Eating Disorders, Medical Complications, and Healing During Pregnancy

Eating disorders can affect all individuals, regardless of who they are or how they identify. For those who are in their childbearing years or pregnant, this time period often overlaps with the age range in which eating disorders (EDs) are commonly diagnosed. Despite the fact that eating disorders and pregnancy can co-occur, there often isn’t an open dialogue about the overlap. With eating disorders potentially causing an increased chance of complications in pregnancy, we believe it’s important to start talking about eating disorders, related medical complications, and pregnancy.

Rates of Pregnancy and Birth in the Eating Disorder Population

Historically (and incorrectly), women with anorexia were thought to be unable to conceive due to menstrual irregularities or amenorrhea, which is a common side effect of the eating disorder (1). This has since been proven false; although women with irregular menstrual cycles do experience decreased rates of pregnancy, women diagnosed with eating disorders are still able to become pregnant and give birth (1). One reason women with EDs are significantly less likely to have children is that fertility is compromised in women with lifetime anorexia and lifetime bulimia (2).

Impacts of Eating Disorders on Maternal and Fetal Health

Given the severe toll EDs can take on an individual’s body, it is unsurprising that these disorders carry a greater risk of pregnancy complications and adverse health effects for both mother and child. Among the most commonly cited maternal risks are increased rates of cesarean section (3), suboptimal nutrition (4, 5) and postpartum depression (3, 6). Expectant mothers with anorexia are more likely to experience hyperemesis gravidarum, or severe pregnancy sickness, and anemia (7).

Eating Disorder Symptom Changes During Recovery

Sometimes pregnancy causes changes in ED symptoms, ranging from a complete remission of the disorder to an exacerbation of symptoms (8, 9). Women who experience symptom reduction – which may be permanent or transient following the birth – often site the well-being of their baby. These women have better birth outcomes. It is significantly less likely that ED symptoms increase during pregnancy but it is possible and is often sparked by an excessive fear of weight gain and changes to the body. In contrast to those whose symptoms diminish, women who experience increased symptoms often give birth to smaller babies with decreased overall health (8, 9).

Care Guidelines for Providers

It is not always immediately evident that a pregnant woman has an ED. The women themselves, especially teens, may not disclose their condition. Or, healthcare providers may overlook the consideration due to the fact that the woman was able to conceive and is therefore in seemingly good health. In order to avoid serious health consequences for both mother and child, it is vital that providers are able to properly identify and address a patient’s eating disorder (9).

Healthcare providers can often recognize a history of disordered eating by reviewing their health history. Assessing menstrual cycle regularity is a good indicator of food restriction and unhealthy body weight. Clinicians should also pay special attention to weight recorded at prenatal visits and ask questions like, “What is it like for you to be weighed at every visit?” or “How are you feeling about your physical changes and weight gain?” in order to detect the presence of an ED (9).

If an ED is suspected or identified, the OBGYN care provider should be prepared to collaborate with a multidisciplinary team well-versed in ED management. Together, they can provide a proper nutrition plan, discuss a healthy weigh-in procedure, provide fetal development education, and screen for postpartum depression. They can also work together to offer encouragement during maternal weight gain to reinforce a positive association with the changing body shape. With multidisciplinary, specialized support behind her, the expecting mother will be better prepared to avoid reproductive complications and have a healthy pregnancy and baby (9).

What to Do if You Are Struggling With an Eating Disorder During Pregnancy

If you are personally struggling with an eating disorder and planning to become pregnant or are pregnant, it’s important to receive the proper care for both yourself and your baby. In addition to finding a qualified OB/GYN, it’s recommended to pursue eating disorder treatment and start recovery prior to becoming pregnant. With the help of a specialized care team able to assess your emotional and physical health, you will be able to start recovery and pregnancy in a healthier spot with a support team advocating for you.

For those who are pregnant and struggling with an untreated eating disorder, we advise seeking eating disorder treatment as soon as possible. We understand this can be a challenge and that it’s difficult to make the first call for help, but recovery will give you your life back. Seeking support is not a sign of weakness, but immense strength. By starting treatment immediately, a mother can make positive changes in her life to support the wellbeing of both herself and her unborn child.

For women who are in recovery and pregnant, it’s important to be aware of how you are feeling throughout the pregnancy and to get support (from friends, family, a therapist, or treatment team) early on. If you notice eating disorder symptoms returning, reach out as soon as possible to ensure you can maintain your health and recovery during your pregnancy.

We want all mothers or mothers-to-be who are struggling with an eating disorder to know they don’t have to live this way forever. With proper treatment, eating disorder recovery is possible. With help and hope, you can get your life back. At The Emily Program, we welcome any mothers and mothers-to-be. You can reach us online or at 1-888-364-5977.

Sources:

1. Bulik, C.M., Hoffman, E.R., Von Holle, A., Torgersen, L., Stoltenberg, C., Reichbom-Kjennerud, T. (1999). Unplanned pregnancy in women with anorexia nervosa. Obstetrics & Gynecology, 116: 1136-1140.
2. Easter, A. (2011). Fertility and prenatal attitudes towards pregnancy in women with eating disorders: results from the Avon Longitudinal Study of Parents and Children. International Journal of Obstetrics and Gynecology, 118(12): 1491-1498.
3. American College of Obstetricians and Gynecologists. Nausea and vomiting of pregnancy. (2004). ACOC Practical Bulletin, 52, 1-15.
4. Roem, K. (2002). Hyperemesis gravidarum—a serious complication of pregnancy. Nutrition & Dietetics, 59, 144-146.
5. Mazzeo, S.E., Slof-Op’t Landt, M.C., Jones, I., Mitchell, K., Kendler, K.S., Neale, M.C., Aggen, S.H. & Bulit, C.M. (2006). The International Journal of Eating Disorders, 39(3), 202-211.
6. Koubaa, S., Hallstrom, T., Lindholm, C., Hirschberg, A.L. (2005). Pregnancy and neonatal outcomes in women with eating disorders. Obstetrics & Gynecology, 105(2), 255-260.
7. Park, R.J., Senior, R. Stein, A. (2003). The offspring of women with eating disorders. European Child and Adolescent Psychiatry, 12 (suppl), 100-119.
8. Stewart, D.E., Raskin, J., Garfinkel, P.E., MacDonald, O.L., Robinson, G.E., (1987). Anorexia nervosa, bulimia and pregnancy. American Journal of Obstetrics and Gynecology, 157 (1194-1198)
9. Newton, Mandi S., and Lesa Chizawsky L. K. “Treating Vulnerable Populations: The Case of Eating Disorders during Pregnancy.” Journal of Psychosomatic Obstetrics & Gynecology 27.1 (2006): 5-7.