Background: Dietitians who care for patients with EDs are expected to have undergone advanced training to develop the knowledge, skills and experience required to provide care safely and effectively. Many dietitians lack confidence and self-reported skill in treating patients with ED's. Adding to this, few maternal health dietetic models of care are reported in literature beyond those in weight management programs, bariatric surgery, and diabetes, highlighting the lack of guidelines in the dietetic management of EDs during pregnancy. Of further concern is the management of EDs in women with high-risk pregnancies, including twin pregnancies.
Aim: This case series highlights dietetic management of a person with Anorexia Nervosa (AN) during a twin pregnancy through a retrospective analysis of dietetic interventions and outcomes.
Results: At pre-conception, trimesters 1-3 and post-partum, blended goals of nutrition intervention in pregnancy and ED recovery were identified. Specific education and strategies utilised were detailed. The decision was made not to prescribe numerical values for food intake (kilojoule targets) and to utilise blind weights with a ‘weight in range’ tracker rather than numerical value. The client met goals for nutrition intake and appropriate weight gain and the twins were delivered safely at 36+4 weeks. The client was discharged from Dietetic care at 16 weeks post-partum and remained abstinent from ED behaviours.
Importance: In the absence of guidelines, case reports are important in establishing trajectory of care. This case report is the first to detail the dietetic interventions used in treating AN in a person pregnant with twins.