Eating disorders affect approximately 7.5 million North American women each year and often peak during the childbearing years. Many women who struggle with an eating disorder may become pregnant either while actively engaging in an eating disorder or in the recovery phases. Even for a woman who has been in recovery from an eating disorder for a long period of time, pregnancy can trigger old habits and behaviors with the new changes and symptoms typically experienced during this time.

Pregnancy and motherhood can increase a woman’s vulnerability to psychiatric conditions such as depression, anxiety disorders, eating disorders, and psychoses. These conditions are often underdiagnosed and dismissed by being attributed to pregnancy-related changes in maternal temperament or physiology. Many conditions are also undertreated due to concerns around potential harmful effects of medication.

Below is a discussion about eating disorders during pregnancy, including signs to watch for, the associated health concerns for the mom to be (and growing baby) and support for women struggling with an eating disorder before and during pregnancy and postpartum.

Signs to watch for

The average woman gains between 25-35 pounds during pregnancy. While it is natural and healthy to put on weight during pregnancy, weight gain is often an idea many women are not enamoured with. It can be even tougher to accept if you are suffering from an eating disorder – it can be extremely worrying and even terrifying.  The idea of weight gain and being weighed can be a huge source of anxiety.

For some women who struggle with an eating disorder during pregnancy, being pregnant becomes a reason to move beyond the illness in order to meet the needs of their body and growing child. This allows them to cope more easily and effectively with the weight gain during pregnancy. For others, pregnancy in the face of a severe eating disorder elicits feelings of deep depression as they struggle with the tension between the idea of weight gain and body image. The majority of women struggling with an eating disorder during pregnancy fall somewhere in between these two extremes.

Women who are actively struggling with an eating disorder during pregnancy will display certain signs and symptoms. Some may include:

• Little to no weight gain or weight loss throughout the pregnancy
• Restriction of major food groups
• Feeling fearful of becoming overweight
• Engaging in extreme forms of exercise to burn calories
• Inducing vomiting to get rid of food eaten
• Chronic fatigue
• Dizziness, headaches, blacking-out
• Skipping or avoiding meals
• Difficulty concentrating
• Social avoidance of family or friends
• Increased depression or anxiety.

Health concerns associated with eating disorders during pregnancy for both mom and baby

During pregnancy, the growing baby receives all its nourishment from the mother’s body. When stores of carbohydrates, proteins, fats, vitamins, minerals and other nutrients are low, the body will drain them to support the growth and development of the baby. If reserves are not adequately restored through sufficient nourishment, the mother can become severely malnourished, and this in turn can lead to exhaustion, depression, anxiety and a myriad of other serious health complications.

The effects of an eating disorder during pregnancy can be debilitating if not treated or addressed professionally. Women suffering from anorexia nervosa are severely underweight and may not gain enough weight during pregnancy. Women with bulimia nervosa who continue to purge may suffer dehydration, chemical imbalances or even cardiac irregularities. Pregnancy heightens these health risks. Women who are overweight due to binge eating disorder are at greater risk of developing high blood pressure and gestational diabetes.

Understanding how an eating disorder may affect the various facets of life as well as those of the unborn baby may encourage a woman struggling with an eating disorder to get the help she both needs and deserves. The following are some of the physical and psychological effects on the mother and growing baby resulting from a mother suffering from an eating disorder during pregnancy:

Physical effects:

• Premature labor
• Low birth weight in baby
• Cardiac irregularities
• Stillbirth or fetal death
• Gestational diabetes
• Miscarriage
• Preeclampsia
• Complications during labor
• Respiratory difficulties
• Abnormal fetal growth
• Increased risk of caesarean birth
• Difficulties breastfeeding

Psychological effects:

• An inability to connect with the unborn child which may continue once the baby is born
• Postpartum depression
• Anxiety or panic attacks
• Low self-esteem
• Poor body image
• Suicidal ideations
• Withdrawal or isolation from loved ones, social functions or events
• Lack of enjoyment in hobbies or activities once enjoyed
• Marital or familial conflicts

Babies born to mothers struggling with an eating disorder are at greater risk for:

• Poor development
• Premature birth
• Low birth weight
• Respiratory distress
• Feeding difficulties
• Reduced or compromised immune function
• Cognitive disorders.

Support for women struggling with eating disorders before and during pregnancy

Though having an eating disorder may decrease the chances of getting pregnant, sometimes women with anorexia or bulimia do become pregnant. When this happens, positive steps should be taken to protect the health of both mother and baby. Professionals can address the specific needs related to pregnancy and disordered eating if the mother to be is willing to be open and honest with her practitioners and healthcare team about her struggles.

Professionals recommend that women struggling with eating disorders do their best to resolve the eating disorder before attempting to get pregnant. This is not always possible and women suffering from eating disorders who become pregnant are advised to seek specialized medical and psychological help.

Those who are pregnant and struggling with an eating disorder are encouraged to:

• Be as honest as possible with the prenatal health provider regarding past or present struggles with an eating disorder or disordered eating.
• Schedule extra appointments with the prenatal health provider to more closely track the growth and development of the baby as well as the health of the mother.
• Consult a nutritionist with expertise in eating disorders before or immediately after becoming pregnant. Work with the nutritionist throughout the pregnancy and post-delivery to create a personal, applicable plan for healthy eating and weight gain. The nutritionist will further be able to assist with the body’s breastfeeding nutritional requirements and healthy weight restoration.
• Individual counseling during and after pregnancy can provide coping mechanisms regarding concerns and fears around food, weight gain, body image and the new role of mothering.
• Attend a support group for people with eating disorders.
• If health providers approve, attend a prenatal exercise class to help get the body moving and encourage healthy limits to exercising.
• Other classes on pregnancy, childbirth, child development and parenting skills can also be helpful in preparing to become a mother and create a connection with the baby.
• Allow the prenatal health provider to assess weight. This information is essential to track the health of the baby. For those who prefer not to monitor their weight gain, standing on the scale backwards and instructing the health providers not to share the number with you might be effective.
• Under certain circumstances, for example those struggling with severe depression or obsessive-compulsive problems, medications may be required, even during pregnancy.

The benefits of a good support structure and a multi-disciplinary medical team are necessary to ensure the delivery of a healthy baby and the continued wellness of the mother. With so much at stake for mom and baby, receiving help to properly address an eating disorder is crucial during pregnancy. As a community, it is vital that we continue to challenge the stigmas that surround eating disorders so those who are struggling can come forward to receive the help needed to recover.

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