Eating Disorders and Pregnancy: An Overview

Eating disorders and pregnancy

The series on eating disorders and pregnancy we kicked off last week with  is one incredibly close to both Monet’s and my hearts. Like so many of our peers, eating disorders are a part of our story – an integral part. We will spend today and the next few weeks on how eating disorders affect fertility and pregnancy, as well sharing our journeys with and through eating disorders. We’ll also spend time focusing on how to embrace your postpartum body in all its glory with the voice of an eating disorder sitting on your shoulder. 

It is important, however, that we start this series with a caveat: neither Monet nor I are medical experts nor have formal medical training. Eating disorders are serious conditions, affecting and stemming from both mind and body factors. Eating disorders are as unique as the men and women that carry them. Anyone who is or knows of someone battling an eating disorder should seek professional medical, spiritual and psychological support. Our views are our own and are not meant to diagnose or treat any medical or psychological conditions. 

Though we are going to be focusing solely on eating disorders in women (because this is a pregnancy and birth blog), the rates of eating disorders in men continues to rise. 

The Numbers
According to the National Association of Anorexia Nervosa and Associated Disorders(1):

  • 50% of people with eating disorders also have depression.
  • Up to 24 million people (of all ages and genders) battle eating disorders IN THE US ALONE.
  • Anorexia is the third most common chronic illness among adolescents.
  • Eating disorders have the highest mortality rate of any mental illness.
  • Only 5% of American women naturally possess the "ideal body type" and physique portrayed by the media and advertising.
  • 42% of 1st-3rd graders confessed wanting to be thinner. 
  • 81% of 10 year olds were afraid of being fat. 

Let those numbers sink in for a moment. Children. Precious little 1st graders have somehow picked up our obsessions with our bodies and are already internalizing the pressure to be thin. 

I want to take a quick moment and speak to moms of daughters (and sons too!) - stop talking about your body. Let it go. Your daughter hears you and takes after you and will begin from an entirely-too-young age adopting YOUR PERCEPTION OF YOUR BODY to her own. She watches you look in the mirror - the faces you make as your scrutinize every bump and curve and divot. She hears as you deflect or rebut compliments. She is a mirror, a sponge - she soaks up what pours out from you. Let's turn off the self-deprecating spigot so the next generation has more freedom than we did.  

Different Types
Most women don't need the above statistics to understand the gravity and prevalence of eating disorders in our Western communities. Most of us have either personally battled these enemies, or have supported someone on this journey. Eating disorders take different forms and twist the life in us in different ways. Below is a brief summary of a few of the most common conditions:

  • Anorexia Nervosa: Extreme self-restriction on food intake due to an unhealthy connection between self-esteem and body image. May or may not include binge/purge tendencies. 
  • Binge Eating Disorder: Recurring episodes of eating significantly more food in a short period of time than most people would normally intake, often accompanied by extreme guilt and shame.(2)
  • Bulimia Nervosa: Binge eating accompanied by self-induced vomiting, laxative use, excessive exercise or fasting. 
  • Athletica Nervosa (also: Athletica Anorexia): Excessive exercise despite the existence of physical harm. Difficult to diagnose since exercise is typically a healthy habit.(3)

Effects on Fertility 
Though eating disorders pose a threat to all levels of health, a silent and often overlooked detriment occurs on a woman's reproductive system. Body fat cells produce estrogen, a big player in a woman's fertility and menstrual cycle.(4) Women with low body fat may experience the erratic menstrual cycles or the loss of the cycle altogether. In a similar vein, obese women may suffer from excess estrogen, and, therefore, experience fertility issues as well. 

Estrogen also plays a key role in maintaining healthy cholesterol levels, gene expression, and bone density and formation.(5)  Many women struggling with eating disorders go months (even years) between periods, and may develop other types of anovulatory conditions (irregular or absent ovulation). When a woman's body does not have enough body fat to sustain the adequate hormone levels required for ovulation, she will experience added difficulty getting pregnant. 

Eating disorders have both short and long-term affects on a woman's reproductive system. If the eating disorder is a prevalent part of a woman's life during adolescence into young adulthood, she may experience long-term damage to her reproductive system. However, if is not until later into adulthood a woman has begun experiencing an eating disorder, fertility issues may be alleviated by healthy diet and positive body fat maintenance. 

Pregnancy and Eating Disorders
If a woman struggling with an eating disorder becomes pregnant, a whole new list of concerns arise. Many women find that the symptoms of their eating disorder are alleviated during pregnancy. Maternal instinct may play a role in trumping the urge to restrict, binge or purge, increasing the odds of healthy weight gain and maintaining the pregnancy. Dr. Ann Kearney-Cooke, PhD, director of the Cincinnati Psychotherapy Institute, explains that pregnant moms who have had active eating disorders are now in “a situation where they’re allowed to eat because there’s this baby growing inside of them. Sometimes it’s like a vacation from the eating disorder for nine months.”(6) 

Many women express extreme concerns about the weight gain associated with pregnancy. Will I gain too much weight? Will I look pregnant or just fat? Will I be able to lose the weight? What will I do if I have to stop working out while I'm pregnant? I'll look like a beached whale. And on and on it goes. Though the scope of research conducted on active eating disorders and pregnancy is limited, studies predict higher risks of preterm babies and low birth weight in women with active eating disorders during pregnancy.(7) The risks are also higher that mom will have a cesarean or postpartum depression when eating disorders are active during pregnancy.(9)

Even for women not "struggling" with an eating disorder, many of the comments people [strangely] feel free making once you're pregnant can have some very detrimental effects. "Wow, you're looking big!" "You sure you're not having twins?" "You sure that due date is right??" Or, and often worse, "You're so tiny - how big is that baby supposed to be?" "Better keep that little guy cooking as long as possible - he doesn't look ready to come out yet!" On both sides of the spectrum, these types of comments can plant seeds of fear and anxiety in the fertile minds of pregnant moms. 

Eating disorders are, by nature, disorders. They are characterized by inaccurate and dysfunctional perspective of and relationships with one's body. Though pregnant women "know" their stomach is getting bigger due to the healthy growth of their fetus, it is often difficult to dislodge all the negative associations with weight gain and a bulging belly. The anxiety, often not expressed, moms may feel translated into the body producing stress hormones. Stress increases the risk of preterm labor, intrauterine infection, and low birth weight.(8) New research also reveals that fetuses that are exposed to extended, high levels of stress throughout pregnancy are at risk for chronic lung disease, developmental delays and learning disorders.(8) Babies learn from their surroundings while in the womb - if they are surrounded by stress hormones from mom, the baby is literally "built" to handle a high-stress environment both inside andoutside the womb.(8)

What can be Done?
Entering pregnancy with an active eating disorder is certainly not a hopeless situation! Thanks to a much greater awareness of the prevalence of eating disorders, there exists a plethora of support options for moms with this struggle. 

  1. The first (and perhaps, one of the most important) steps in pursuing a healthy pregnancy is to admit to both yourself and your doctor/midwife that you have an active eating disorder. Do not downplay the effects of this condition on your health and daily life. It is essential that your caregiver is fully aware so he/she can support you and you baby as effectively as possible. This will also enable them to keep an eye out for warning signs of fetal growth retardation and other prenatal risks. 
  2. Seek whatever treatment necessary to help you deal with the source of the disorder (stressors, abuse, unhealthy relationships, control issues, etc.), as well as to provide you with support to dialogue about pregnancy weight gain and postpartum body changes. 
  3. Be aware that though eating disorder symptoms often dissipate during pregnancy, they may come back with a vengeance after baby arrives. This leaves moms at a much higher risk of postpartum depression and postpartum psychosis. Familiarize yourself with the symptoms, what's normal and what's not, and actively seek support BEFORE feeling overwhelmed by the symptoms.  
  4. Surround yourself by people who will support you, but also love you enough to speak the truth to you. Accountability and community are very important steps to finding long-term physical and emotional healing, both during and after pregnancy. 

If you or someone you know is struggling with an eating disorder, there are literally hundreds of community resources available to offer support and healing - this is not a struggle you have to manage alone.

Next week I'll be sharing a portion of my personal journey into and through an eating disorder, facing and engaging the sources and triggers of the disorder, as well as the role real, whole, traditionally-prepared foods played in healing my body and my spirit from the inside out. Looking forward to sharing with you all!