Over my many years as a practicing obstetrician, I can say that one of the most commonly asked question is “how much weight should I gain?” Women are naturally concerned about their babies’ health, but many are concerned about the impact their pregnancy will have on their waistlines. It’s normal to wonder if a pregnancy will alter your looks permanently, but it is particularly problematic for women who suffer from eating disorders.
The National Institute of Health defines eating disorders as “serious and often fatal illnesses that cause severe disturbances to a person’s eating behaviors. Obsessions with food, body weight and shape may also signal an eating disorder.” The most common eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder.
Women with anorexia nervosa and bulimia because of their disease are acutely aware of changes in their bodies and may struggle with the normal and typical weight gain of 25 to 35 pounds during an average pregnancy. In fact, women with a BMI less than 18.5 will need to gain between 28-40 pounds during pregnancy. In recent years, social media has entered the conversation as much attention is given to posts and images of celebrities and others showing almost heroic post-pregnancy weight loss very quickly after delivery.
The medical literature regarding pregnancy and eating disorders is rather scant, but obstetricians are aware of the risks associated when a woman does not gain an appropriate amount of weight during pregnancy. These risks vary from patient to patient, but women who are underweight as in the case of women with anorexia and bulimia prior to conceiving and then fail to gain enough weight are at increased risk of having an infant with low birth weight and all the associated complications of low birth weight. These include respiratory problems, intraventricular hemorrhage or brain bleeds, heart problems, and intestinal and eye damage.
Some of these problems can cause lifelong disability or may even be fatal. Because of these risks, it is very important to seek proper care during these high-risk pregnancies. Women with bulimia and anorexia nervosa with proper treatment can have a healthy pregnancy. Treatment includes seeing multiple healthcare providers including obstetrician, nutritionist, and psychiatrist. Frequent weigh-ins and open dialogue with the care team can optimize good outcomes.
Besides the health risk for the infants, mothers too are at risk of developing serious health problems. For instance, women with anorexia and bulimia may suffer from malnourishment, vitamin and mineral deficiency, dehydration, anxiety, depression, post-partum depression, and in extreme cases, death. Since the health risks are so great for both mother and baby, it is imperative that a pregnant woman with any eating disorder be candid and open about her problem.
Pre-conception counseling is always a good idea but especially in the case of women with anorexia or bulimia. This consult allows both provider and patient to outline a plan to have the best outcomes. Once pregnant, close monitoring of weight will be an essential part of all prenatal visits. Ideally, the obstetrician will work in concert with a nutritionist and psychiatrist to help a patient deal with the complexities of proper weight gain over the course of the pregnancy. This team approach should continue after delivery as studies have shown that women with anorexia and bulimia may backslide into their disease following delivery. Some literature suggests that sufferers may be at greater risk of post-partum depression and may need counseling regarding proper infant nutritional needs.
Anorexia nervosa and bulimia are complex and comprehensive syndromes that require expert knowledge and understanding. Treatment plans can span many years and are often a series of successes and relapses. Pregnancy will add another dimension to the condition. Many women with eating disorders can overcome their symptoms during pregnancy because of their strong desire for a healthy baby, but others will find pregnancy a very stressful adjustment.
Women with eating disorders can achieve a healthy pregnancy and deliver a healthy happy baby if they remain diligent and get the necessary support they need. Of course, resolving an eating disorder before becoming pregnant is the best scenario, but is not always possible. Perhaps for some women with eating disorders, a pregnancy and all the potential it represents will be just the impetus they need to finally get the help they need.
Dr. Hardy practices obstetrics and gynecology at Atlantic Ob/Gyn located in Va. Beach and Chesapeake. Please visit www.atlanticobgyn.com.