Pregnancy can be a lovely and exciting time for many women. It is a momentous, life changing event, where the woman’s body will now become a vessel for another life to grow and flourish. This can feel empowering for many women and they take on the changes necessary for nourishing this new life without much effort or thought. For others, it is not that easy. Pregnancy (and motherhood) require a great deal of strength, both physically as well as psychologically and emotionally, even when moving into this space as an overall healthy woman. What if you are struggling with an eating disorder when you become pregnant? Or are in recovery from an eating disorder when you become pregnant? This is the case for many women- in American and worldwide. Consider the following statistics to better understand why this is an issue that needs to be attended to, rather than ignored.

• Eating disorders affect approximately seven million American women each year and tend to peak during childbearing years
• Pregnant women with active eating disorders are at a much higher risk for delivering preterm and low birth weight babies
• Pregnant women with an active eating disorder appear to be at greater risk for having a Cesarean section and developing postpartum depression
• Pregnant women with active eating disorders are at increased risk of hyperemesis, delivering infants with significantly lower birth weights and smaller head circumferences

For many women, a healthy weight gain during pregnancy is approximately 25-35lbs. The necessary gain can be higher for women who have been struggling with an eating disorder, as their pre-pregnancy weight may be dangerously low. This can be extremely triggering for some women, and close supervision and guidance from a trained eating disorder specialist is usually necessary. Other maternal issues that can occur are psychological upset, perinatal depression, anemia, increased risk of hyperemesis gravidarum, and more problems with episiotomy repair. While studies regarding the risk to the baby vary greatly it is possible for women with a history of an eating disorder had a higher rate of miscarriage, small for gestational age babies, low birth weight babies, babies with microcephaly, intrauterine growth restriction, and premature labor (especially if the mother’s body mass index was <20). History of an eating disorder or struggling while in pregnancy with an eating disorder can also adversely affect the breastfeeding relationship between mother and baby.

Women who struggle with an eating disorder previous to or during a pregnancy are at a higher risk for perinatal distress and are more likely to indicate postpartum mood issues, anxiety, panic attacks, self-esteem and body image issues, and other mental health concerns. These issues have negatively affect not only the new mother, but the infant, and the significant other/partner of the woman suffering.

Woman suffering from an eating disorder while pregnant will show many different symptoms and signs that are as varying and different as woman themselves. Some common factors for health care providers and loved ones to be aware of are:

• Little to no weight gain throughout pregnancy
• Fear of weight gain during pregnancy
• Excessive exercise to avoid normal pregnancy weight gain
• Induced vomiting (sometimes hidden as morning sickness)
• Fainting, dizziness, dehydration, chronic fatigue
• Social isolation
• Avoiding meal times with others
• Increased depression or anxiety symptoms

Effective treatment throughout the pregnancy and postpartum period are important in order to promote a healthy outcome for both mother and baby. There are several supports that should be in place, with the two most important being an OB that is somewhat knowledgeable about eating disorders and an eating disorder specialist for therapy. Meeting with a nutritionist that is trained in treating eating disorders will also be very important for a healthy outcome. Medication may be necessary during pregnancy or in the postpartum period, especially if co-morbid psychological issues are present. Group therapy, support groups and peer and peer support along with birth and parenting classes are also great ways to supplement the support that is necessary during this time.

At the Chrysalis Center, many of these services are offered by trained eating disorder specialists, which can help achieve a healthy pregnancy and postpartum period, both physically and emotionally.

Megan Schlude, MA, LPA facilitates the Motherhood Matters program, which offers specialty services to women in pregnancy and the postpartum period, including women suffering from an eating disorder during the perinatal period.