effectiveness and comparative effectiveness reviews (American Agency for Healthcare Research and Quality). RESULTS: The search yielded 441 records, and 30 articles were included. The psychiatric outcome associated with EDs in women was mainly perinatal depression. The most prevalent obstetric outcomes observed in women with EDs were vomiting, hyperemesis, bleeding, and anemia. Most studies found maternal anorexia nervosa and bulimia nervosa to be associated with low birth weight and slow fetal growth. Women with binge EDs delivered children with increased birth weight. Of the 30 studies included, methodological quality was good in seven, fair in eight, and poor in 15 studies. CONCLUSION: A considerable body of evidence was reviewed to assess obstetric and perinatal outcomes in EDs. Acute and lifetime EDs, especially if severe, correlated with poor perinatal, obstetric, and neonatal outcomes. Obstetricians and general practitioners should be vigilant and screen for EDs during pregnancy.

The Brazilian version of the SCOFF questionnaire to screen eating disorders in young adults: cultural adaptation and validation study in a university population.

OBJECTIVE: This study translated, culturally adapted, and validated a Brazilian Portuguese version (SCOFF-BR) of the Sick, Control, One Stone, Fat, Food Questionnaire (SCOFF) to screen eating disorders in young adults. METHODS: This study used back-translation to culturally adapt the questionnaire according to International Society of Pharmacoeconomics and Outcome Research principles. The SCOFF-BR validation process involved a sample of men and women aged 18-32 years from a university community. After the participants completed the SCOFF-BR questionnaire, pre-trained researchers interviewed them with the Mini International Neuropsychiatric Interview (MINI). The presence of eating disorders was determined according to DSM-5 criteria. RESULTS: Of the 361 subjects, 9.7% had an eating disorder (2.2% anorexia nervosa, 5% bulimia nervosa, and 2.5% binge-eating disorder). Using a cutoff point of two positive responses, we obtained a sensitivity of 80% and a specificity of 71.5%, with an accuracy of 72.3%. The positive and negative predictive values were 23.1% and 97.1%, respectively. CONCLUSION: This study demonstrated that the Brazilian version of the SCOFF questionnaire presents satisfactory accuracy and reliability to screen eating disorders among young adults in the Brazilian university community.

[Schizophrenia: research perspectives]. / Grands axes de recherche sur la schizophrénie.

Current data and perspectives for schizophrenia research were reviewed in this paper. Increased incidence of schizophrenia is correlated to perinatal environmental factors, recent immigration, urban life and cannabis. Determining endophenotypes seems to be a promising strategy in the field of molecular genetics. Side effects and efficacy of treatments for schizophrenia could, now, be better predicted by the use of pharmacogenetic studies. Functional neuroimaging studies have described hypoactivations of certain brain areas supporting the hypothesis of a dysfunction of inner speech during auditory and verbal hallucinations. Dopaminergic and glutamatergic systems are disturbed in schizophrenia. These data contribute to a better understanding of the disease and may help to decrease the stigma that surrounds schizophrenia.

Anti-neuropeptide Y plasma immunoglobulins in relation to mood and appetite in depressive disorder.

Depression and eating disorders are frequently associated, but the molecular pathways responsible for co-occurrence of altered mood, appetite and body weight are not yet fully understood. Neuropeptide Y (NPY) has potent antidepressant and orexigenic properties and low central NPY levels have been reported in major depression. In the present study, we hypothesized that in patients with major depression alteration of mood, appetite and body weight may be related to NPY-reactive autoantibodies (autoAbs). To test this hypothesis, we compared plasma levels and affinities of NPY-reactive autoAbs between patients with major depression and healthy controls. Then, to evaluate if changes of NPY autoAb properties can be causally related to altered mood and appetite, we developed central and peripheral passive transfer models of human autoAbs in mice and studied depressive-like behavior in forced-swim test and food intake. We found that plasma levels of NPY IgG autoAbs were lower in patients with moderate but not with mild depression correlating negatively with the Montgomery-Åsberg Depression Rating Scale scores and with immobility time of the forced-swim test in mice after peripheral injection of autoAbs. No significant differences in NPY IgG autoAb affinities between patients with depression and controls were found, but higher affinity of IgG autoAbs for NPY was associated with lower body mass index and prevented NPY-induced orexigenic response in mice after their central injection. These data suggest that changes of plasma levels of anti-NPY autoAbs are relevant to altered mood, while changes of their affinity may participate in altered appetite and body weight in patients with depressive disorder.

Current concepts in the pharmacotherapy of paraphilias.

Concerns about paraphilia and its treatment have grown in the past few years. Although the aetiology of paraphilia disorder is still not completely understood, pharmacological treatments have been proposed for this disorder. Paraphilias are a major burden for patients and society; nevertheless, only a few individuals with paraphilias voluntarily seek treatment. Antidepressants have been used in the treatment of certain types of mild (e.g. exhibitionism) and juvenile paraphilias. Antilibidinal hormonal treatments, such as steroidal antiandrogens and gonadotrophin-releasing hormone (GnRH) analogues, have also been studied and they seem to be effective in paraphilic disorders, although caution should be taken in the prescription of these treatments in order to avoid or minimize adverse effects and the risk of victimization. The combination of psychotherapy and pharmacological therapy is associated with better efficacy compared with either treatment as monotherapy. Paraphilia is a chronic disorder and a minimal duration of treatment of 3-5 years is highly recommended for severe paraphilia with a high risk of sexual violence. In conclusion, this review of the literature provides suggestive evidence that paraphilias are well characterized disorders marked by pathological dimensions. Although further research is necessary to confirm treatment efficacy and to improve our knowledge of long-term tolerance, available data on the use of selective serotonin reuptake inhibitors, steroidal antiandrogens and GnRH analogues strongly suggest the efficacy of these treatments for paraphilic disorders.

Avaliação de fatores de risco associados com elevação da pressão arterial em crianças / Evaluation of risk factors associated with increased blood pressure in children

A mensuração da pressão arterial é hoje reconhecida como um componente importante da rotina questionada por estudos epidemiológicos que têm mostrado um aumento da prevalência de hipertensão essencial na faixa etária pediátrica.

[Evaluation of risk factors associated with increased blood pressure in children]. / Avaliação de fatores de risco associados com elevação da pressão arterial em crianças.

OBJECTIVE: To identify factors associated with increased arterial blood pressure in children. METHODS: In this cross-sectional study, arterial blood pressure was measured in 672 children between 2 and 11 years of age from two schools in the city of Belo Horizonte, Brazil. After providing informed consent, all children had their blood pressure and anthropometric parameters measured. Blood pressure was measured based on the recommendations of the Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents. The following variables were assessed: age, sex, race, urban life quality index, weight, height, and body mass index. Analysis of variance was used for comparison of means and the chi-square was used for comparison of proportions. Variables associated with increased blood pressure were included in a multiple regression model. RESULTS: According to univariate analysis, increased systolic and diastolic blood pressure were associated with high urban life quality index, white race and high body mass index. On multivariate analysis, body mass index, urban life quality index and height remained associated with increased systolic blood pressure; urban life quality index and age were associated with increased diastolic blood pressure. CONCLUSION: In this study, excess weight and obesity were associated with increased systolic blood pressure. Other unidentified factors were partially associated with increased blood pressure in children from the school with elevated urban life quality index.

Avaliação de fatores de risco associados com elevação da pressão arterial em crianças / Evaluation of risk factors associated with increased blood pressure in children

OBJETIVOS: Identificar fatores associados a níveis elevados de pressão arterial em crianças. MÉTODOS: Estudo transversal da pressão arterial de 672 crianças entre 2 e 11 anos de idade em duas instituições de ensino de Belo Horizonte, entre setembro e dezembro de 2001. A pressão arterial foi mensurada seguindo os parâmetros estabelecidos pelo relatório do Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents. As seguintes variáveis foram estudadas: idade, sexo, cor da pele, índice de qualidade de vida urbana, estatura e índice de massa corporal. Para a comparação das médias, foi utilizada a análise de variância, e para a comparação de proporções, o teste qui-quadrado. As variáveis associadas a níveis mais elevados de pressão arterial foram incluídas em análise de regressão linear múltipla. RESULTADOS: Na análise univariada, níveis mais elevados de pressão arterial sistólica e diastólica estiveram associados com crianças de cor branca, crianças da região com alto índice de qualidade de vida urbana e com elevado índice de massa corporal. Na análise multivariada, apenas o índice de massa corporal, o índice de qualidade de vida urbana e a estatura mantiveram-se associados com níveis elevados de pressão sistólica. Em relação aos níveis mais elevados de pressão arterial diastólica, apenas as variáveis índice de qualidade de vida urbana e idade foram mantidas no modelo após o ajustamento. CONCLUSAO: O sobrepeso e a obesidade estiveram associados com níveis mais elevados de pressão arterial sistólica. Outros fatores, não identificados, foram parcialmente associados a níveis mais elevados de pressão arterial de crianças do estabelecimento privado do ensino.