GLOBAL. This is the second of a two-part series on eating disorders and pregnancy. In the first article I described my own experience of suffering anorexia during my pregnancy 27 years ago. There was no term “pregorexia” back in 1987, and no one knew that I struggled with an eating disorder during my pregnancy. I told no one, not my husband nor my obstetrician. Yet, I had all the visible signs of something going wrong during my pregnancy … low weight gain and a very small baby bump.
In this final article I’d like to share more about how pregorexia affects both the mom and baby.
Detecting Eating Disorders During Pregnancy
The prevalence of eating disorders among childbearing women has been estimated at approximately 4%. The prevalence of eating disorders in pregnancy, however, appears to be lower.
Detection of eating disorders in pregnant women in the clinical setting can be a challenge. While it might be visibly detectable to see a woman with anorexia, detecting someone visibly with bulimia is not obvious, as many of these women are of normal weight or slightly above normal weight. Someone with binge eating disorder (who can be at normal, above or obese weight range) is another group that cannot detect easily without exploration into patient’s eating history.
Once identified, a collaborative team approach should be initiated to care for a pregnant mother with an eating disorder including the attending obstetrician, a perinatologist (if maternal or fetal condition is severe), eating disorder therapist, eating disorder dietitian, and, if necessary, a psychiatrist with expertise in treating eating disorders. It’s also wise to add a lactation consultant to assist with breastfeeding education during pregnancy and provide support after the baby is delivered. A pediatrician is also needed once the baby is born to monitor closely infant’s health and growth. The team works together to provide the highest level of care to the pregnant woman and her baby in utero. Having an established team in place during the prenatal period offers a vital opportunity to provide education and support that can positively affect the health outcome of the baby and mother.
It’s vital for a pregnant woman with eating disorder to share with her obstetrician during the first visit her struggles with food and her body. The obstetrician may not ask, leaving it in the hands of the woman to disclose her disorder.
Risks Factors Associated With Eating Disorders Extending into Pregnancy
Women with a history of an eating disorder, including anorexia, bulimia, binge eating disorder and other specified feeding or eating disorder (OSFED), face distinct challenges during pregnancy. Predisposing factors for eating disorders during pregnancy are generally the same as for other eating disorders occurring during other periods of life. Factors such as the genetic heritability, unhealthy family dynamics, excessive exercise, distinct personality types including those with traits of perfectionism and obsessive-compulsive behaviors as well as comorbid psychiatric disorders including depression and anxiety can all play a part in an eating disorder during pregnancy.
Pregnancy can occur in the absence of menstruation and it’s important for women/teens to realize that they are not protected from pregnancy to occur. If there is no menstruation (also known as amenorrhea), one might consider it impossible for conception. However, when ovulation occurs for the first time after a period of amenorrhea, it is possible for the first egg ovulated to become fertilized if the woman is not taking any birth control measures. It’s also important to note the eating disorder population was more than twice as likely than general population to use fertility treatment to conceive pregnancy.
Most eating disorders occur during pregnancy in women with a history of the disorder or are currently active in the disorder. On the contrary, some women with active eating disorders during pregnancy report a temporary and sometimes a permanent cessation of behaviors during pregnancy. Usually this occurs when the pregnant mother sees the value in eating healthy because she now has a reason to nurture herself … it’s nourishing her baby.
What happens to the body image of a pregnant woman with an eating disorder? The answer is, it depends.
Many pregnant women with eating disorders are terrified of gaining weight during pregnancy. The average woman gains between 25-35 pounds during pregnancy. While this amount is required for a healthy pregnancy, for women with eating disorders, having to gain this amount can be very frightening and can exacerbate eating disorder behaviors during pregnancy. Women who are underweight may even need to gain up to 40 to 50 lbs during pregnancy.
As mentioned above, some women with active or history of eating disorders find pregnancy a time to finally let go of their unhealthy behaviors and have more acceptance to proper nourishment and of a growing belly. Unfortunately, research has show, women who have abstained from their eating disorder during pregnancy often re-engage in the unhealthy behaviors 10 weeks post-partum in an effort to lose weight.
Pregnancy can be a time of significant developmental change for a woman, and this time can bring up to the surface many past dormant psychological issues. Some of the issues include the woman’s own conflicts about bodily changes, adjustment to new roles, personal concerns about her own mothering abilities as well as psychological separation in pregnancy.
The transition to the role of motherhood can be overwhelming to new moms with eating disorders. Life becomes very chaotic and unstructured that can cause a lot of stress. There is disruption in daily routine and sleep schedule making it more difficult to maintain proper eating habits. With the chaos, stress and feelings of loss of control, some moms may be triggered to engage in binge eating episodes. Of all the eating disorders, including anorexia and bulimia, binge eating disorder is the most common eating disorder to develop during pregnancy.
Women with history of chronic eating disorders are more likely to report a history of childhood sexual abuse and physical abuse when compared to women with no history of an eating disorder. Trauma is the by-product of these types of abusive violations to women with eating disorders. It has been shown trauma and abuse histories increase risk to perinatal depression, postpartum depression as well as other psychiatric disorders. Traumatic life incidences are also associated with complications during pregnancy, including high pregnancy hyperemesis (vomiting) and increase risk to miscarriages, preterm contractions and delivery complications.
According to the National Eating Disorders Association (NEDA), women with anorexia are usually underweight and may not gain enough weight during pregnancy. They risk delivering a baby with low birth weight and related health problems. Women with bulimia 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 are at greater risk of developing high blood pressure, and gestational diabetes.
Risks for the Mother: Poor nutrition, dehydration, increased risk of miscarriage, cardiac irregularities, gestational diabetes, severe depression during pregnancy, premature births, labor complications (increased risk of Caesarean delivery), difficulties nursing and bonding with baby, post-partum depression.
Risks for the Baby: Poor development in womb, premature birth, low birth weight for age, respiratory distress, feeding difficulties, neurological conditions and other perinatal complications.
Since the treatment of the pregnant mother with an eating disorder is best done in a collaborative team approach each professional on the team will have his or her own respective treatment goals. The dietitian working with the patient on nutritional intake, body image and weight gain; the obstetrician on the overall medical management of the health of the mom and fetus; and the therapist working on the psychological dynamics of how the pregnant mother is adjusting to the pregnancy as well as the body image changes, weight gain and transition into parenthood. A perinatologist, psychiatrist and lactation consultant may also play a role.
The team can provide addition support to patients while offering them resources to free eating disorder support groups, such as Anorexia Nervosa and Associated Disorders (ANAD). These support groups are offered nationwide and can give a pregnant woman with an eating disorder outside support from others struggling with eating disorders.
New Web-based Support Group for Pregnant Women and Moms Struggling with Eating Disorders
“Lift the Shame” is the first web-based support group of its kind specifically targeted to offer support and resources to pregnant women and moms with eating disorders. This ANAD support group is a free, confidential online group in English hosted by certified eating disorder therapist Maggie Baumann, MFT, CEDS, in partnership with Chicago-based Timberline Knolls Eating Disorder Center.
The group is held the second Sunday of each month from 4-5 pm (PST)
How to Find Treatment
If you are struggling with Pregorexia or any type of eating disorder, contact one of the follow resources for treatment and professional support referrals: