People with eating disorders harness a number of powerful motivators to fuel their recoveries. For some women, chief among these is the desire to have children one day. As that ‘day’ nears, fertility, pregnancy, and childbirth present unique challenges to those with active eating disorders, as well as those in recovery.
Women with active anorexia nervosa or bulimia nervosa may have more difficulty conceiving. The good news is that research suggests that fertility problems are no more common in women who have recovered from eating disorders than those with no eating disorder.
Many women with eating disorders, especially anorexia nervosa and atypical anorexia nervosa, do not regularly get their periods, and menstrual irregularities are not uncommon in women with bulimia nervosa. Use of birth control pills will override the body’s usual hormonal cycling, and thus can mask the body’s natural state. It may seem like one is “getting their period” during the placebo week, but it doesn’t reflect if the body can actually ovulate on its own.
Lack of menstruation (termed ‘amenorrhea’) can be a result of low weight (or low weight for your body’s particular needs), inadequate caloric intake, too much exercise, and stress. If you are not menstruating or menstruating irregularly, it can be hard (though not impossible) to get pregnant. Approximately one-third of women with anorexia nervosa who fully restore their weight experience a delay in return of regular periods and normal fertility.
If you are in recovery from an eating disorder and are having difficulty conceiving, talk to your doctor about next steps (which may depend on where you are in your recovery process).
Options might include:
- A medical workup including tests of hormone functioning
- Nutritional counseling to aid with weight restoration and/or diversification of your diet
- Psychological counseling to address anxiety related to fertility issues or difficulty modifying eating and exercise patterns
Pregnancy during an Acute Phase of Illness
The many physical risks of having an eating disorder, such as malnutrition, dehydration, electrolyte imbalances, and cardiac issues, can be exacerbated while pregnant, and are risky for mom and baby. For mom, complications include miscarriage, cardiac irregularities, premature birth, increased risk for cesarean birth, gestational diabetes, and depression. For the developing fetus, possible risks include delayed fetal growth, low birth weight for age, premature birth, and respiratory distress.
If you become pregnant while experiencing active eating disorder symptoms, be upfront with your OB/GYN doctor. Your physician can help you decide what would be most helpful to ensure a healthy pregnancy and post-partum experience. This might include more frequent appointments with the OB/GYN, and/or additional counseling.
Healthy women are typically recommended to gain 25-35 pounds during the course of their pregnancy to support the healthy growth of the baby. Weight gain can be complicated to navigate for people with current or past eating disorders in a number of ways:
- Weight is routinely monitored throughout pregnancy, and it is likely to be a topic of conversation at your regular OB/GYN appointments.
- If you are underweight when you become pregnant, it is likely that you will be advised to gain more weight than this.
- If you are normal- or over-weight, struggle with binge eating, and experience a steep weight gain trajectory, your physician may make recommendations to slow weight gain.
- At any weight status, the prospect of a changing body shape may feel scary.
- Changes in eating habits (e.g., food cravings, managing nausea) and risk of relapse.
Whatever your particular experience is, it is useful to have an open dialogue with your partner and your medical provider about it. There is no one ‘right way’ through pregnancy; rather, those supporting you along the way can help you find your way.
Beyond a certain point, being pregnant becomes visible and there is potential for an uptick in the number of people who are paying attention to your body during this time. You may hear unwanted comments on the size of your baby bump and your changing shape. People may try to enter your personal space to touch your belly or unwittingly invade your mental space by commenting on your eating or telling you their personal pregnancy story – their food cravings, heartburn, swollen ankles, etc.
In these instances, the best defense is a good offense – thinking ahead of time about if and how you will respond. You may want to come up with some go-to gestures and phrases, such as a hand placed on your belly or a comment such as “I’d prefer you not touch my stomach.” You can also role-play interactions with your therapist or family and friends for practice. If you find yourself obsessing about the changes in your body shape and the comments from others, it can also be helpful to determine how helpful these thoughts are, and try to rework them.
Proper nutrition – eating enough, eating often enough, and eating a variety of foods – is an essential part of pregnancy and eating disorder recovery. A nutritionist specialized in working with individuals with eating disorders may be an essential member of your health care team during and immediately following pregnancy. It’s likely that your nutritionist will ask you to keep track of what you’re eating to determine what, if any, changes should be made to best support your and the baby’s health. If you’re worried about a resurgence of eating disorder symptoms or are finding it difficult to implement dietary recommendations, that’s reason enough to speak with a therapist who can you to problem-solve tricky situations as they arise. A pregnancy-related or eating disorder support group may also help provide perspective and validation for your experience.
Potential Postpartum Issues
After the baby is born, the sleep/wake schedules of new parents are turned upside down. With this shift, there may be a tendency for eating to become dysregulated.
- Keep your eating pattern as normal as possible.
- Ask others to help out with the baby so that you can take a break to eat.
- Rely on easy-to-prepare foods on hand so that prep time is reduced.
Breastfeeding moms need to take in adequate nutrition for mom and baby. Consult with your doctor, but it’s typically recommended that breastfeeding moms consume 400-500 more calories per day (above their own weight maintenance needs) than new moms who are not breastfeeding.
Mood and Anxiety
Be on the lookout for signs of emerging postpartum depression and anxiety, such as sadness and crying, irritability, poor concentration, and feeling worthless and disconnected from others (including your newborn). To learn more about pregnancy and post-partum mental health symptoms and resources, read here.
Just as you needed to adjust to your body’s changes during pregnancy, so too will you need to adjust to your post-baby body. For those with a history of an eating disorder, weight monitoring in the post-partum period can be useful to ensure that changes are occurring safely and at a modest rate. Talk with your doctor about how and when it is safe to begin exercising, and attend to your exercise mindset to ensure that it’s aligned with your long-term health.
For More Information
- Mental health and pregnancy information (U.S. Office of Women’s Health)
- Pregnancy and eating disorders (National Eating Disorders Association)
- Maternal mental health research reports by the World Health Organization