Co-Director Kathryn Emerick, MD
photo: Jamie Manser
Pregnancy and the postpartum period are transformative phases marked by profound physical, emotional, and identity changes. This time may be particularly challenging to someone grappling with a difficult relationship with food or their bodies.
Pregnancy is a time when a person’s body undergoes incredible changes – changes that are not within the person’s control. Pregnant people may not be able to control how much weight they gain or where that weight appears, but they will certainly be weighed and measured countless times throughout their pregnancy. For those with a history of eating disorders, this monitoring can trigger heightened anxiety about body image. In individuals with a history of induced vomiting, morning sickness can be a particular trigger for purging behaviors. Also worth noting is that the nutritional monitoring recommended with gestational diabetes may trigger counting behaviors that someone has worked to diligently remove from their lives.
There’s considerable concern about how the return of disordered eating behaviors and thoughts can affect the patient’s quality of life, particularly given their link to higher rates of anxiety and depression. In cases of anorexia nervosa, insufficient nutrition may lead to inadequate weight gain and nutrient deficiencies, jeopardizing the well-being of both the mother and the unborn child. Additionally, women with bulimia nervosa may struggle with electrolyte imbalances, which can have severe consequences for fetal health.
This issue is not confined to pregnancy; the post-partum period may also be a difficult time for those with a history of eating disorders. In media – particularly social media – the pressure to "bounce back" and the perception that others are indeed quickly returning to their pre-pregnancy body weight and size can exacerbate existing concerns about body image. Hormonal fluctuations, sleep deprivation, and the overwhelming demands of new motherhood can create a perfect storm for individuals susceptible to eating disorders, especially when the protective factor of fetal wellbeing is removed.
It is crucial that healthcare providers working with pregnant people screen carefully for eating disorders. Many women are reluctant to disclose a history of disordered eating spontaneously and others may not even be aware that some of their habits – like calorie-counting or intense exercise – are associated with a disordered relationship with their body.
Navigating eating disorders in pregnancy and postpartum requires a collaborative, holistic approach including the OB team, mental health professionals and nutritionists. It is important to address and treat eating disorders at any stage in the reproductive lifespan to protect the lives and wellbeing of mothers, children and families.
If you are provider, a recent treatment guideline for managing anorexia in pregnancy may be of particular interest: Galbally, Megan et al. “Management of Anorexia Nervosa in Pregnancy: a Systematic and State-of-the-Art Review.” The Lancet. Psychiatry 9.5 (2022): 402–412.
If you, or someone you love is struggling with an eating disorder please visit the Eating Disorders Hope website for resources.