Pompe à GNRH : le désir d'enfant et la grossesse à l'épreuve des troubles des conduites alimentaires

Abstract : Introduction: This thesis is the result of reflexions and clinical experiences from our work of pregnancy in women suffering from lifetime eating disorders (ED). Among different methods of assisted reprodutive technology (ART), we chose to study a special population: women seeking GnRH pulsatile administration treatment. Main hypothesis: there is an important rate of women with a lifetime ED seeking GnRH pulsatile administration treatment . Secondary hypothesis: maternal ED have influences on the desire for a child, pregnancy and early mother-child interactions. Main objective: to evaluate pregnant women with a lifetime ED after seeking GnRH pulsatile administration treatment, from the 4th month of pregnancy until the 8th week of postpartum. Secondary objectives: to obtain scientific data about women with lifetime ED seeking GnRH pulsatile administration treatment ; to better inform the multidisplinary care of these patients in the ART services ; to obtain scientific data about the experience of pregnancy in women with a lifetime ED and about the presence and severity of ED during pregnancy and postpartum ; to estimate the prevalence of postpartum depression in these women. Design: A descriptive comparative three-group design in which collected data were compared - one of women with lifetime ED who became pregnant after GnRH pulsatile administration treatment, one of women without lifetime ED who became pregnant after using other ART methods , one of women without lifetime ED who had a spontaneous pregnancy. Evaluation criteria: EDE to evaluate ED during the pre- and post-natal period ; clinical semi-structured interviews to evaluate how the pregnancy is experienced ; IRMAG to evaluate maternal representations ; HAD to evaluate anxiety and depression during the pre and postnatal period ; STAI to evaluate anxiety ; EPDS to evaluate risk of postpartum depression. This study is observational and prospective: during the prenatal period - 3 evaluations were conducted, between 16 and 20 weeks of amenorrhea (SA), between 24 and 28 SA and between 28 and 32 SA ; during the postnatal period - 1 evaluation was conducted around the 8th week. Conclusion: Eating disorders and GnRH pulsatile administration can be considered as a real public health issue, requiring strategies to address prevention, identification and multidisciplinary care for these women during pregnancy and postpartum. An eating disorder screening tool should be included in the initial intake, because these patients may be at a higher risk for negative maternal and fetal outcomes than non eating disorder patients.
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Irema Barbosa Magalhães Santos. Pompe à GNRH : le désir d'enfant et la grossesse à l'épreuve des troubles des conduites alimentaires. Psychologie. Université Sorbonne Paris Cité, 2015. Français. ⟨NNT : 2015USPCB210⟩. ⟨tel-01914948⟩

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