Beyond the bump: Eating disorders in pregnancy

On Monday, April 13, the Academy for Eating Disorders (AED) released the summary of their twitter chat on eating disorders andpregnancy, which was held April 10. Pregnancy is a challenging time for the body and mind, but with the added stress of an eating disorder, it can be dangerous for both mother and child.

Maggie Baumann, MFT, CEDS was the guest on this tweet chat, as a practicing psychotherapist in Newport Beach who specializes in eating disorders treatment, including those affecting pregnant women and mothers. Not only does Baumann have eating disorder expertise, but also has the benefit of personal experience. To prevent others from suffering a similar fate, Baumann wrote a blog about her experience with 'pregeroxia,' which was shared nationally and internationally. Since then, she has also helped to create the first online support group for pregnant women and mothers dealing with eating disorders, called Lift the Shame.

Baumann first addressed the issue of how eating disorders may affect fertility, emphasizing that even in a state of amenorrhea (not menstruating regularly), women with anorexia can still ovulate and become pregnant. However, those with binge eating disorder (BED) usually have a higher BMI and may experience more difficulty in conceiving, often due to polycystic ovarian syndrome. Additionally, pregnancy, if it occurs, can cause out-of-control feelings in women with a history of an eating disorder, which only exacerbates their symptoms. This perfect storm is also heightened by the concomitant pregnancy weight gain, mood swings, and appetite changes.

Pregnancy already comes with the risk of numerous medical complications, but having an eating disorder can heighten that risk and also influence the types of problem women face. Cardiac problems, miscarriage, gestational diabetes, premature birth, labor problems, preeclampsia, and an increase in C-sections are all associated with eating disorders. In some cases, the thyroid may be affected, which is essential for carrying a pregnancy to term, especially after the first trimester. According to Baumann, the best way to avoid or manage these complications is to keep an open dialogue with your treatment team and obstetrician and accept their support.

Psychologically there is a broad spectrum of how a woman with an eating disorder might respond to pregnancy. For some, it may exacerbate eating disorder symptoms and trigger depression, while others may see it as an opportunity to recover for the baby and may experience joy and a cessation of behaviors. Although some research has suggested that these women are more likely to report experiencing negative feelings upon discovering that they were pregnant, that heightened negativity dissipated by 18 weeks gestation.

Often women are hesitant to share their history with their obstetrician, so if the doctor doesn't ask, an eating disorder can be missed entirely, putting both mother and child at risk. Eating disorder-sensitive obstetricians use the SCOFF questionnaire to screen women for these disorders. This five-item questionnaire can point to a possible case of anorexia or bulimia and alert the doctor so they can provide resources and further support to the patient.

As a woman struggles with eating, so too can that influence how well her baby is nourished. For those with a restrictive eating disorder, this may mean the baby does not get enough nutrients and could be small for gestational age or low-birth weight. In cases of bulimia or BED, an excess of calories may increase the risk of gestational diabetes for the mother and result in an overweight baby at delivery. However, the effects on the baby are not purely physical; attachment is a critical piece of mother-child bonding and can be impaired by maternal depression, which is often comorbid with an eating disorder.

Because of all these risks, an expectant mother may experience substantial shame if she can’t overcome her disorder to care for her baby. This may, in turn, prevent her from seeking help for fear of being labeled a bad mother. External sources of shame and blame are common, with family and friends’ criticisms that the woman is not caring for her baby’s health. Instead of shaming, Baumann says that family and friends can help by educating themselves about eating disorders, steer clear of comments on weight or size, and provide support.

The current media climate has put additional pressure on expectant and new mothers to gain pregnancy weight in a certain way (i.e. to have a 'cute baby bump' and nothing more) and to lose weight immediately following delivery. Celebrity pregnancies, including the recent royal pregnancy and birth provide unrealistic standards for women to live up to. The focus on restricted diets and excessive exercise to burn off baby weight is detrimental to both mother and baby, especially if the mother is breast-feeding.

Obstetricians should not only screen women for eating disorders, but should take measures to ensure the health and safety of both mother and child. One simple step is to do blind weighing, so that the focus is not on the scale or numbers. Additionally, the AED has a list of referrals to physicians who specialize in treating pregnant women with eating disorders. Another great resource Baumann suggested was the book, How Does this Pregnancy Make Me Look?, which helps to address body image concerns during pregnancy.

Lastly, Baumann emphasized that therapists and providers can play a strong role in promoting attachment between mother and baby both in utero and postpartum. Eating disorders during pregnancy are not a sign of weakness, but of an illness that needs to be treated with the same care that any physical illness would be.

This twitter chat addressed a considerable mental and physical health issue that has the power to affect not only the mother, but also the next generation. Providers, families, and friends all have the power to support these women so that they can access necessary resources essential for a healthy and happy pregnancy.