pregnancy and eating disorder

Pregnancy and eating disorders

Pregnancy is a time when body image concerns are more prevalent, and as consultant dietitian Sarah Keogh explains, for those who are struggling with an eating disorder, the nine months can cause disorders to become more serious.

Pregnancy and eating disorders

Pregnancy can bring with it all its own challenges and even the most relaxed woman can find herself getting concerned about how her body will change and what it will look like after the baby is born. Can you imagine what it must be like for the many women who are suffering from an eating disorder?

Eating disorders are surprisingly common among women during their childbearing years. About seven women in every thousand have anorexia nervosa. Bulimia affects up to one woman in every 100. Other kinds of eating disorders are also common. One study found that 11.5% of pregnant women had an eating disorder. Many women stop their disordered eating once they find they are pregnant but not everyone can manage this. We look at the effects of eating disorders on pregnancy, on the baby and some of the effects they can have both before and after having a baby.


Having an eating disorder can make it more difficult to become pregnant. If body weight is too low, the body can find it hard to make all of the hormones needed to become pregnant. Lack of fat is the main problem here. Fat cells produce some of the oestrogen needed for ovulation. Many of the nutrients that are needed for conception – such as zinc and selenium – may also be missing. Even if you have a healthy weight, binging, purging and vomiting affect the body’s ability to become pregnant.

pregnancy and eating disorders

Many women who are anorexic do not have periods – in fact, not having periods is one of the ways of diagnosing anorexia. About 50% of women with bulimia have irregular periods. Not having periods does make it much harder to become pregnant but not impossible! Just because you have a low body weight or irregular periods, it doesn’t mean there is no chance that you can become pregnant, it just makes it a little bit harder. Women with bulimia actually have a higher rate of unplanned pregnancies, partly because they thought they couldn’t become pregnant and so stopped taking precautions.

Once someone becomes pregnant, what effects can an eating disorder have? 

The biggest problem is that pregnancy can increase the anxiety women have about weight gain. The changes in weight and shape can trigger a recurrence of an eating disorder in women who suffered from one in the past. On the other hand, many women with an eating disorder see an improvement during pregnancy due to worries about the effects it may have on the baby.

For those women who find it difficult to get to normal eating during pregnancy, what effects can an eating disorder have?

Studies that look at the effects of eating disorders during pregnancy are limited but there are some effects seen. Women with bulimia who continue to binge and/or purge during the pregnancy are more likely to report having had a miscarriage – up to double the normal risk. Women with anorexia nervosa are more likely to have smaller babies. This may sound great from a labour point of view but babies that are born too small are more likely to have problems with obesity, high blood pressure, heart disease and kidney problems in later life. Women with active eating disorders during pregnancy are also more likely to have a premature baby, more complications during delivery and a higher risk of caesarean sections.

 What about after the birth?

Post-natal depression can affect any woman after birth, but it is almost three times more likely in women who had an active eating disorder during pregnancy. Post-natal depression affects not only the mother, but also the emotional bond she forms with her child.

Women with eating disorders are also less likely to breastfeed, or, if they do breastfeed, they tend to stop sooner than women who do not have eating disorders.

pregnancy and eating disorders

Research on mothers with eating disorders also suggests that these women may be far more controlling of their babies and children. This is seen especially during meals and playtime. More conflict is seen during mealtimes where a mother has an eating disorder and these mothers tend to be more critical of their children in general. Children whose mothers have an eating disorder also tend to weigh less than other children – and the more concerned the mother is about her own weight, the less her child is likely to weigh.

It is easy to see that an eating disorder that continues into pregnancy can cause a range of problems that can affect both mother and baby. So what can we do?

By far the best place to start is before becoming pregnant. Dealing with an eating disorder can take time so the sooner you start the better. Talk to your GP and ask for a referral to someone who is experienced in working with eating disorders. Don’t wait for your GP to ask – research shows that only 10% of women with bulimia are picked up by their GPs and that only half of those get a referral for specialist help – so ask! And help is really important. There are some women who just wake up one day and say, ‘that’s it!” but most women need a lot of help and support to deal with an eating disorder and the sooner you get it, the better.

If you are already pregnant and struggling with an eating disorder do tell your GP or obstetrician. One of the biggest problems with eating disorders, especially bulimia, is that many women feel a sense of shame that they are so out-of-control. In reality, asking for help is the first step to getting better and making sure you and your baby have a healthier, happier pregnancy.

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Ask Allison

Q My sister-in-law and I both work three-day weeks and we help each
other out with child minding on our working days, which up until recently has worked out really well. Between us, our kids are aged between five and nine years – the problem is that it’s now become quite apparent that we have very different parenting styles. I prefer my two daughters (seven and nine) to have a structured day. For example, in my house, we have allocated times for television and iPads, etc. My sister-in-law, however, lets the kids run loose after school – homework is ignored and my kids end up wired after eating sugary treats all afternoon. I am considering looking at after-school childcare for the kids, but I’m worried that this is going to cause a family argument. Is there a diplomatic way that I can ask my sister-in-law to introduce some discipline into her child-minding days? It certainly doesn’t do her two kids any harm when I am minding them in my own house!

In a word, no, there is no diplomatic way to do this as it may very likely seem like your saying that your parenting style is better than
hers. As L’Óreal says, ‘now here comes the science bit.’ Dr. Kaylene
Henderson, a child psychiatrist, wrote a very interesting blog about ‘the
science behind the Mummy Wars’. She explains that before she had
children of her own she hadn’t been aware of how parents have a
very specific sense of the right parenting style. She also found that parents could be very definite in defending their chosen parenting style. Dr. Henderson, who describes herself as a curious, scientific, open-minded person, was surprised at how defensive parents could be and, at times, of their judgemental attitude towards each other. She explained the neurology of the Mummy Wars; okay, I’ll need you to bear with me for a second. Warning; I’m about to use some neuro-techie language.

Why do we judge each other?
As we have all had different experiences, this means that we all have very different memories stored in our brains. Most of our memories are ‘explicit’ memories – these are ones that we can recall easily such as important dates that mean something to us; important birthdays, special events or stories of and about our lives.
There is another type of memory called ‘implicit’ memory that plays a
key role in our parenting. This type of memory is the stuff that you do on autopilot. Psychologists call these heuristics or rules of thumb –
such as tying your shoelace, or driving your car (once you have learnt
to do both first!). Otherwise we’d really waste a huge amount of time
pondering over tasks that we have readily available to us. This seems to be where the science bit of our parenting style kicks in. This implicit memory goes all the way back to when you were an infant being parented by your parents. This is when you started the process of storing up how they did it into your memories.
Unless you make a conscious choice and effort to parent differently, what you saw and unconsciously learnt will be your automatic go-to parenting style.

We learn habits
This can really kick into gear when we feel our parenting style is
being mirrored or highlighted by disapproval from another parent. I know the cold sweat you feel when your child decides to make their outstanding bad behaviour performance at, of course, the most public and worst time. The implicit autopilot of how your parents dealt with these outbursts will flow unconsciously from you if you haven’t worked super hard to be aware and consciously change the old habits.
What’s happening for the on-looking parent is that they see you doing something they are used to doing, but you are doing it all wrong. Simply, because that is not how they know how to do it.

Find a way that works
You both have different parenting styles – who is to say which type is correct? You just need to know what works best for your family and that’s the bottom line. The irksome feelings won’t go away. You can talk to your sister-in-law, but I’m adding a caveat that it would be hard not to hurt her feelings. What we’re possibly looking at is that you prefer a more structured form of parenting, whereas your sister-in-law has a more permissive style. I’m not sure the two styles can mix, the mixture is a bit like oil and water.
If a collaborative shared form of parenting style can be agreed upon, then that is great, but our learnt hardwiring may prove difficult to change despite the intent to do so.
Perhaps, your own instinct of changing childcare might work best for you. In terms of making childcare work; the fit is ultimately the most
important aspect as you want a cohesive congruent feeling of the other caregiver to just ‘getting it’, like in any good partnership. Best of luck
with this and I wish you both well.

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Ask Sarah

Q I’ve heard a lot about the Paleo diet and as I am very interested in reducing the amount of processed foods and grain based meals my family eats, we are considering following this diet. From what I read it seems to be a back-to-basics type of eating. Is a Paleo diet safe for children? My kids are aged seven and nine.

A The Paleo diet is one of the most fashionable diets around at the moment. It is also known as the ‘caveman diet’ and is based on cutting out processed foods, starchy foods like bread and potatoes and eating more meat, vegetables and fruit.
As fad diets go, it is not the worst but there are some good and bad sides to it. Reducing the amount of processed foods we eat is always a good idea and by doing that you will usually reduce the amount of fat, salt and sugar you eat, which is a good thing! The problem with the Paleo diet is that it also cuts out dairy (on the basis that cavemen didn’t drink milk) and this means that the diet is very low in calcium. For this reason it is really not suitable for children who do need a lot of calcium for growing bones. How did cavemen manage without dairy? They ate a lot more food than we do (up to 10,000 calories per day compared to the 2,000 most of us eat). By eating that amount of food they were able to pick up just enough calcium from green vegetables and seeds. To put it in perspective, you would need to eat 16 servings of broccoli a day to get all the calcium you need. This is easier to do if you eat 10,000 calories per day rather than 2,000.
The other problem with the paleo diet is that it is not entirely based in science. Many of the Paleo diets out there say you should not eat wheat, even though we know that cavemen did in fact eat wheat and other grains. These diets also don’t recommend that you eat blubber and the big lumps of fat that were also a large part of the caveman diet!
A final problem is that many Paleo diets encourage people to cut out beans and lentils and to get their protein from meat and fish instead. Many studies over the last few years are clear that eating too much animal protein is linked with more cancer and heart disease. Eating some vegetarian meals based on beans and lentils is a great way to get your protein without always going for meat.
Is this a diet we should follow? I think there is a lot we can learn from the Paleo diets. We could all do with eating less salt, sugar and processed foods and adding in more nuts and seeds as well as more vegetables. However, I think following a strict Paleo diet could lead to low levels of calcium and vitamin D and so it is not suitable for children or teens and adults would need to think about a calcium supplement.