I finally started experiencing the roller coaster joys of new motherhood, but my journey to parenthood wasn’t the most pleasant one. Throughout my second and third trimesters, I received tons of unsolicited remarks from family and friends. Two stung the most: “Now you can eat whatever you want and get away with it” and “Wow, you’re really getting big.”
Having dealt with mental health issues throughout my life, including an eating disorder, these comments were unbearably triggering. I already had fears of relapsing and succumbing to toxic habits, including obsessing over calories, overexercising, bingeing and purging, and starvation—all of which I had worked very hard to gain control over in the past decade.
In my baby bump journey, I learned I wasn’t alone: Research shows up to 7.5% of pregnant women have an eating disorder. Those can include anorexia nervosa, bulimia nervosa, binge-eating disorder, and avoidant restrictive food intake disorder. People who previously recovered from an eating disorder may experience a relapse in pregnancy, explains Nicole Avena, PhD, assistant professor of neuroscience at Mount Sinai School of Medicine and author of What to Eat When You’re Pregnant. This can occur in a first-time pregnancy or subsequent one.
The reality is for pregnant people like me, the focus on weight from loved ones, society, and medical teams can make pregnancy a constant battle. It was one I had to fight through. If you have an eating disorder in pregnancy or have a fear of relapsing, there is help available. Here’s all you need to know.
Why Pregnancy Can Trigger an Eating Disorder
While the exact cause of eating disorders isn’t understood, pregnancy comes with a mountain of mental and physical changes, which can be especially difficult for a person who has struggled with any type of eating disorder. “This can include exhaustion and fatigue; mood and hormonal changes; increased hunger cues; nausea; and complications in pregnancy (hypertension, gestational diabetes, pregnancy loss),” says Brittany-Lyne Carriere, a Toronto-based full spectrum doula.
The feelings can be worsened by societal expectations and perceptions surrounding weight and body image before, during, and post pregnancy. This kind of scrutiny is compounded on social media, especially with before and after posts showing pregnant and postpartum bodies. A study found 46% of women said media portrayals of pregnant women and new moms brought on negative emotions, such as self-consciousness, frustration, hopelessness, and depression.
Medical teams often also place heavy focus on pregnancy weight. It’s one of the quantitative ways thought to assess health and growth during pregnancy, Dr. Avena points out, while the American College of Obstetricians and Gynecologists offers guidelines for recommended weight gain during the three trimesters.
“You are ‘flagged’ if you don’t gain within a certain amount of pounds when pregnant as being at risk for developing complications either with the delivery or with the development of the baby,” says Dr. Avena. On the other hand, you’re told not to gain too much weight either. This can all put a lot on pressure on pregnant people, especially those with a history of an eating disorder.
Symptoms of an Eating Disorder in Pregnancy
Warning signs that shouldn’t be ignored include:
Restrictive/anorexic habits with foodStressing over food intake (calorie counting and/or orthorexia, an unhealthy fixation on eating healthy)Bulimia (bingeing and/or purging)Anxiety or fear around food
Complications of an Eating Disorder in Pregnancy
Eating disorders in pregnancy can be dangerous. Pregnant people with an eating disorder are at a “higher risk of pregnancy complications and negative outcomes, such as miscarriage, premature delivery, small head circumference, and difficulty nursing,” says Dr. Avena.
Research shows it can also lead to fetal growth restriction, low birth weight, and microcephaly.
How To Manage an Eating Disorder in Pregnancy
In pregnancy, postpartum, and beyond, grounding techniques are beneficial life skills to use to manage toxic habits and intrusive thoughts surrounding eating disorders and disordered eating. Here’s what experts recommend.
Acknowledge your feelings
Don’t conceal thoughts and feelings about your disordered eating, says Alexandra Sisam, ND, a licensed naturopathic doctor based in Toronto who focuses on eating disorders. “It’s very normal to be triggered by being pregnant, to not feel OK in a body that is changing and out of your control,” she adds.
She advises pregnant people struggling with thoughts of disordered eating to either verbalize emotions aloud or write them down: “Don’t keep it inside due to shame or fear of what others are thinking as it can create an environment of isolation and a sentiment that there is something wrong with you when there isn’t.”
Try and shift your perspective
Reframing thoughts can also help alleviate your stresses. “Remind yourself that it will not always feel and/or be like this,” says Dr. Sisam.
You can also remind yourself these changes are something extraordinary that’s happening to you. “You’re growing a little person inside of you and that’s incredible,” says Carriere.
And moreover, keep telling yourself the additional nutrients you are taking in during pregnancy are for the baby—that you’re nourishing this new and exciting life you’re about to bring into the world.
Speak up about being weighed
Experts say weight in pregnancy doesn’t always have to be so black and white. Lindsay Shirreff, MD, MSc (HQ), FRCSC, an OB-GYN at Mount Sinai Hospital in Toronto, asserts that such a determination should be made via a case-by-case assessment, rather than done as a standard practice, because it ultimately depends on the well-being of the patient and baby.
If stepping onto the scale is advised, accommodations can be made for a pregnant person with a history of eating disorders. “If seeing the value on my office scale is upsetting for a patient, I offer to weigh patients blindly—aka facing backward and the number isn’t shared. In fact, I don’t discuss this data at all unless I am concerned,” says Dr. Shirreff. That concern may come if someone gains more weight than expected because of the risk of maternal or fetal adverse outcomes.
In some instances, it may be necessary to weigh a patient from the outset of pregnancy. Due to my eating disorder history and being underweight per my height and BMI, my midwives and OB-GYN recommended that I be weighed blind from the beginning and that they closely monitor my progress from there.
If you prefer not to know your weight during pregnancy, let your health care provider know. They can make accommodations to help you feel comfortable and empowered throughout your pregnancy. If they don’t seem to respect your feelings, it can make all the difference to find a medical team that works for you.
Find healthy ways to cope
Try implementing coping mechanisms to help manage triggers and stressors. “Consider deep belly breaths, light stretching, yoga, and meditation,” offers Dr. Sisam. “These are all things that can allow our nervous system to slow down, enter a state of calm, and help you make the situation more manageable.”
Additionally, consider limiting exposure time to unpredictable stimuli by putting a cap on screen time, then switching up your environment by going for a walk, for instance.
Seek therapy
If you’re concerned that eating disorder behaviors are being carried into pregnancy and want professional support, don’t be afraid to reach out.
If a person “exhibits any history of an eating disorder or a current negative relationship with food, it is best to seek out therapy, and if possible, securing this resource prior to getting pregnant,” says Dani Mendelson, LCSW, of Nurture Therapy in Chicago, who treats patients with eating disorders during pregnancy.
If it isn’t possible to secure a therapist prior to your pregnancy, don’t beat yourself up. “It is great to begin therapy when you can and if there is some type of barrier with finding a therapist, at least make sure to let your obstetrician or midwife know of your eating disorder so they can appropriately monitor you and the baby,” says Mendelson. “It is a strength to admit that you have an eating disorder and finding help for it should feel very empowering because you want to make sure that you and your baby are healthy. ”
A great first place to look for a therapist is through your OB-GYN, midwife, or another medical professional you are working with. “They may partner with specific practices and have additional knowledge of providers in and around your area,” explains Mendelson. For instance, they may refer you to a local and affiliated eating disorder treatment center.
You can also reach out to your health insurance company for assistance, especially if you are looking for in-network providers. Also, the National Eating Disorders Association (NEDA) and the American Pregnancy Association can connect you to resources.
Dani Mendelson, LCSW
It is a strength to admit that you have an eating disorder and finding help for it should feel very empowering because you want to make sure that you and your baby are healthy.
— Dani Mendelson, LCSW
Find a support network
Support from loved ones is also critical for a pregnant person who is struggling. It’s important to lean on people who are truly supportive and can help with things like setting up health care appointments and offering rides to and from.
Dr. Avena says family and friends can help by respecting healthy boundaries, including avoiding comments around weight or what a pregnant person should be eating. “Even if it’s intended as a compliment and/or encouragement, it’s better to not say anything at all,” says Dr. Avena. “And further to this, avoid giving advice or tips related to food because there is no right or wrong way to eat; don’t talk about weight gain and bump size, or physical activity—unless solicited.”
What To Do After Birth
Taking care of yourself should be top of mind even after giving birth since an eating disorder can continue or worsen postpartum. It can also increase your risk for postpartum mental health conditions, including depression and anxiety. Focus on healthy coping mechanisms that work for you and seek professional help whenever it’s needed. Know you aren’t alone and help is available. Also, be kind to yourself.
Initially, I beat myself up when the eating disorder reared its ugly head during my pregnancy. Fortunately, with the support of loved ones and therapy, I cultivated the skills to manage these stressful moments. Ultimately, the major revelation for me was learning that even if I didn’t have an eating disorder history, there’s no such thing as a “normal” pregnancy to begin with. It isn’t a linear journey. From this, I grew to have more compassion for myself, and it helped me appreciate the good days more and weather the bad ones with a bit more ease.
