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Eating Disorders and Pregnancy: Does Your Body Feel Like a Wonderland?

Media images of pregnancy often look like this: a smiling woman with glowing eyes, shiny long hair, and a perfectly round belly, held from behind by a handsome man. Yoga magazines show pregnant women in challenging poses that most of us would struggle to get into even without a protruding belly. Most women will admit that they fantasize about feeling enlightened and sexy when they become pregnant.

Yet for the 7 million American women each year who struggle with eating disorders, pregnancy can arouse ambivalence and even fear.

The National Institute of Health recommends that pregnant women eat a well-balanced diet, and that they take in about 1,800 calories per day during the first trimester, 2,200 calories during the second trimester, and 2,400 calories per day during the third trimester. These guidelines don’t exactly follow the old adage of “eating for two,” but they can be intimidating and even frightening for a woman who has been consumed by caloric intake during some time in her life. The average weight gain for a single pregnancy is between 25 and 35 pounds, and women with low BMI scores before pregnancy may need to gain even more than this.

Women who are currently struggling or who have struggled with an eating disorder or food addiction commonly have unrealistic and even distorted views of their weight and body shape. They often look at their bodies under a microscope, and they interpret common nuances as abnormal or unacceptable. These women may have developed a fear of what they perceive as overweight, thus they control their eating habits in a way that does not allow them to maintain their basic health. Even during pregnancy, the secrecy that many women experience with eating disorders can make it difficult to ask for help.

During pregnancy, women may feel pressure to shift from a focus on how food impacts the way their body looks and feels, to a focus on how food affects the health of their baby. Some women experience this shift as a relief – freed from their own expectations to be thin. Even a woman with a history of an eating disorder may find it easier to cope with weight gain during pregnancy because her body has a new purpose of growing her baby.

However, women can also experience increased depression, and feel even more conflicted about weight gain for their babies while they struggle with their own body image issues. Women who have struggled with an eating disorder in the past, whether they have fully recovered or not, often experience shame and guilt associated with food and their bodies. During pregnancy, allowing themselves to take in more calories and watch their bodies grow bigger can cause such painful feelings to resurface. These women may also be more likely to feel out of control during pregnancy, whether related to gaining weight, physical symptoms, or general bodily discomfort. Morning sickness, food aversion, and new cravings may be particularly confusing and challenging.

During pregnancy, allowing themselves to take in more calories and watch their bodies grow bigger can cause such painful feelings to resurface.-Marni Greenberg

Some women feel that they are not being a “good mother” if they are not enjoying their bellies and breasts growing in size during pregnancy. They may feel pressure to love the sensations of their babies moving within their bodies. A woman who has felt at odds with her body and its normal functions may interpret these sensations as awkward or uncomfortable because they are outside of her control.

Pregnancy and Eating Disorders: What Are the Health Risks?

Women who have not yet fully recovered from an eating disorder and continue to engage in disordered eating are urged to seek help before becoming pregnant to best protect their reproductive health. Women with unresolved eating disorders during pregnancy can experience very serious symptoms. Both anorexia (obsessive dieting or starvation to control weight gain) and bulimia (binge eating and vomiting, or using laxatives to rid the body of excess calories) can negatively affect the reproductive process. Women with eating disorders have reduced chances of conceiving due to amenorrhea (lack of menstrual cycle) or irregular menstrual cycles related to reduced calorie intake, excessive exercise, and/or psychological stress.

…these women are also at risk for experiencing pregnancy complications such as gestational diabetes, miscarriage, preeclampsia, respiratory problems…-Marni Greenberg

Pregnant women share all of their nourishment with their baby. After the stores of carbohydrates, proteins, fats, vitamins, minerals and other nutrients go towards supporting the growth and development of their baby, a woman who is not taking in enough to replenish these stores can become malnourished. Thus, women who have eating disorders while pregnant may experience exhaustion, depression, and other health complications. Likewise, these women are also at risk for experiencing pregnancy complications such as gestational diabetes, miscarriage, preeclampsia, respiratory problems, labor complications, and fetal health problems. Alternatively, women struggling with the binging behaviors associated with bulimia can gain excess weight during pregnancy, which places them at risk for hypertension.

Women with eating disorders have higher rates of postpartum depression and are more likely to have problems breastfeeding due to decreased nutrients and fluids. A woman who has struggled with the way her body looks and feels may have aversions to some of her body’s normal functions. Thus, feeding a baby at her breast may arouse complicated feelings. Engorged, leaky breasts and/or pain can be challenging. In addition, women who are breastfeeding not only have to take in more calories, but they also must commit to many hours per day spent feeding their babies, which can further contribute to a sense of lacking control over their bodies.

The good news is that women who have recovered from an eating disorder or food addiction in the past can have healthy babies if they are able to maintain normal weight gain throughout pregnancy. In preparation for pregnancy, women should consult their health care providers, meet with a nutritionist to start a healthy diet, including vitamins and/or supplements, and achieve and maintain a healthy weight. It is also recommended that women seek counseling to address any underlying issues related to food and their bodies that are likely to surface during pregnancy.

Prevention Tips for a Healthy Pregnancy

It is recommended to schedule a prenatal visit early on and fully disclose your history. Nutritionists can be helpful to create a well-balanced meal plan and establish goals for healthy weight gain. It’s important to seek professionals with a specialty in eating disorders that understand the risks and symptoms. Women who have struggled with over-exercising should talk to their health professionals about how to create a safe prenatal exercise plan. If frequent weigh-ins at the doctor are stressful, ask your doctor if you can stand backwards and face away from the scale numbers.

Due to the increased risk of postpartum depression, counseling should continue after childbirth…-Marni Greenberg

Due to the increased risk of postpartum depression, counseling should continue after childbirth in order to maintain physical and mental health. Women who find that their eating disorder symptoms improve during pregnancy may notice their symptoms worsening after childbirth. Support from health care providers, family, and friends is essential. Those within a woman’s support network who know of her eating disorder history should be asked to be available following the birth. A lactation consultant should also be part of the team to help with early breastfeeding.

Ultimately, creating and maintaining a sustainable recovery plan is essential for mom, baby, and family. A supportive team surrounding the family will help everyone cope with the inevitable changes and stressors involved in starting a family.

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