Pregnancy and Eating Disorders

Eating disorders affect approximately seven million American women each year and tend to peak during typical child bearing years. Pregnancy is a time when body image concerns are more prevalent and for those who are struggling with anorexia or bulimia, the nine months of pregnancy can cause disorders to worsen.

There are basically two types of eating disorders: anorexia and bulimia. Anorexia involves starving oneself and avoiding appropriate food intake. Bulimia involves binge eating and then purging by means of vomiting or laxatives to rid the body of excess calories. Both types of eating disorders affect the reproductive process and pregnancy.

How do eating disorders affect fertility?

Eating disorders, particularly anorexia, affect fertility by reducing your chances of conceiving. Most women with anorexia do not have menstrual cycles and approximately 50% of women struggling with bulimia do not have normal menstrual cycles. The absence of menstruation is caused by reduced calorie intake, excessive exercise, and/or psychological stress. If a woman is not having regular periods, getting pregnant can be difficult.

Eating disorders hamper fertility beyond menstruation and ovulation. If by chance ovulation and fertilization are successful, the uterus is often not conducive to implantation.

How do eating disorders affect pregnancy?

Eating disorders affect pregnancy negatively in a number of ways. The following complications are associated with eating disorders during pregnancy:

  • Premature labor
  • Low birth weight
  • Stillbirth or fetal death
  • Intrauterine growth retardation
  • Likelihood of Caesarean birth
  • Low APGAR scores
  • Delayed fetal growth
  • Respiratory problems
  • Gestational diabetes
  • Complications during labor
  • Low amniotic fluid
  • Miscarriage
  • Preeclampsia

Women who are struggling with bulimia will often gain excess weight which places them at risk for hypertension. Women with eating disorders have higher rates of postpartum depression and are more likely to have problems with breastfeeding.

The laxatives, diuretics, and other medications taken to rid the body of calories are harmful to the developing baby. These substances take away nutrients and fluids before they are able to be used to feed and nourish the baby. It is possible they may lead to fetal abnormalities as well, particularly if they are used on a regular basis.

Recommendations for Women With Eating Disorders

If you are struggling with an eating disorder, you have an increased risk of several complications and it is essential that you take action to increase the probability of having a healthy baby. The good news is that the majority of women with eating disorders can have healthy babies. Also, if you eat right and gain normal weight throughout your pregnancy, there should be no greater risk of complications or birth defects.

Here are some suggested guidelines for women who are dealing with eating disorders and have a desire to get pregnant or have discovered that they are pregnant:

  • Prior to Pregnancy:
    • Achieve and maintain a normal and healthy weight
    • Avoid purging activities
    • Consult your physician and receive a medical check up
    • Meet with a nutritionist and start a healthy pregnancy diet supplementing with prenatal vitamins
    • Seek counseling to address your eating disorder and any underlying concerns; seek both individual and group therapy
  • During Pregnancy:
    • Seek a prenatal visit early in your pregnancy and inform your doctor that you have been struggling with an eating disorder
    • Achieving normal weight gain is essential; the closer you are to normal weight, the better the chance of having a healthy baby
    • Eating a well-balance meal with all the appropriate nutrients is a necessity
    • Avoid purging activities
    • Seek counseling to address your eating disorder and any underlying concerns; seek both individual and group therapy
  • After Pregnancy:
    • The physical and emotional changes of pregnancy may trigger depression and/or a relapse of eating disorder symptoms
    • You are more susceptible to postpartum depression
    • Continue counseling through individual and group sessions
    • Inform your safe network (doctor, spouse, and friends) of your eating disorder and the increased risk of postpartum depression; ask them to look out for you. (Ideally, they will know of your disorder before the baby is delivered.)
    • Eating disorder behaviors can hamper your breastfeeding efforts, so don't allow yourself to fall back into unhealthy patterns.

It may be easy to fall back into an eating disorder after the baby is here, but remember the new habits you formed during pregnancy are healthy for you all of the time and not just during pregnancy. Not only will your new habits help your breastfeeding efforts, but you will be a healthier mom for your baby.

Reprinted with permission from American Pregnancy Association