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Eating disorders and pregnancy

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Kyle Looby

Pregnancy and eating disorders don't mix. But eating healthy -- or eating at all -- can be difficult for women who have suffered from anorexia or bulimia. There is hope for these women to have healthy pregnancies with the right help.

The struggle
During her pregnancy, Manda Erickson spent a lot of time with her head in the toilet. Throughout most of her pregnancy, Erickson vomited after every meal and sometimes even after snacks. Though many women suffer from morning sickness, Erickson's illness seemed extreme, and it was. Erickson spent several overnights in the hospital hooked up to IVs for lack of weight gain -- but what her doctor didn't know was that Erickson was forcing herself to vomit. She had been struggling with bulimia for four years.

"Not long after I turned 23, I became pregnant. It was a messy situation and my first instinct was to eat. But the more weight I gained with my pregnancy and the more I started to show, the more I was appalled by my appearance. I remember the first time I threw up while being pregnant," Erickson says. "Afterwards, I ate some fruit so the baby would not starve. This had become my rationale. If I ate just a little bit of good stuff afterwards, it would be ok."

While many women are concerned about gaining too much weight during pregnancy, some moms-to-be are so terrified of gaining weight that they either restrict their calorie intake to an unhealthy degree or purge after meals.

Abbie Natenshon, a psychologist specializing in eating disorders and the author of When Your Child Has an Eating Disorder: A Step-by-Step Workbook for Parents and Other Caregivers, says both behaviors can cause serious health problems for mother and baby. While some moms come into pregnancy with full-blown eating disorders, other moms become pregnant during recovery from their disorders.

What all of these women share is the potential for falling back into their eating disorder behaviors when they find themselves faced with the myriad of bodily changes brought about by pregnancy.

"For some, it may be possible to take a hiatus from the dysfunctional behaviors while pregnant for the sake of the unborn child," says Natenshon. "For others, when weight gain begins, the anxiety can get too extreme to contain and the behaviors continue through pregnancy."

Conceiving with an eating disorder
While bulimics rarely have trouble conceiving, anorexics are often surprised to learn they are pregnant because amenorrhea, or the absence of a menstrual period, is one symptom of anorexia, according to Anorexia Nervosa and Related Eating Disorders Inc. (ANRED), a nonprofit organization dedicated to providing information on eating disorders and their treatment and prevention. Whether women with eating disorders want to conceive or are surprised by their pregnancies, many still have trouble controlling their eating disorder behaviors.

After struggling with her weight since age 12, S. Abbot lapsed into full-blown anorexia when she couldn't control her weight during pregnancy. "I knew, consciously and intellectually that my 'diet' was not good, healthy or right, especially for a developing child, but we sufferers don't see (actually, honestly, visually see) ourselves like others do. We see grotesque, disgusting obesity when we weigh 100 lbs," Abbot says. "I not only loved this baby, but I WANTED this baby for the part of me and my family he was. I quit smoking for him, wouldn't take drugs or even aspirin for him, but I wouldn't eat for him."

The risks of eating disorders during pregnancy
ANRED advocates that women wanting to become pregnant treat their eating disorders prior to conceiving. If eating disordered moms-to-be start their pregnancies at an unhealthily low weight, they run the risk of damaging their bodies and those of their unborn children.

According to ANRED, during pregnancy, the baby takes nutrients from the mother's body and if those nutrients are not replaced by eating nutritious food, the mother can develop depression, exhaustion and malnutrition. The mother's teeth and bones can become weak, which can lead to stress fractures and broken bones later in life. Pregnant women with eating disorders are also at higher risk for diabetes, and potentially fatal liver, kidney and heart damage.

According to a study reported in Eating Disorders Review (Nov/ Dec 2000), babies of eating disordered moms have a higher than normal risk of miscarriage and premature delivery. If they survive to term, these babies can have a multitude of problems, both physically and mentally.

They can be born with a cleft lip, a cleft palate, or jaundice. But most of the babies' problems will likely show up later in life. They tend to be slower developing, smaller and weaker than other children their age, according to the study. These children may never reach their full potential either intellectually or emotionally, and they can grow into adults who have poor social skills and difficulty relating to other people.

ANRED also cautions eating disordered moms about the emotional risks their disorder poses to their children, who could be at risk of developing eating disorders themselves if they are underfed by mothers who haven't received treatment for their own eating disorders.

ANRED also states some mothers with eating disorders can make poor role models, and because motherhood is often stressful, many mothers who have suffered in the past with an eating disorder find themselves returning to their old habits when stress hits. Children see this as normal behavior and unless they learn differently, they are likely to develop an eating disorder as a stress coping mechanism.

Getting help during and after pregnancy
Natenshon says many women who struggle with eating disorders are able to get control of their eating habits early on in the pregnancy, but they tend to lose that control when they start gaining weight. Kim Berger, a social worker who works with pregnant eating disorder sufferers, agrees.

"In my experiences with patients who have eating disorders during pregnancy, about half of them abstain from eating disorder behaviors during pregnancy for fear of hurting the baby," says Berger. "However, many revert to their old habits once they start gaining weight because that's when they start feeling a loss of control. Starving or binging and purging are comforting habits for these women, their safety net. They feel better when they're engaging in these behaviors "

Natenshon also says many women with eating disorders who are open about their problem with their health care providers can break free from the disorder during pregnancy. She says, "Being open with health providers can help a person to overcome the problems, first because for many it feels good to confide in someone for the first time. Anorexia and bulimia tend to be secretive diseases, a particularly unfortunate reality in that they are also the most lethal of all the mental health disorders, killing and maiming 6 to 13 percent of those afflicted." "Second, a skilled health professional will know how to help, by referring the patient to an eating disorder specialist (psychotherapist) and hopefully to a nutritionist as well. It is through individual and family psychotherapy that the issues underlying the disorder can become worked through and the habits surrounding it overcome, thereby curing the disease," she says.

However, after pregnancy, these women may experience additional problems, such as depression and frustration with weight gain, so postpartum is the time for eating disordered women and their health care providers to be very vigilant. Postpartum eating disordered moms need extra support so they can avoid a relapse into their disorder.

Abbot is a prime example of this post-pregnancy lapse. "Immediately after the pregnancy, I relapsed into full anorexia again, starting out as another regular diet, eventually eliminating food until there were virtually no solids eaten and exercise was up to six to 10 hours of constant working out every day, seven days a week," says Abbot. "I was a size one, barely 100 pounds when I spontaneously suffered a fractured vertebra putting me in bed for months." It was this very injury that saved Abbot's life.

Erickson's story has a happy ending: she gave birth to a healthy girl, is now pregnant with her second child and has been free from bulimia for two years. S. Abbot's story doesn't end quite so well: although she is free from anorexia, her son, while physically healthy, is behind his peers academically. Abbot blames herself and her anorexia for this. Because of her experience Abbot counsels other moms-to-be on dealing with an eating disorder during pregnancy.

"If there's anything I could tell a pregnant sufferer of an eating disorder it would be this: your child will suffer (or not) all of his life because of what you do now," she says. "If you truly love that child, you'll just believe others when they say you need to get some help. You'll just take their word for it and do it. After all, if they're wrong, it's only nine months out of your life. If they're right, it's a lifetime out of someone else's."