Eating Disorders & The Pregnant Mom
Ideally, pregnancy is a time of overwhelming joy. A mother, in some 9 months, will be bringing a new life into this world. The processing is both challenging and exciting, and brings many life changes. Unfortunately, for women with eating disorders, these changes can be especially difficult. It is important that a mother-to-be understands the challenges facing her and her baby in order to keep both of them healthy and happy during and after pregnancy.
There are two relatively common types of eating disorders: anorexia and bulimia. Anorexia is typically characterized by compulsive, extreme dieting and, occasionally, excessive exercise resulting in extreme weight loss. Bulimia, by contrast, involves a cycle of bingeing and purging of food after eating, typically by self-induced vomiting, abuse of laxatives or compulsive exercise. These two disorders have caused severe health problems in women and, in some cases, men around the world. Some of the worst cases have resulted in death due to malnutrition or other complications. Considering how devastating these disorders can be to anyone, what is the effect on someone who is pregnant?
First of all, eating disorders can easily affect the process of conception. Anorexia can cause a woman’s menstrual cycle to complete stop completely (a condition called amenorrhea), and bulimia affects the regularity of the cycle. This is due to a low calorie intake, and negatively affects a woman’s fertility. A woman with amenorrhea may not ovulate, and a fertilized egg may have difficulty implanting in the uterus. For this reason, conception may be difficult.
Even if a woman is able to conceive, problems may persist. Aside from relatively common complications, such as premature birth, gestational diabetes, and a higher risk of a C-section, the eating-disordered mother faces several other potential problems. One of these is the increased chance of miscarriage. This occurs when a pregnancy unexpectedly ends within the first 10 weeks, sometimes due to the death of the fetus.
Miscarriages may be accompanied by severe blood loss, which puts the woman at risk as well. The risk of miscarriage nearly doubles in women with eating disorders. Another major concern is the possibility of stillbirth. This occurs when a child is carried to term but dies shortly before or during birth. Mothers with eating disorders also face a higher risk of stillbirth than other women.
Babies born to women with eating disorders are more likely to be premature and to have low birth weights. There are a variety of risks associated with these factors, including depression, developmental issues, increased allergies, and a weakened immune system. These effects are the most pronounced when the mother’s eating disorder is active: that is, when she is restricting her diet and/or purging while she is pregnant. Women who had eating disorders in the past but have since recovered are more likely to have successful pregnancies.
Mothers with eating disorders are also at risk for serious, related conditions known as Preeclampsia and PIH (pregnancy induced hypertension). Preeclampsia symptoms include protein in the mother’s urine, and unusually high levels of water retention. PIH causes the mother’s blood pressure to rise, which may harm both mother and child if severe.
Elevated states of PIH can lead to nausea, vomiting, and drowsiness, and can result in malnutrition or deprivation of oxygen for the child. Again, mothers with eating disorders are more likely to experience these conditions and have more severe cases. Rapid weight gain may contribute to the higher chance of contracting PIH.
The average woman should gain about 25 - 35 pounds during pregnancy. This can be especially emotionally difficult for the woman with an eating disorder, who may feel that her life and body are out of control. She may blame herself and fear that she is hurting her baby. Since a common component of eating disorders is low self-esteem, it may be tempting for a mother-to-be to want to “sacrifice” herself for the baby.
Some may use pregnancy as an “excuse” to eat healthy foods, only to fall back into starving or purging habits after childbirth. It is important that the eating-disordered woman learn to create lifelong habits of healthy eating and better self-esteem for her own sake. A healthy, happy mother during and after pregnancy is more likely to raise a healthy, happy child.
An eating-disordered mother may also experience severe depression during and after pregnancy, and may have difficulty breastfeeding or bonding with her child. Emotional support is essential during this time. She may feel lonely or isolated, and have difficulty caring for her new baby. Friends and family should be willing to help and support the new mother and should be careful not to draw attention to her weight gain, as doing so may trigger her eating disorder.
Women with eating disorders have the most successful pregnancies after recovery. If possible, a woman with an eating disorder should delay pregnancy until a year or more after she has recovered and is maintaining a stable weight on her own. Many women with eating disorders do recover and give birth to healthy children.
There are many ways in which an eating-disordered woman can improve her chances of a healthy, successful pregnancy. During a period of attempted conception, a woman with an eating disorder is normally advised to make a pre-conception appointment with her doctor. She also should make steps toward recovery, avoiding starving or purging behaviors.
Often she will need to visit a nutritionist, who will help her plan a healthy diet and prescribe prenatal vitamins to help supply any missing nutrients. This is especially important, as the body will divert nutrients to the fetus first, which may mean that the woman does not get adequate vitamins and minerals. Calcium deficiency is common in pregnant women, so the mother-to-be should ensure that she is getting enough for both her and the baby.
During pregnancy, the woman should keep periodic doctors’ appointments, continue to see her nutritionist and follow her diet plan. She should also seek counseling to help her recover from the eating disorder and understand its causes. The counseling should continue even after childbirth, as postpartum depression could lead to relapse, and therefore a repetition of the same self-destructive behaviors.
Finally, a healthy child is born! The challenges do not end here, however. The new mother should have a close support network of her spouse or partner, friends, family, and health care professionals. She will need their emotional support in the case of postpartum depression. It is also advised that she contact a lactation consultant, who can help with any problems that early breastfeeding can bring.
Many women have faced and overcome eating disorders to become healthy, happy mothers. However, it is important that a woman thinks seriously about the challenges she will face in a pregnancy before she tries to conceive. While she may be tempted to think of pregnancy as a quick-fix that will “force” her to eat correctly for the baby’s sake, eating disorders seldom go away in nine months. The first priority of an eating-disordered woman should be to get well for herself.
Then, when she becomes a mother, she will have the strength and confidence to care for herself and her baby. A woman who becomes pregnant while still struggling with an eating disorder should treat her pregnancy as a unique opportunity to seek counseling and to learn healthier habits that will last a lifetime. A mother is a role model. When she is healthy and values herself, her children will learn to do the same.
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