How Pregnancy Can Affect Those Who Have Had Eating Disorders

For pregnant people who struggle with an eating disorder, the three trimesters can be challenging. Here's what experts suggest.

Pregnant person
Photo: Getty Images/damircudic. Art: Anna Halkidis

I'm finally experiencing the roller coaster joys of new motherhood, but my journey to parenthood wasn't the most pleasant one. Throughout my second and third trimesters, I received tons of unsolicited remarks from family and friends. Two stung the most: "Now you can eat whatever you want and get away with it" and "Wow, you're really getting big."

Having dealt with mental health issues throughout my life, including an eating disorder, these comments were unbearably triggering. I already had fears of relapsing and succumbing to toxic habits, including obsessing over calories, overexercising, bingeing and purging, and starvation—all of which I had worked very hard to gain control over in the past decade.

In my baby bump journey, I learned I wasn't alone: Research shows up to 7.5 percent of pregnant women have an eating disorder. And those who previously recovered may experience a relapse, explains Nicole Avena, Ph.D., assistant professor of neuroscience at Mount Sinai School of Medicine and author of What to Eat When You're Pregnant. This can be dangerous as pregnant people with an eating disorder are at a "higher risk of pregnancy complications and negative outcomes, such as miscarriage, premature delivery, small head circumference, and difficulty nursing," says Dr. Avena.

The reality is for pregnant people like me, the focus on weight from loved ones, society, and medical teams can make pregnancy a constant battle. It was one I had to fight through.

Triggered by the Focus on Pregnancy Weight

Pregnancy comes with a mountain of mental and physical changes, which can be especially difficult for a person who has struggled with any type of eating disorder. "This can include exhaustion and fatigue; mood and hormonal changes; increased hunger cues; nausea; and complications in pregnancy (hypertension, gestational diabetes, pregnancy loss)," says Brittany-Lyne Carriere, a Toronto-based full spectrum doula.

The feelings can be worsened by societal expectations and perceptions surrounding weight and body image before, during, and post pregnancy. This kind of scrutiny is compounded on social media, especially with before and after posts showing pregnant and postpartum bodies. A study looking at how media portrayals of pregnant women and new moms affect women found 46 percent of them said it brought on negative emotions, such as self-consciousness, frustration, hopelessness, and depression.

Medical teams often also place heavy focus on pregnancy weight. It's one of the quantitative ways thought to assess health and growth during pregnancy, Dr. Avena points out, while the American College of Obstetricians and Gynecologists offers guidelines for recommended weight gain during the three trimesters. "You are 'flagged' if you don't gain within a certain amount of pounds when pregnant as being at risk for developing complications either with the delivery or with the development of the baby," says Dr. Avena. On the other hand, you're told not to gain too much weight either.

But experts say weight in pregnancy doesn't always have to be so black and white. Lindsay Shirreff, M.D., MSc (HQ), FRCSC, an OB-GYN at Mount Sinai Hospital in Toronto, asserts that such a determination should be made via a case-by-case assessment, rather than done as a standard practice, because it ultimately depends on the well-being of the patient and baby.

If stepping onto the scale is advised, accommodations can be made for a pregnant person with a history of eating disorders. "If seeing the value on my office scale is upsetting for a patient, I offer to weigh patients blindly—aka facing backward and the number isn't shared. In fact, I don't discuss this data at all unless I am concerned," says Dr. Shirreff. That concern may come if someone gains more weight than expected because of the risk of maternal or fetal adverse outcomes.

In other instances, it may be necessary to weigh a patient from the outset of pregnancy. Due to my eating disorder history and being underweight per my height and BMI, my midwives and OB-GYN recommended that I be weighed blind from the beginning and that they closely monitor my progress from there.

How To Navigate Pregnancy and Eating Disorders

In pregnancy, postpartum, and beyond, grounding techniques are beneficial life skills to use to manage toxic habits and intrusive thoughts surrounding eating disorders and disordered eating. Here's what experts recommend.

Acknowledge your feelings

Don't conceal thoughts and feelings about your disordered eating, says Alexandra Sisam, N.D., a licensed naturopathic doctor based in Toronto who focuses on eating disorders. "It's very normal to be triggered by being pregnant, to not feel OK in a body that is changing and out of your control," she adds. She advises pregnant people struggling with thoughts of disordered eating to either verbalize emotions aloud or write them down: "Don't keep it inside due to shame or fear of what others are thinking, as it can create an environment of isolation and a sentiment that there is something wrong with you when there isn't."

Try and shift your perspective

Reframing thoughts can also help alleviate your stresses. "Remind yourself that it will not always feel and/or be like this," says Dr. Sisam.

You can also remind yourself these changes are something extraordinary that's happening to you. "You're growing a little person inside of you and that's incredible," says Carriere.

And moreover, keep telling yourself the additional nutrients you are taking in during pregnancy are for the baby—that you're nourishing this new and exciting life you're about to bring into the world.

Speak to your doctor

If you prefer not to know your weight during pregnancy, let your doctor know. They can make accommodations to help you feel comfortable and empowered throughout your pregnancy. If they don't seem to respect your feelings, it can make all the difference to find a medical team that works for you.

Find healthy ways to cope

Try implementing coping mechanisms to help manage triggers and stressors. "Consider deep belly breaths, light stretching, yoga, and meditation," offers Dr. Sisam. "These are all things that can allow our nervous system to slow down, enter a state of calm, and help you make the situation more manageable."

Additionally, consider limiting exposure time to unpredictable stimuli by putting a cap on screen time, then switching up your environment by going for a walk, for instance.

Seek therapy

If you're concerned that eating disorder behaviors are being carried into pregnancy and want professional support, don't be afraid to reach out. Warning signs that shouldn't be ignored include restrictive/anorexic habits with food, stressing over food intake (calorie counting and/or orthorexia, an unhealthy fixation on eating healthy), and bulimia (bingeing and/or purging).

If a person "exhibits any history of an eating disorder or a current negative relationship with food, it is best to seek out therapy, and if possible, securing this resource prior to getting pregnant," says Dani Mendelson, LCSW, of Nurture Therapy in Chicago, who treats patients with eating disorders during pregnancy.

If it isn't possible to secure a therapist prior to your pregnancy, don't beat yourself up. "It is great to begin therapy when you can and if there is some type of barrier with finding a therapist, at least make sure to let your obstetrician or midwife know of your eating disorder so they can appropriately monitor you and the baby," says Mendelson. "It is a strength to admit that you have an eating disorder and finding help for it should feel very empowering because you want to make sure that you and your baby are healthy. "

A great first place to look for a therapist is through your OB-GYN, midwife, or another medical professional you are working with. "They may partner with specific practices and have additional knowledge of providers in and around your area," explains Mendelson. For instance, they may refer you to a local and affiliated eating disorder treatment center.

You can also reach out to your health insurance company for assistance, especially if you are looking for in-network providers.

How Loved Ones Can Offer Support

Support from loved ones is also critical for a pregnant person who is struggling. Dr. Avena suggests that family and friends can help by respecting healthy boundaries, including avoiding comments around weight or what a pregnant person should be eating. "Even if it's intended as a compliment and/or encouragement, it's better to not say anything at all," says Dr. Avena. "And further to this, avoid giving advice or tips related to food because there is no right or wrong way to eat, don't talk about weight gain and bump size, or physical activity—unless solicited."

What you can do instead to be helpful is to ask open-ended questions about what kind of help and support they'd like. That can include offering to set up health care appointments and giving them a ride to and from, suggests Dr. Avena.

Most importantly, if you are concerned about a loved one who you sense is struggling in pregnancy, Dr. Shirreff advises reaching out to a prenatal care provider, such as a midwife, OB-GYN, nurse, and family physician, or organizations such as the National Eating Disorders Association (NEDA) and the American Pregnancy Association that can connect you to resources.

Initially, I beat myself up when the eating disorder reared its ugly head during my pregnancy. Fortunately, with the support of loved ones and therapy, I cultivated the skills to manage these stressful moments. Ultimately, the major revelation for me was learning that even if I didn't have an eating disorder history, there's no such thing as a "normal" pregnancy to begin with. It isn't a linear journey. From this, I grew to have more compassion for myself, and it helped me appreciate the good days more and weather the bad ones with a bit more ease.

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