Eating Disorders during Pregnancy: A Challenging Time for Many Women

Pregnancy is often a cause for great celebration, yet for the seven million women in America who are facing an eating disorder such as anorexia nervosa or bulimia, it can be one of the most challenging times in their lives. The National Institute of Health recommends that women consume around 1,800 calories in the first trimester, 2,200 calories in the second, and 2,400 calories in the third. For women who have been seriously restricting their caloric intake, these numbers can be alarming.

Women can struggle to cope with the changes that take place so quickly in their bodies. The issue can be particularly tough for women with body dysmorphia – a condition in which people become obsessed with real or perceived thoughts. Body dysmorphic disorder can cause immense distress and interfere with a person’s everyday life – thus, they may miss social events, or avoid going to work, because they are afraid that people will notice their flaws.

These women can become terrified that they will gain inordinate amounts of weight during pregnancy, and can continue to indulge in unhealthy eating behaviors, or find that their pregnancy has triggers a relapse of an eating disorder they may have had in the past.

Strong emotions can take over the body, especially in the first few weeks of pregnancy (including tiredness, nausea and weight gain or loss and those caused by an eating disorder). In the second and third trimesters, weight gain is important – The American College of Obstetricians and Gynecologist recommend a total gain of between 25 and 35 pounds during pregnancy). In the third trimester, women can find that pressure placed by the baby on organs can affect satiety and their ability to eat sufficiently. 

These emotions and sensations are normal and should be distinguished from the symptoms of an eating disorder.

Women facing an eating disorder may encounter symptoms such as increased depression when they are pregnant; often, those who are struggling (or have struggled) against an eating disorder can feel shame and guilt about eating, and they can worry that they are not enjoying the changes which are taking place in their bodies (including breast and belly growth). They can also be less in tune to bodily cues (such as hunger), since they are used to stifling these cues in order to keep their bodily weight low.

It is vital that women who have had, or who have an eating disorder when they become pregnant, see a qualified nutritionist, and that they be honest about any mixed feelings they are having about their pregnancy. This is because they need to consume healthy amounts of proteins, carbohydrates, vitamins, minerals and other nutrients, to support the growth and development of their baby.

Because babies absorb so many nutrients, mothers can become malnourished and have a greater chance of feeling fatigued, or depressed. They can also have a greater risk of health complications such as miscarriage, respiratory problems, preeclampsia and gestational diabetes. The problem does not only lie with starvation, but also with bingeing. Two eating disorders – bulimia nervosa and binge eating disorder – may not result in weight loss; on the contrary, they may cause excessive weight gain during pregnancy, which increases the risk of hypertension. It is vital to work alongside a nutritionist to ensure that women maintain a normal weight during pregnancy.

Counseling is also indicated for those with any underlying issues relating to food and body image. The gold standard therapy for eating disorders is cognitive behavioral therapy, in which patients are taught to identify and differentiate between the way they think, feel and act. The therapist helps the patients identify self-destructive patterns in thought, emotion or behavior and helps the patients come up with a ‘plan of action’, so that stress and negative feelings can be channeled in a healthier manner.

The good news for women with eating disorders is that with professional help, they can have a healthy, safe pregnancy, one in which optimal nutrition for both mother and baby, becomes the overriding goal. After birth, it is vital that counseling and nutritional support continue, to help new mothers cope with any problems they may encounter during breastfeeding. The key is to shift the focus away from the ‘lack of control’ that motherhood brings, to feeding the body with nutritious food, in the hope that pregnancy and motherhood become a positive, enriching experience.