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Pregnancy and Eating Disorders: What You Need to Know

Pregnancy brings new demands and changes to a person’s body – it’s necessary to get the right amount of caloric intake, vitamins, and minerals to remain healthy and ensure the fetus is developing. Prenatal care is highly specialized, and nutritionists have developed detailed eating plans for pregnancy to match these requirements. Unfortunately, many eating disorders bring nutritional imbalances and a lack of adequate caloric intake, causing several health problems to arise and possibly endangering the pregnancy.

During pregnancy, this can have a powerful effect on both the mother and the fetus. Before pregnancy, an eating disorder that involves restriction or purging can drop nutritional levels to a point where menstruation stops, a condition called amenorrhea. This is known to make becoming pregnant more difficult. However, some studies indicate that people with anorexia nervosa have accidental pregnancies much more often than expected because they mistakenly think there is no need for contraception. Not only anorexia nervosa affects pregnancy and conception, however. People with bulimia nervosa, binge eating disorder, and ARFID have all shown irregular menstruation and complicated pregnancies.

Because of the precariousness of pregnancy, it is even more important that expecting women who have eating disorders seek support from a professional eating disorder treatment center. Residential care can provide the kind of hands-on, round-the-clock care required in these situations, but day treatment can also help manage complications in pregnancy as well as treating the eating disorder.

During a pregnancy, without eating disorder treatment and support, the following health issues could arise as a result of engaging in disordered eating behaviors:

Early Labor

Pregnant women with eating disorders are subject to a higher chance of premature labor and early birth than others. By the time the fetus is viable, especially in the latter stages of pregnancy, getting enough nutrients to facilitate rapid growth is difficult without enough nutritional intake. Even in a “normal” pregnancy, the mother will have to raise their food intake.When an eating disorder like anorexia nervosa or bulimia nervosa is present, the lack of nutritional intake causes a miscarriage or premature birth.

Some of the complicationsof having a child before their due date might include:

  • Incomplete organ development
  • Anemia
  • Jaundice
  • Infections
  • Low heart rate

Premature babies are often required to stay in intensive care for weeks or months after birth for support with breathing and feeding until their bodies can take over.

Postpartum Depression

Another study performed by NIMH indicated that without treatment, the presence of an eating disorder can significantly increase the risk of postpartum depression. Depression and anxiety are common co-occurring disorders; they often act as triggers for disordered eating behaviors. When added to the increased risk of depression after giving birth, these factors make a depressive episode much more likely. In fact, up to 30 percent of women with eating disorders go on to develop postpartum depression after giving birth, which is 10 percent higher than those who don’t show symptoms of an eating disorder.

For these reasons, treatment for depression is standard for eating disorders, and new mothers are encouraged to consult with a therapist in the weeks and months after giving birth. Antidepressants might be prescribed, although they are often unsuitable for nursing mothers. Similarly, antidepressants may be useful for an eating disorder patient suffering from depression, but they are not usually prescribed for eating disorders themselves.

Slower Fetal Growth and Developmental Issues

When pregnant women do not take in enough calories each day, their body struggles to provide enough energy for proper fetal growth. In many cases, this can result in premature births that cause low birth weights and nutritional deficiencies in the infant. Even when brought to term, the baby may suffer from lower weight or other issues.The worst-case scenario is a miscarriage, causing a failure to bring the child to term.

Furthermore, restricted growth can impact how fetuses’ organs form, resulting in an increased risk of breathing difficulties, brain hemorrhages, and heart problems. In the modern-day, pregnancy is heavily managed; sonograms and genetic testing allow doctors and nurses to monitor the fetus’s health. The prenatal medical team will normally try to counteract these symptoms with vitamins and other nutrients, but prolonged minimal caloric and nutritional intake only exacerbate developmental issues.

Heart Health

Pregnancy puts stress on the heart as the mother gains weight and provides additional blood flow to the fetus.This can cause inadequate oxygen flow to the fetus, which might cause brain damage or other organ difficulties. Disordered eating behaviors put additional strain on the heart by limiting nutrients that it needs to work effectively.

As sodium, potassium, magnesium and other electrolytes swing out of balance, the neural signals to the heart can be interrupted, which can cause heart irregularities. As this repeatedly occurs, the heart muscle can start to atrophy, resulting in lasting health problems for the mother. The entire cardiovascular system is affected by poor nutrition, and although the medical team can help to some extent, disordered eating behaviors should always be avoided during this time.

Struggles With Body Image

With exceptions such as ARFID, which is not usually caused by a negative body image or desire to lose weight, people with eating disorders are dissatisfied with their weight or have a fear of gaining weight. Pregnancy, of course, causes weight gain, even in people who restrict calories or purge. This can be very difficult for a person with body dysmorphia to deal with. They might double down on disordered eating behaviors to counteract the natural weight gain.

Compounding these body image struggles is a sense of guilt or shame, which influences low self-esteem and anxiety. People with eating disorders often feel guilty about their disordered behaviors as well as their perceived “flawed” body weight. They will often go to great lengths to hide their disorder, using tactics such as wearing loose clothing to hide their body or binge eating in secret, so the people close to them don’t know about it. When a person with an eating disorder becomes pregnant, they are often aware of the negative effects disordered eating can have on the fetus. This causes new feelings of guilt in addition to the already-existing ones.

Additionally, people are more likely to comment on a pregnant person’s body, as misguided as this is. They may mention something like, “You’re as big as a house!” Although they may be well-meaning, people with eating disorders are already sensitive about their bodies and weight gain, so the pregnancy may be a time full of triggers surrounding their body.

Binge Eating Disorder and Pregnancy

Many people with an eating disorder are used to dieting or calorie restriction as part of their desire to lose weight. For anorexia nervosa, this is usually obvious and part of the diagnostic criteria, but people with bulimia nervosa and binge eating disorder are usually “on a diet” as well, at least publicly. Pregnancy is known to influence eating disorders in a few different ways. First, the individual might experience urges to increase their disordered eating behaviors to prevent the natural weight gain caused by pregnancy. However, in other cases, worry about the baby’s health might spur them to stop using disordered behaviors – which can be helped with specialized treatment.

Some research also indicated that pregnancy is a period of particularly high risk for the onset of binge eating disorder. As an example, a person who has been strictly dieting for years may figure that they will gain weight anyway, and give up their diet to eat lots of food. Normally, eating what you want, when you want is a healthy attitude for someone susceptible to eating disorders, but this sudden switch of eating patterns can trigger binge eating disorder. Another example might be a person who has bulimia nervosa stopping the purging behaviors but continuing to binge eat.

Although binge eating disorder is certainly treatable, a person whose BED onset happened during pregnancy might not be aware there is a problem – or they might be embarrassed to admit it. That’s why their family and friends must be available to listen, learn, and provide support.

When to Seek Help from an Eating Disorder Treatment Facility

As pregnancy can act as a trigger for body image dissatisfaction and disordered eating behaviors, early care from eating disorder therapists is essential to prevent lack of nutrition from disturbing the health of both the fetus and the mother. Unfortunately, eating disorders tend to cause missed or late periods, causing the pregnancy to be unexpected While this might cause or worsen feelings of guilt on the part of the mother, there is no reason to lose hope. Thankfully, it is never too late to receive eating disorder support and start making healthy changes during pregnancy.

If you or a loved one is pregnant and also suffers from an eating disorder, there’s no reason to delay.  Reach out and find a quality treatment center today – for the health of the mother and the child.

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.