How Pregnancy and Postpartum are Affected by Eating Disorders

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.

Women suffering with EDs fear losing control of eating and weight, causing damage to their baby and worry about being unable to cope. They often have unrealistic, idealized expectations of motherhood.

Postpartum Adjustment in Women with Eating Disorders

Studies show the majority of mothers with EDs have less favorable maternal adjustments and that attachment can be impaired.

Jennifer said that she felt bonded with her baby at the hospital, but “as soon as I realized that she was going to be a burden and that my life wasn’t going to be the way it was and how much it was going to change, I couldn’t connect with her.  I don’t remember when that changed.  I have regrets about how I spent the first couple of months.”

Heather, another mother afflicted with disordered eating and anxiety, described her experience of new motherhood saying, “I didn’t expect it to be such an assault on our marriage, an assault on everything that you know.”

With greater adjustment difficulty, the incidence of postpartum moods disorders rises.

Infant and Child Feeding in Women with Eating Disorders

breastfeeding baby, benefits of breastfeeding, children asking about breastfeeding, siblings breastfeeding, cute baby face, baby hand on faceSome studies indicated that women with EDs were less likely to breastfeed fearing changes in body shape, yet greater awareness that breastfeeding quickens weight loss can prompt women to breastfeed. Many women with EDs report low desire to breastfeed and many have difficulties when they try.  Weaning is a cautionary time as they are vulnerable to binge eating and starvation.

Regarding feeding, Heather lamented, “I have to be concerned with what she’s eating and what I’m eating.  When I’m really anxious, my hunger cues go away or I ignore them.”  Jennifer commented, “I cannot totally separate it, when I’m feeding Sally, I’m over-worried about giving her a variety.”

When Sally was five months old, a doctor commented about her being chunky, which created angst and Jennifer started to reduce the number of daily bottles. Research found that 50% of mothers with EDs report being concerned their child will become overweight.

What Can Help?

How are you feeling as your body is changing with pregnancy?   Do you have a history of anxiety, depression, or eating disorders?   Do you have an exercise routine?  Are you able to sleep/eat when the baby is sleeping?

Simply being aware can help a family, or Mom, seek needed extra support.

At risk Moms should prepare prenatally. Find a lactation consultant if you plan to breastfeed, join a new mom’s group, hire a birth and/or postpartum doula to help you transition confidently to motherhood. Jennifer said her new mom’s group “was very helpful. It was so nice hearing other moms feeling the same way I did.  It was something to look forward to.”

Learn and practice techniques to relieve stress. Be aware of the signs of postpartum mood disorders and talk with a counselor before birth.  Use the Edinburgh Postpartum Depression Scale to self-screen. Seek out nutrition and exercise education and support.

It is especially important for Moms with a history of, or active, ED to have realistic expectations and to make the baby as real as possible early in pregnancy.   Take time through reading, classes, and talking to new parents, to expose the reality of life with a newborn.

Other effective strategies include cognitive behavioral therapy (CBT), medications, relaxation, meditation, yoga, and fish oil.  Seek opportunities to explore worries and triggers for unhealthy behaviors and actively enlist a multidisciplinary support system.

Low spousal support is a risk factor in postpartum relapse of EDs.  A Mom with an ED must set  positive and healthy goals and strategize paths to achieve them; reaching goals can help nurture a sense of control and confidence in her ability to be a mother.sleeping baby, baby in towel, hours old baby, new baby, newborn care, soothing an infant, harvey karp 5 s, breastfeeding basics, breastfeeding education, new parent education, mystic childbirth education,

At prenatal checks, a Mom may decide whether she’d like to know her weight, if she prefers not to know, she should request to be weighed with her back turned.

She says she would have benefited from a direct approach of having someone prepare food, take the baby and have her sit to eat three times a day. “I felt pressure to eat, pressure to nourish someone else, I was too anxious to even swallow.”

Jennifer also said that having someone make food for her and caring for the baby while she ate helped her and she ate more at those times.

Mothers with EDs may need assistance improving their ability to recognize and respond to their child’s cues. It’s a Mom’s job to serve a variety of healthy options and it’s their child’s job to decide what and how much they will eat.

Breastfeeding difficulties often accompany EDs and it may be helpful for a Mom to have “permission” to stop nursing.  Heather told me, “I did not like breastfeeding and the stress of being on the clock and being the only person to feed her, but I needed the assurance that it was okay not to breastfeed and that I would still be a good mom.”

Conclusion

The history or presence of an eating disorder in expectant and new mothers can create a multitude of issues that hinder the confident and strong basis of a new family.

Support is vital.  Practical and emotional support, reassurance and praise for learning to be a capable parent are critical elements that benefit any new Mom, but are imperative for a new Mom with an ED or history of an ED.

References

Astrachan-Fletcher E, Veldhuis C, Lively N, Fowler C, and Marcks B. 2008. The Reciprocal Effects of Eating Disorders and the Postpartum Period: A Review of the Literature and Recommendations for Clinical Care. Journal of Women’s Health. 17(2):227-239.

Bansil P et al. 2008. Eating Disorders among Delivery Hospitalizations: Prevalence and Outcomes. Journal of Women’s Health. 17(9):1523-1528.

Cantrell C, Kelley T, and McDermott T. 2009. Midwifery Management of the Woman With an Eating Disorder in the Antepartum Period. Journal of Midwifery & Women’s Health. 54(6):503-508.

Koubaa S, Hallstrom T, and Linden Hirschberg A. 2008. International Journal of Eating Disorders. 41(5):405-410.

Leddy M, Jones C, Morgan M, Schulkin J. 2009. Eating Disorders and Obstetric-Gynecologic Care. Journal of Women’s Health. 18(9):1395-1400.

Martoz-Ordonez C. 2005. Pregnancy in women with eating disorders: a review. British Journal of Midwifery 13 (7):446-448.

Mazzeo S et al. 2006. Associations among Postpartum Depression, Eating Disorders, and Perfectionism in a Population-Based Sample of Adult Women. International Journal of Eating Disorders 39(3):202-211.

Stein A, and Fairburn C. 1996. Eating Habits and Attitudes in the Postpartum Period. Psychosomatic Medicine. 58:321-325.

Swinbourne, Jessica M. and Touyz, Stephen W. 2007. The Co-Morbidity of Eating

Disorders and Anxiety Disorders: A Review. European Eating Disorders Review 15, 253–274.

 

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3 Responses to How Pregnancy and Postpartum are Affected by Eating Disorders

  1. Mothers with histories of eating disorders, who have young children between 1-5 years of age, are invited to participate in a study testing a new parent-based prevention program. For more information, contact us at 650-723-7885 or email tfeldman@stanford.edu

    • ldecesare says:

      Thank you for making Mother’s Circle readers aware of this study. Is there a geographic area you’re working with? What is the duration of the study? I would be interested in conclusions and results down the road.

  2. Program for moms with eating disorders: The Eating Disorders Research Program at Stanford University is now studying a new parenting program for mothers with a history of an eating disorder, who have a child between 1-5 years old. This research takes place at Stanford University. The program is designed to help mothers and fathers with their dilemmas in child feeding. If interested, please contact tfeldman@stanford.edu or visit us at http://edresearch.stanford.edu/studies.html

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