For women who have had or currently have an eating disorder such as anorexia nervosa (intense calorie restriction) or bulimia nervosa (cycles of binging and purging), pregnancy can trigger habits and emotions that exacerbate the condition.
We know some patients are reluctant to share their history of eating disorders, but it’s important to discuss it with your doctor so we can support you through a healthy pregnancy. Patients with a history of eating disorders are at increased risk for:
- Infertility or subfertility
- Stillbirth
- Premature birth
- Difficulty breastfeeding
- Having babies with low birthweight
Eating disorders can present unique challenges during pregnancy, but a healthy pregnancy is possible with proper care and support.
In March 2022, the first comprehensive guidelines were released to help providers manage pregnancy for women with anorexia nervosa. The guidelines focus on behavioral health, obstetric, medical, and nutritional care to support the patient and baby.
UT Southwestern’s specialized maternal health team can provide supportive care to increase your chances of a healthy pregnancy, and our colleagues in psychiatry who specialize in managing eating disorders play a crucial role in pregnancy care, too.
I’ve asked my colleague, Carrie McAdams, M.D., Ph.D., to discuss some of the concerns women with eating disorders have regarding pregnancy and how, together, we help them manage their unique challenges.
Personalizing care for pregnant women with eating disorders
While anorexia nervosa is characterized by distorted body image and disturbed eating behaviors, the root cause is more complicated and may represent a lifelong challenge that is unique to each patient.
During pregnancy, treatment is based on when a person was diagnosed with the eating disorder and where they are in their recovery. Three main timeframes include:
1. Women who have successfully managed their eating disorder.
Wanting to have a baby can be an extra motivator for some women to put in the hard work to overcome their eating disorder. Women who have regained and maintained a stable weight, are eating regularly, and making sure they get enough nutrition often can focus on making sure that they continue to eat enough to support the pregnancy.
Drinking protein shakes can be quite beneficial – not to fully replace meals, but to provide some nutrients and offer satiety without the mental stimulus of eating more.
We’ll also want to monitor exercise. For some women who have faced eating disorders, it may be beneficial to reduce exercise to avoid triggers or unintentional weight loss.
2. Women diagnosed with an eating disorder while pregnant or trying to get pregnant.
Accepting you have an eating disorder can be difficult. Sometimes, it takes struggling to get pregnant or experiencing multiple miscarriages for the disorder to come to light.
For example, some women who have engaged in high-intensity exercise throughout their life may not be aware that these activities can contribute to infertility and early miscarriages. Learning that one may need to gain weight and reduce their exercise to achieve fertility is often a surprise, as the concept of weight gain leading to better health is rarely presented. Patients with an eating disorder can find it difficult to change entrenched behaviors, such as reducing exercise and increasing fat and calorie intake.
We meet these women where they are in the timeline of acceptance to start the journey toward recovery. This can include helping them physically prepare for a healthy pregnancy by optimizing nutrition or finding a balance of nutrition and behavioral health support.
Wanting a pregnancy can be a very strong motivation to change disordered eating. Typically, treatment starts with education about mental and physical wellness. Developing more insight about the situations, types of food, and times that make eating harder and easier is a top priority for women who are just starting to recognize their own disordered eating disorder as they become pregnant.
3. Women whose symptoms increase during pregnancy.
Common pregnancy issues such as fluctuating hormones, morning sickness, nutrition, hydration, or adjusting medications can become more complicated with an eating disorder.
Some patients with bulimia nervosa may start to recognize how physiological factors such as hunger and hydration exacerbate symptoms previously viewed as more psychological, such as binge-eating or vomiting. For example, many women with morning sickness find improvement with frequent small snacks – this strategy is also helpful for women with eating disorders.
Helping women find aspects of their health that they can control, such as drinking protein shakes when unable to eat meals or taking their medications, is an important part of this process. A dietitian with expertise in eating disorders can be very helpful by providing a meal plan as a guide.
A personalized approach tailored to the specific situation is required to care for and support women who struggle with particular aspects of their eating disorder during pregnancy.