Over the course of a single spring, I worked with three women struggling with postpartum anxiety. During our time together, I learned that they all had a history of eating disorders. This connection motivated me to research and talk to women about how eating disorders affected their pregnancy and postpartum experience. [Names have been changed.]
Eating Disorders as Related to Childbearing
The two most common eating disorders (EDs) are anorexia nervosa (AN) and bulimia nervosa (BN), estimated to affect 5 – 10 million females in the United States. Approximately 4.5% – 9% of women of childbearing age have a past or active eating disorder. AN is characterized by extreme calorie restriction, obsessive dieting and loss of periods. Symptoms of BN include repeated episodes of binge eating followed by purging, fasting, excessive exercise and abusing laxatives, diuretics and enemas. Both experience extreme fear of weight gain and distorted perception of body image.
Women struggling with EDs often exhibit perfectionism, obsessive behavior, extreme sensitivity, seriousness, anxiousness, self-consciousness, impulsivity, a feeling of being out of control, negative self image and a high level of self-blame. There is a strong correlation among perfectionism, anxiety and eating disorders.
While there are some contradictory study results, EDs have been linked to maternal and fetal risks including excessive vomiting during pregnancy, cesarean section, postpartum depression/anxiety, anemia, hypertension, pre-eclampsia, miscarriage, intrauterine death, preterm delivery, breech presentation, low Apgar scores, low birth weight, fetal growth restriction, small-for-gestational-age infants and slow weight gain.
Research also indicates a significantly greater incidence of anxiety and depressive disorders in women with EDs than in the general population. Shame and guilt about their illness can cause secretiveness, denial of a problem or reluctance to disclose symptoms to providers.
Eating Disorders and Pregnancy
Studies indicate that many women with EDs have a temporary remission during pregnancy which changes in the third trimester and the first three to six months postpartum, when symptoms often reemerge more severely than before pregnancy.