Disordered eating in pre-conception and pregnancy
I have been incredibly fortunate to have some amazing psychology students work with me again this semester. One of these students, the very fabulous Clemence Magisson has produced this incredible resource that explains how our eating behaviours can have an impact on our wellbeing during the perinatal period (and vice versa). Thanks Clemence for all of your hard work!
The journey to parenthood, from conception to birth, is a physically and emotionally unique experience. Some people embrace the physical changes of pregnancy and feel beautiful and strong. Others struggle to enjoy the way being pregnant makes them look or feel. Changes in appetite and weight can be distressing, and make you feel like your body is out of control. The constant weighing, tracking and comparing during antenatal appointments can feel like a high level of scrutiny and can be particularly triggering for people with a history of disordered eating and body image concerns. Eating disorders can occur in people of all ages, genders, ethnicities and sociocultural backgrounds, and have significant impacts for pregnant and postnatal people.
An eating disorder can exist prior to conception, in which case pregnancy might further aggravate eating disorder symptoms. Pregnancy and early parenthood can also trigger the first onset of eating disorder behaviours. There are serious health risks associated with eating disorders that can be very dangerous for both the parent and their baby. Unfortunately, eating disorders during the perinatal period often go undetected and untreated. It is critical to be informed of how eating disorders impact fertility, pregnancy and neonatal outcomes.
What are eating disorders?
Eating disorders are serious and complex issues characterised by disturbed eating behaviours and unhealthy preoccupations with food, body, weight and shape. They can affect all aspects of a person’s life, from their physical and mental health, to their social functioning and relationships. When severe, they can be life-threatening illnesses.
It is important to understand that issues involved in eating disorders extend beyond the visible symptoms of harmful eating patterns. These behaviours become a person’s way of coping with life’s stressors, and represent the signs of underlying psychological issues. The most common types of eating disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder.
Anorexia nervosa is characterised by maintaining a significantly low body weight through calorie restriction, excessive exercise or other unhealthy compensatory behaviours. There is an intense fear of gaining weight and the person develops a distorted body image (they perceive themselves far heavier than in reality). Their self-worth and self-evaluation are largely based on their appearance, weight and shape.
Bulimia nervosa is marked by recurrent bingeing episodes, which involve eating a large amount of food in a short amount of time. The individual feels a loss of control over their eating. Binges are then followed by purging and other unhealthy compensatory behaviours, including self-induced vomiting, misusing laxatives or diuretics, fasting or excessive exercise. As with anorexia, someone with bulimia will base their self-evaluation largely on their appearance and weight.
Binge eating disorder involves recurrent bingeing episodes in which an excessive quantity of food is consumed quickly without the person being able to exert control. Individuals will often engage in these binges even when they are not hungry or already physically full. Binges usually occur while alone to avoid embarrassment. The person may feel disgusted, guilty or depressed following the binge. Unlike in bulimia, individuals with binge eating disorder do not engage in any compensatory behaviours, but feel distressed over their eating habits.
It is important to note that you can still experience disordered eating and body image issues without a formal diagnosis. Even if you don’t realise that your eating is disordered, some of your behaviours can be harmful to yourself and your baby.
Based on empirical research, the current resource was created to inform those who are concerned about experiencing an eating disorder or related issues during the perinatal period, from preconception to birth. Eating disorders can affect anyone and it is never too late to reach out for support. Topics that are covered include:
Preconception and eating disorders
Eating disorders during pregnancy
Eating disorders after birth
Further help and resources
Preconception and Eating Disorders
If you have an eating disorder, it is strongly recommended that you postpone attempts at pregnancy until you are in recovery.
There are numerous medical complications associated with eating disorders that can hinder successful conception. Poor nutrition, excessive exercise and low body weight can cause your period to stop. The absence of menstruation is a condition referred to as secondary amenorrhea, and is common in individuals with anorexia and bulimia. Misusing laxatives or diuretics can also disrupt your menstrual cycle and halt your period. Without ovulation, your ovaries do not release eggs that can be fertilised, so conception cannot occur. Being underweight is not a favourable environment for a baby to grow, so your body responds by trying to save its energy and preventing reproduction.
Although not all individuals with binge eating disorder are overweight or obese, recurrent overeating can cause hormonal imbalances and result in irregular menstrual cycles. In cases where binge eating disorder does lead to obesity, your reproductive health is severely affected. Research shows that individuals with binge eating disorder are more likely to become obese than those without the disorder. Obesity is a common and well-known risk factor of infertility in both men and women.
People with eating disorders often struggle with stress, anxiety and depression, which can lead you to engage in fertility-harming behaviours such as smoking and increased alcohol consumption. You may also experience decreased libido, which can indirectly decrease your chances of conceiving by engaging in less frequent sex with your partner.
It was formerly thought that pregnancy was a rare occurrence for women with eating disorders. Although the associated medical complications can indeed make it more difficult to become pregnant, successful conception does still occur. However, to protect the health of yourself and your baby, an eating disorder should be addressed before attempting pregnancy. Recovery will also maximise your chances of successful conception, and lead to an overall more positive pregnancy and postpartum experience.
Eating Disorder During Pregnancy
Having an eating disorder during pregnancy can have very dangerous effects on the future parent and their baby. Being aware of these risks, which are outlined in the current section, can help you recognise the need to seek support.
If a parent engages in disordered eating while pregnant, such as calorie restriction and overexercising, then the baby will not obtain the necessary nutrients to grow. This may lead to intrauterine growth restriction (IUGR), which is a condition that is diagnosed when the foetus does not grow as expected. IUGR can cause a range of serious complications for your baby’s birth and early life, such as difficulty breathing and maintaining body temperature. Of further concern, anorexia has been associated with increased rates of stillbirth, a term that refers to the death or loss of the baby prior to or during delivery. Premature birth is another risk of anorexia, which occurs when the baby is born before they are fully developed. Additionally, studies have also linked anorexia with lower birth weight. These risks can lead to a wide range of short- and long-term complications that can impact the baby’s quality of life, from heart problems to abnormal brain development. Research has also shown that bulimia can have similar effects, including stillbirth and premature delivery.
Binge eating disorder is associated with high blood pressure and can also lead to gestational diabetes. This refers to diabetes that is first diagnosed during pregnancy, which puts your baby at an increased risk of premature delivery, breathing difficulties and type 2 diabetes and obesity later in life. Untreated gestational diabetes can also result in stillbirth. Moreover, excessive birth weight is another health complication associated with binge eating disorder. Babies that are too large are more likely to sustain birth injuries or require a caesarean delivery (surgical delivery through incisions in the uterus and abdomen).
In addition to the harmful effects that eating disorders can have on the growing baby, there are also serious physical and mental health risks for the pregnant person. Engaging in purging behaviours such as laxative and diuretic misuse puts the individual’s body at risk of dehydration, electrolyte imbalances and cardiac irregularities, which pregnancy will aggravate. Having an eating disorders during pregnancy also puts you at a greater risk of perinatal depression, as well as experiencing labour complications. If you have a caesarean delivery, your body may take longer to recover.
Considering the serious health effects that an eating disorder can have on the parent and their future baby, it is crucial to obtain immediate support. Please refer to the “Further Help and Resources” section for more information.
Eating Disorders After Birth
Following pregnancy and delivery, most people will find that their bodies have changed and you may have unrealistic goals for weight loss. You are at an increased risk of relapse or experiencing the first onset of an eating disorder during the postpartum period. As such, you should be informed of the health risks that an eating disorder can have on your newborn baby, which are outlined in the current section.
People with an eating disorder can have a distorted perception of food quantities. You may think you are eating a large amount of food, when in reality you are severely restricting your portion sizes. Contrastingly, you may also underestimate your food intake, as is often the case in individuals with binge eating disorder. If you have a distorted perception of food, an eating disorder can lead you to underfeed or overfeed your baby without realising it. Parents with anorexia have been found to misperceive their baby’s size, and will view them as “chubbier” than they are in reality. This distorted body image can also lead a parent to underfeed their newborn.
The consequences of underfeeding a baby are severe: the baby can develop excessive jaundice (yellowing of skin), dehydration and hypoglycaemia (low blood glucose levels). If these serious consequences of underfeeding are not addressed, they can cause brain damage and lifelong disability.
Overfeeding your infant can cause discomfort, irritability and disturbed sleeping patterns in the short-term. In the long-term, continuously overfeeding your baby can increase their chances of becoming overweight. This is important to address, as rapid weight gain in infancy is linked to a greater risk of obesity in adulthood.
By over-exercising or restricting food intake, a parent with an eating disorder can have difficulty maintaining or even loose milk supply. The baby will suffer nutritional deficiencies, which can result in growth and developmental issues.
Moreover, a parent struggling with an eating disorder after giving birth is at an increased risk of postnatal depression. Having a mental health disorder can hinder your ability to take care of your baby and lead to adverse cognitive, emotional and developmental issues for the newborn. A baby’s difficult start to life will impact their future, but addressing your eating disorder will enhance positive outcomes for you and your baby. Please refer to the next section, “Further Help and Resources” for more information.
Further Help and Resources
Research has shown that most pregnant people do not tell their healthcare providers about their eating, body, shape and weight concerns. Shame and fear of judgement can prevent you from accessing the support you need. However, due to the dangerous effects an eating disorder can have on the parent and baby, it is crucial that you reach out and seek help. Accessing appropriate services will protect you and your baby, and promote a healthy pregnancy and positive parenting experience. Below is a list of recommendations if you are concerned about experiencing eating and weight issues at any stage of your journey from conception to early parenthood.
1. Honesty
If you are trying to get pregnant, you will benefit from telling your healthcare provider about your disordered eating. They will help you to address your concerns, and may refer you to a specialist. By taking care of your mental health and making the right changes to your eating behaviours, you will increase your chances of successful conception.
Being honest about current or past struggles with an eating disorder will enable your doctor or midwife to prepare you for the physical changes you will experience during pregnancy. You can obtain additional check-ups and close monitoring, which will lead to improved outcomes for you and your baby’s wellbeing.
If a professional does not seem responsive or sensitive to your struggles, you should change healthcare providers. Indeed, there is still considerable stigma surrounding eating disorders, especially when they relate to parenting. A healthcare professional who is considerate of your experiences will provide you with appropriate support and services.
2. Counselling or psychotherapy
Eating disorders are complex mental health issues that can be difficult to overcome. Obtaining psychotherapeutic treatment is strongly recommended and will help you address the underlying cause of an eating disorder. You will gain insight into your condition, and learn strategies to manage issues about your weight, body and food. If you want to access psychological treatment, talk to your primary healthcare provider, who will refer you to the appropriate services.
3. Consulting a nutritionist with expertise in eating disorders
An eating disorder can make it difficult for you to have a balanced and healthy diet. A nutritionist will help you create a healthy eating plan to follow during and after pregnancy.
4. A strong support network
Talking to close friends and family about your concerns regarding eating and weight during pregnancy can help you feel more prepared. It is important that they understand how your condition affects you, and how they can best support you. Encourage them to look out for warning signs, and who they should contact if they are concerned about you.
5. Reflect
Consider making a list of reasons why it is important to eat well during and after your pregnancy. Ask yourself what kind of parent you want to be, and what kind of role model you want to be for your child. You have the power to teach the next generation that a person’s value extends beyond their weight and appearance. Keep this list and use it as a reminder for triggering times.
6. Additional resources
For information on adopting a healthy diet during pregnancy, consider visiting this evidence-based, patient-focused website:
The following websites will provide you with additional information and support regarding eating disorders: