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.
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.
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.
More like this:
Anxiety in women
When it’s not just ups and downs
Look after your mental health