Research on the incidence of eating disorders during pregnancy (and in general) is limited. In addition to a relative lack of studies, the results of the studies we do have may be skewed by the reluctance of many women who are pregnant to admit they have an eating disorder. Some estimates indicate that—if subthreshold disorders are included—eating disorders may affect between 5 to 8 percent of women during pregnancy. One study conducted in Norway found that one out of 21 women had an eating disorder while pregnant, with binge eating disorder being the most prevalent.
The Impact of Eating Disorders on Pre-Pregnancy
Women with eating disorders often have irregular or missed periods. Women with these symptoms often assume they cannot get pregnant. This belief is not true–while women with active anorexia nervosa have more difficulty conceiving and seem to have lower rates of pregnancy, pregnancies do occur. The rate of unintended pregnancies is, in fact, higher in women with anorexia nervosa—perhaps due to the belief that contraception is unnecessary. Research on the fertility of women with eating disorders is mixed. Two small studies found the rate of eating disorders in women attending fertility clinics to be approximately 10 percent or higher, which is much higher than the rates of eating disorders among women in the population. However, outcome studies have consistently reported that fertility rates in women with a lifetime history of anorexia nervosa do not differ from women without such a history. Thus, it appears that despite the high prevalence of menstrual irregularities, women with anorexia nervosa are becoming pregnant. Many women with bulimia nervosa—even those at what would be considered a “healthy” weight range—also have irregular menstrual periods. However, fertility does not seem to be a significant problem for women with bulimia nervosa.
Having an Eating Disorder and Wanting to Be Pregnant
If you have an eating disorder or issues with body image and want to get pregnant, it may be advisable to delay pregnancy and seek treatment for your eating disorder first. You will be stronger and healthier and better prepared for the challenge of pregnancy and parenthood. Once you do move forward with getting pregnant, it can be very important to share your history and concerns with your health professionals. You can let them know, for example, to handle your weighing and weight gain gently and with extra compassion.
Being Pregnant With an Eating Disorder
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. Inadequate weight gain during pregnancy is one warning sign to monitor. Other signs of a suspected eating disorder can include:
Intense fear of gaining weightAnxiety around or avoidance of eatingPreoccupation with feeling fatExcessive exerciseUnusually large intake of foodAbnormal electrolyte levels
Effect of Pregnancy on Eating Disorders
Every woman is different and eating disorders vary in their presentation and course, so it is not surprising that pregnancy can affect eating disorders in idiosyncratic ways. Pregnancy appears to be a higher-risk period for the onset of binge eating disorder (BED)—perhaps some women who have been dieting see pregnancy as a time during which it is permissible to break free from restrictive eating. For some women who become pregnant, their preexisting eating disorders persist through the pregnancy. For yet other women, pregnancy can exacerbate an eating disorder or lead to relapse for those with a history. For others, eating disorder symptoms may decrease during pregnancy—the knowledge they are nourishing another human being may provide the motivation to eat appropriately and inhibit other behaviors such as purging and excessive exercise. Some women with bulimia may be able to stop bingeing and purging entirely during pregnancy. However, if your eating disorder does not improve with your pregnancy it is important not to blame yourself—everyone is different.
Pregnancy and Body Image
Pregnancy is a time of tumultuous body changes that can be hard for any woman and exceptionally stressful for those with eating disorders. Even when symptoms of eating disorders decrease during pregnancy, concerns about shape and weight are likely to remain high. One of the most significant physical changes during pregnancy is weight gain, something feared by many people with eating disorders. Some women struggle to tolerate pregnancy-related weight gain and body changes. Anecdotally, many women report that their pregnancies seemed to invite increased comments from other people about their bodies—this can be difficult. Yet others report feeling liberated from weight concerns during pregnancy. Some women with eating disorders appreciate pregnancy as a new context to view their body and its capabilities.
Pregnancy Outcomes
Eating disorders can negatively affect all systems of the body and can impact the baby as well. Women with anorexia nervosa appear to have higher rates of miscarriage, prematurity, slower fetal growth, and low birth weight babies. Women with binge eating disorder have higher rates of miscarriage and an increased risk of higher birth weight babies.
If You Are Pregnant With an Eating Disorder
Many women with eating disorders are afraid to disclose their eating disorder, but failing to do so can increase the risk to you and your baby. You can benefit from the additional support. Your providers can help look out for the health of your baby. As of yet, there are no specific treatments for eating disorder during pregnancy. Recommended eating disorder treatments call for a team of professionals including a therapist and a registered dietitian nutritionist to join the obstetrician’s continuing care. A registered dietitian can be critical in providing information about nutritional needs during pregnancy and how much weight should be gained. Many women with past or current eating disorders struggle with accepting this weight gain and can benefit from additional education and support on the importance of eating enough during pregnancy.
Postpartum Eating Disorders
Just as pregnancy can impact the course of an eating disorder in a variety of ways, so too can the postpartum period. For women whose symptoms improve during pregnancy, two different post-partum patterns have been observed: some will continue to show decreased eating disorder symptoms following giving birth, while others relapse.
High Risk
The period after a woman has given birth is 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.
Depression
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
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.
Support
Lift the Shame is a free, monthly, one-hour telephonic support group facilitated by Jena Morrow Margis at Timberline Knolls on the third Friday of every month from 3:00-4:00 pm EST. For more information, visit the website.
A Word From Verywell
Know that an eating disorder is not a choice, but a serious mental illness. Also, know that help is available. It is never too late to seek help for an eating disorder. If you are not in treatment, pregnancy can be an opportune time to reach out for help. Finding a therapist and dietitian with eating disorder expertise and giving them permission to coordinate with your obstetrician is a great first step.
