Challenges in the management of gestational diabetes mellitus in anorexia nervosa

Anorexia nervosa is a serious psychiatric disorder characterized by restrictive eating leading to an unhealthy low body weight. Anorexia nervosa is associated with infertility and increases the risks for preterm infants as well as low birth weight and small-for-gestational age infants. Treatment for anorexia nervosa includes acceptance and tolerance that all foods can be nourishing; helping individuals with anorexia nervosa eat more variety and types of food is a cornerstone in treatment. Gestational diabetes mellitus is a common pregnancy complication associated with fetal macrosomia and pre-eclampsia. Its management includes monitoring both carbohydrate intake and blood glucose levels. In a woman with anorexia nervosa prior to pregnancy who subsequently developed gestational diabetes, disordered eating cognitions and restrictive eating behaviors increased after beginning monitoring for gestational diabetes mellitus, with weight loss and a preterm delivery. Dietary counseling related to gestational diabetes mellitus should be individualized for patients with a history of anorexia nervosa.