How to Deal with an Eating Disorder During Pregnancy

Three Methods:Understanding Your ConditionGetting Specialized Prenatal CareFinding the Support You Need

Eating disorders like bulimia and anorexia nervosa can be extremely dangerous and, in severe cases, potentially fatal. Pregnancy makes the situation even more complicated. When you are pregnant, a great deal of attention is focused on your rapidly changing body, which can be extremely upsetting and stressful if you are coping with an eating disorder; in fact, in some cases, pregnancy can even trigger a relapse in women who have recovered from bulimia or anorexia. Getting help as soon as possible is crucial. Pregnant women with eating disorders risk malnutrition, dehydration, cardiac issues, gestational diabetes, and other health problems; in addition, they may miscarry, deliver their babies prematurely, or give birth to babies with low birth weight, respiratory difficulties, and feeding problems.

Part 1
Understanding Your Condition

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    Know the symptoms of bulimia nervosa. People with bulimia find themselves stuck in a cycle of binging and purging – eating large amounts of food and then vomiting, taking laxatives, and/or exercising excessively to get rid of what they have consumed. Bulimia can have catastrophic health consequences, and it’s even more dangerous during pregnancy. If you are pregnant and you binge and purge, you need to seek medical treatment immediately.
    • Some women experience the symptoms of bulimia nervosa for the first time when they become pregnant. Others have long histories of the condition. Either way, you need to be honest with your doctor and get the help that you need.
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    Recognize the symptoms of anorexia nervosa. People with anorexia restrict their food intake severely, resulting in excessive weight loss and malnutrition. The condition is extremely dangerous, and during pregnancy, it poses additional risks – to both you and your unborn baby. If you are pregnant and think you may have anorexia, talk to a doctor right away.
    • As with bulimia, you may experience the symptoms of anorexia for the first time during pregnancy (in the media, this condition has been termed “pregorexia,” but that’s not a recognized medical diagnosis), or you may have a long history of the condition. Either way, get medical help immediately.
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    Understand the signs of binge eating disorder. People with binge eating disorder (BED) experience episodes during which they consume very large amounts of food, without the purging associated with bulimia. If you have BED, you might feel “out of control” or powerless around food, and you may feel guilty or depressed about your binges. Though not as immediately dangerous as bulimia or anorexia, binge eating disorder does pose serious health risks, which may be exacerbated during pregnancy. See a doctor right away if you suspect you have BED.
    • As with other eating disorders, binge eating disorder sometimes occurs for the first time during pregnancy; it can also be a long-standing condition triggered or aggravated by pregnancy. Either way, report your symptoms to your doctor.
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    Acknowledge the seriousness of your condition. If you are pregnant and have any of these eating disorders, you risk malnutrition, dehydration, heart problems, gestational diabetes, psychological issues, labor complications, and breastfeeding difficulties. In addition, your condition may affect your baby. Risks to your baby include:
    • premature birth (which can pose many dangerous health problems)
    • low birth weight
    • respiratory problems and/or respiratory distress at birth
    • feeding problems
    • developmental delays
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    Realize that pregnancy can trigger the body-image issues associated with eating disorders. During pregnancy, your body changes very quickly. You gain weight, and your breasts and belly grow. Well-meaning people will comment on these changes, and you may feel upset, embarrassed, or self-conscious. For women prone to eating disorders, all of this can be triggering.
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    Be aware of the complex nature of eating disorders. Eating disorders can appear to be all about food, weight, and body image – and that can seem particularly true if your condition was triggered by healthy pregnancy weight gain. However, most people with eating disorders have underlying issues that are unrelated (or loosely connected) to their bodies, such as depression, anxiety, relationship problems, and a need for control. Therefore, though medical treatment for eating disorders is absolutely necessary, you will probably also need some kind of counseling to deal with the psychological backdrop.

Part 2
Getting Specialized Prenatal Care

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    Be honest with your obstetrician. Many women feel embarrassed, guilty, or ashamed about their eating disorders, especially during pregnancy, when they become responsible not only for themselves for also for their unborn babies. Resist the urge to conceal your condition. Your obstetrician needs to know about your eating disorder. Provide a detailed description of your symptoms so that he or she can help you and your baby.
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    See a nutritionist. Your obstetrician should be able to refer you to a nutritionist, who will help you develop an eating plan to ensure adequate nourishment for your and your baby. Check in with this person regularly, and do your best to follow his or her advice. Remember that a nutritious diet is one of the most important factors in ensuring a healthy pregnancy.
    • Your nutritionist is also a fantastic resource for dealing with the postpartum period. Plan to continue seeing this person after your baby is born.
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    Monitor your health. Your obstetrician may want to perform additional tests to make sure that you are staying as healthy as possible. He or she may want to check you for anemia, osteoporosis, and other complications that can result from poor nutrition and be exacerbated during pregnancy. In addition, if your condition is severe, he or she should monitor your cardiac health and overall wellness.
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    Track your baby’s development. Having an eating disorder places you in a higher risk category that most pregnant women, so it’s important that you work with your obstetrician to monitor your baby’s growth and development. Depending on your specific circumstances, you may need more frequent doctor’s appointments, additional ultrasound examinations and laboratory work, or referrals to specialists. Follow your doctor’s advice.
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    Discuss your weight gain with your doctor. If you started your pregnancy at a healthy weight, you probably need to gain between 25 and 35 pounds by the time you deliver; if you were underweight, you may need to gain more, and if you were overweight, you may be able to gain less. Talk to your doctor about your weight gain goals, and do your best to follow his or her recommendations. Remember: pregnancy is temporary, and gaining weight is necessary for your baby’s health.
    • You will probably have to weigh in at every doctor’s appointment. For women with eating disorders, this prospect can be stressful, but it’s crucial to monitoring the health of you and your baby during pregnancy. If you find this part of the appointment especially upsetting, talk to your doctor.
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    Consider hospitalization. If your condition is severe, your doctor may recommend hospitalization. You may need intravenous fluids and nutrition, and you may need to undergo additional testing. Hospitalization may be required if:
    • your vital signs concern your doctor
    • you are dehydrated
    • you show signs of malnutrition
    • you have cardiac symptoms, such as arrhythmia
    • you do not gain sufficient weight, even after seeing a therapist and nutritionist
    • you have signs of preterm labor or other complications

Part 3
Finding the Support You Need

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    Find a counselor. Individual therapy is almost as important as specialized prenatal care. Your therapist can help you deal with your feelings about food, weight, pregnancy, and motherhood. He or she can also help you discover some of factors that are contributing to your condition, so that you can deal with them and move forward. If possible, choose someone with experience treating pregnant women with eating disorders.
    • Like your nutritionist, your therapist will continue to be an excellent resource for you even after your baby is born. Remember that the postpartum period will be challenging, too; if possible, plan to keep seeing your counselor during this time.
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    Join a support group. There are probably support groups for people with eating disorders in your community. Find one and attend a meeting – you might be surprised by how helpful and comforting these groups can be.
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    Be open with your spouse or partner. If you have a spouse or partner that you trust, tell this person about your condition. He or she can encourage you to eat healthfully, see your doctor regularly, and strive for healthy, moderate weight gain. Just as importantly, he or she can offer love, compassion, and emotional support.
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    Tell trusted friends and relatives about your eating disorder. Close friends and relatives can also provide important emotional support. Tell the people you trust what you are going through; give them an opportunity to listen and help you.
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    Avoid anyone who makes you feel worse. If you have friends or family members who judge you harshly, criticize your actions, or make you feel bad about yourself, avoid them. Continue to see your doctor, nutritionist, and therapist, and surround yourself with people who support you.


  • If you have an eating disorder and are not yet pregnant, the best course of action is seek treatment immediately, before you conceive. Treating your eating disorder and staying at a healthy weight before conception will maximize your odds of a healthy pregnancy.
  • If you are pregnant and have an eating disorder, resist the feelings of guilt and shame that sometimes occur. You have a condition; it is not your fault. It does not mean that you don’t love your baby or that you won’t be a wonderful mother. You just need help.
  • Try to focus on the fact that your body is changing in order to support your baby. Remind yourself that there's a difference between being "fat" and being pregnant.
  • Women with eating disorders often struggle in the postpartum period as well. Plan to continue seeing your therapist and nutritionist after your baby is born, and continue to attend your support group, if you have one.
  • Some women who have long-standing eating disorders actually improve considerably during pregnancy -- for whatever reason, they are able to eat well and nourish their babies during this time. If you fall into this category, that's great for you and your baby, but don't get complacent. Understand that your symptoms will likely return after pregnancy. Seek treatment.

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Categories: Pregnancy