Pregnancy and Eating Disorders

By Maggie Baumann, LMFT, CEDS

As I am preparing this article on pregnancy and eating disorders, it’s a topic I am very familiar with for a number of reasons:

1.  I am in the process of writing a chapter on “Eating Disorders During Pregnancy” in collaboration with other chapter authors for a treatment book featuring eating disorders in special populations entitled An Integrative Psychological, Medical, and Nutritional Approach to the Treatment of Eating Disorders, with an expected print date of 2017.*

2. Almost 30 years ago, I was a pregnant woman with an eating disorder and I lived silently, with not a soul knowing.

I have two daughters, and it was my second pregnancy I struggled the most with my anorexia. My second daughter is now a healthy 28-year-old, yet she was not unscathed by living in the womb of a pregnant mom restricting calories and excessively exercising.

I spoke to this daughter as I was trying to prepare this article in the midst of being a daughter myself supporting my 83-year-old mom dying from emphysema.

My daughter understood the pull I was experiencing to share this important, and personal, topic to the eating disorder community and balancing my dedication to my mom.

My daughter said, “Mom, have you ever heard of Buzzfeed?” She added, “Write the article highlighting the topic in an easy to read, user friendly format.”

How lucky am I to have this daughter alive for her to share her wisdom with me. I loved her idea and it allowed me the balance I needed as I was preparing this article between my professional and personal worlds.

Popular Q & A on Eating Disorders and Pregnancy

Q1: How can an eating disorder history or diagnosis impact fertility?

A: The loss of periods and irregular periods often occur in girls and women struggling with eating disorders. This can impact fertility and the ability to conceive a child. It’s also important to understand that ovulation and pregnancy can occur in absence of menses.

In some women with anorexia, lack of menstruation does not mean she is infertile. Ovulation can still occur resulting in a pregnancy while the woman may believe she is protected from getting pregnant.

Pregnant women with BED usually have higher BMI’s and can have more difficulty conceiving compared to normal weight women.

According to recent research, 76.4 percent of infertility patients did not report current or past eating disorder to their infertility health care provider.

Q2: How might pregnancy trigger an increase of eating disorder symptoms?

A: Pregnancy can cause “out of control feelings” in women with a history of, or active eating disorders — triggering an increase in eating disorder behaviors such as calorie restriction, bingeing, purging and obsessive exercise.

The loss of control to a woman’s body shape/size, weight, appetite and mood can be destabilizing to some women at risk for eating disorders during pregnancy.

Another trigger — often the first thing pregnant women are exposed to in obstetrician’s office is the scale. This can cause intense fear for those patients with eating disorders.

Pregnancy hormonal fluctuations, an increase in anxiety and in marital stress also play roles in why some women may feel this loss of control and the need to use the eating disorder as a coping tool during pregnancy.

Q3: What are some of the medical complications of eating disorders during pregnancy?

A:  Complications for pregnant mothers can include cardiac problems, miscarriage, gestational diabetes, premature birth, labor problems, preeclampsia, and breech presentation and increase C-sections.

Potential complications for the fetus/baby can include low birth weight, IUGR (Intrauterine Growth Restriction), respiratory distress, large for gestational age infants for those women with BN/BED, cleft palate, microcephaly (abnormally small circumference of fetus/baby’s head), blindness, learning disabilities (including ADHD) and mood disorders later in life.

Q4: How might women with eating disorders experience a pregnancy psychologically?

A: For many women with active eating disorders during pregnancy, depression, anxiety and disconnection or lack of attachment to the fetus/baby are common.

It is also known, depression in the mother can also negatively affect the baby in utero. Antidepressants can be safely given to pregnant women in high-risk cases to help improve the mood of the mother and the environment of the developing baby.

On the flip side, some women with active eating disorders prior to pregnancy report cessation of behaviors and feelings of joy during pregnancy. Some women can maintain recovery in postpartum. However, even among women who experience a remission of eating disorder symptoms during pregnancy, a large percentage will relapse within six months postpartum.

Pregnancy is not a treatment for eating disorders. A formalized treatment plan is recommended for all women so the underlying causes of the eating disorder can be identified and successfully treated.

Q5: How can pregnancy influence body image in women with eating disorders?

A: Fears of an increase in body shape/weight can cause women to engage in restrictive eating with increased anxiety over self-image.

Today “Baby bump” comparisons to celebrities is a factor media publicizes, influencing normal pregnant women (with and without eating disorders) to believe a small size stomach is healthy, not dangerous.

Q6: What are some guidelines for women with eating disorders to follow when they learn they are pregnant?

A: It is most important for women to share with their OB that they have an eating disorder or history of an eating disorder. This gives the obstetricians the red flag to monitor the pregnancy with special precautions.

It’s also essential for pregnant women with eating disorders to work with a collaborative treatment team with expertise in eating disorders care. The eating disorder team can include the OB or perinatologist (on obstetrician trained to treat high risk pregnancies), therapist, dietitian and psychiatrist, if needed.

Many pregnant women carry shame about their behaviors that they know can be harmful to their babies and don’t share their eating disorder information to their obstetricians. Obstetricians who are knowledgeable about eating disorders and sensitive to these patients can use the SCOFF questionnaire that can help women feel more safe and, therefore, more likely to disclose their history and experience with their disorder.

Q7: How can an eating disorder diagnosis impact a woman’s ability to nourish her baby?

A:  If a woman struggles feeding herself due to her eating disorder, this can transmit to poor nourishment to her baby in utero and after the baby is born. Some pregnant women with a history, or active, eating disorder can let go of the harmful behaviors to allow healthy nourishment for herself and her baby. Oftentimes, moms feel pregnancy is a time during which eating is “allowed” because the purpose is for the baby’s health.

An excess of calories, though, can cause other problems. For women with BN or BED, too many calories can cause overweight babies at delivery and increase the risk of gestational diabetes in the pregnant mother.

Q8: How might an eating disorder impact a new mother’s ability to connect with or care for her baby?

A: The bonding of a pregnant mother and infant starts in utero. Peri/Postnatal depression negatively affects the mother’s ability to securely bond to her baby. The depression makes her less “present” to her body and to the baby growing inside.

Preoccupation with weight loss during the pregnancy and postpartum, along with researched statistics showing moms with eating disorders experience shorter breastfeeding time interferes with the mother physically and emotionally connecting to her baby. This poor attachment can have lasting negative affects on the relationship of mother and child, and to the child’s development, even into adulthood.

Q9: What influences the shame that many pregnant women with eating disorders experience?

A: Shame can come internally from pregnant woman when the severity of her eating disorder overrides an honest wish to nourish her baby. The cycle of the behaviors can overwhelm the mother and can prevent her from making health decisions for herself and her fetus/baby.

External criticism also contributes to the shame pregnant women experience from public and family members on “not caring for the baby’s health.” This shame can influence a pregnant woman into silence about her disorder.

Q10: Do you have any specific treatment recommendations for clinicians treating pregnant women with eating disorders?

A: It is most important to work with a multidisciplinary eating disorder treatment team including: OB/perinatologist, therapist, dietitian, lactation consultant and, if needed, a psychiatrist.

This treatment team needs to understand the core issues of how and why eating disorders develop in the first place and that a pregnant woman with an eating disorder can struggle from anorexia, bulimia or binge eating (or combination of).

Treatment by a therapist should focus on coping skills and promoting secure attachments/bonding to the fetus/baby in utero. Treating trauma related to the eating disorder during pregnancy can have a negative impact on the physical/emotional health of the mother and her fetus/baby.

Clinicians should understand the special needs that they are caring for two and that eating disorders during pregnancy is not a sign of weakness but of the illness.

Q11: What are resources for OB-GYNs to learn more about caring for an expecting mom with a history or current eating disorder?

A: If a provider does not have expertise in treating pregnant women with eating disorders, OB-GYNs can contact the Academy of Eating Disorders for physician referrals to those with this expertise.

Another link for obstetricians to gain more knowledge of eating disorders during pregnancy is the Obstetrical Gynecological Survey.

Q12: What resources are there for women who are pregnant who have an active eating disorder?

A: A free web-based support group for pregnant women and moms with eating disorders — called “Lift the Shame” is hosted on the 3rd Sunday of the month at 6-7 pm (CT) by Timberline Knolls Residential Treatment Center. Participants can register for “Lift the Shame” here.

In terms of dealing with body image issues and weight gain during pregnancy, the book, “Does This Pregnancy Make Me Look Fat?” by authors Claire Mysko and Magali Amadei is very helpful. The website Eating Disorder Hope has numerous articles on “pregnancy and eating disorders.”