Eating Disorders in Pregnancy

  • By:  Melissa Waddell, WHNP

Read this to find out why pregnant women with eating disorders have to be extra-vigilant.

Pregnancy, with all its complexities and delicacies, can be further complicated by eating disorders. With an estimated 10 million females struggling with these mental illnesses, it is not uncommon for a woman to develop an eating disorder, such as anorexia, bulimia, or binge eating disorder, during her childbearing years.

Anorexia is defined as obsessive dieting or starvation to control weight gain. Bulimia is defined as recurrent episodes of binging on an abnormal amount of food, followed by a purging behavior, such as self-induced vomiting, excessive exercise, or laxative abuse.

Many aspects of pregnancy can be frightening in themselves to any woman, such as the several biological changes that occur and the necessary weight gain. For a woman who is struggling with an eating disorder or body dysmorphia, these fears can be exacerbated to an entirely new level as the battle against her eating disorder is fought not only for her own life, but for the life of her unborn child as well.

Research has shown variable outcomes for women with past or current eating disorders who become pregnant. For some women, the eating disorder may continue unchanged during the pregnancy. For some women with a history of an eating disorder, pregnancy may trigger a relapse, either during pregnancy or in the first six months postpartum. Yet for many women with a past or current eating disorder, pregnancy may be a time of motivation for recovery.

Eating disorders often fly under the radar due to the shame and secrecy they evoke. Pregnant women may experience magnified feelings of guilt and shame over the potential for harm to their baby. They also often fear judgment from others. As a result, they may be reluctant to disclose their problem, and in many cases may not believe or admit to themselves they even have a problem.

There are a few warning signs that could indicate an eating disorder which include: inadequate weight gain during pregnancy, intense fear of gaining weight, anxiety around or avoidance of eating, preoccupation with feeling fat, excessive exercise, unusually large intake of food, and abnormal electrolyte levels.

Research has shown that women with an active eating disorder during pregnancy are at greater risk for having a Cesarean section; delivering preterm babies; delivering low birth weight babies; and developing postpartum depression.

However, there is promising news. Research has also demonstrated that women who are able to get appropriate prenatal care and keep their eating disorder under control can have a normal, healthy pregnancy and baby.

The period after a woman has given birth is also a high-risk time for the recurrence or exacerbation of eating disorder symptoms, especially in those whose symptoms decreased during pregnancy. Women experience tremendous pressure to return to their pre-pregnancy bodies and weight. This pressure can be especially distressing to those with an eating disorder.

Women with current or past eating disorders also appear to have higher rates of postpartum depression, which can also be a serious problem. There is some evidence that women with eating disorders may use breast milk expression as a purging method or prolong breastfeeding as a means to control body weight. Still, other women will avoid breastfeeding in order to return to eating disorder behaviors.

Relapse rates among women with eating disorders who give birth are significant, indicating that women should remain in treatment through the postpartum period, even if their symptoms improved during the pregnancy. Adjustment to motherhood and the role changes as well as the physical changes can be challenging for all women, not just those with eating disorders.

Melissa Waddell, WHNP, is a nurse practitioner at Atlantic Ob/Gyn. For information, call 757-463-1234 or visit www.atlanticobgyn.com.

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