By Elizabeth Claydon, PhD, MPH, MS, Assistant Professor at West Virginia University School of Public Health
“I’m a very instinct driven person, so … it was sort of like an inner fight between eating disorder and mama bear mindset.” ~ Amelia, mother of one
The quote above is from a mother (name changed to protect her identity) who participated in interviews I did a few years ago with women about eating disorders and pregnancy.1 My own pregnancy had come at the heels of a relapse and recovery of my own eating disorder and I wanted to understand the lived experience of others in order to help future mothers-to-be. This research has become one of my greatest passions as I have seen the need for greater awareness to this topic and to amplify the voices of those with this lived experience.
Eating disorders affect reproduction, fertility, pregnancy, and the pregnant individual in a variety of ways. Many eating disorders may impair fertility, for example, how binge eating disorder is overrepresented within polycystic ovarian syndrome populations.2 However, in other cases, individuals who are not menstruating regularly, due to nutritional and hormonal imbalances, may incorrectly assume they cannot get pregnant and therefore take fewer precautions when sexually active. It is important to understand that even if menstruation is not occurring or is occurring irregularly, or an individual has a low body weight, they may still be ovulating and can still become pregnant.3 Additionally, pregnancy, if it occurs, can cause out-of-control feelings in women with a history of an eating disorder, which may only exacerbate their symptoms. This perfect storm is also heightened by the concomitant pregnancy weight gain, hormonal changes, and appetite variations.
Pregnancy already comes with the risk of numerous medical complications, but having an eating disorder can heighten that risk and also influence the types of problem women face. Miscarriage, poor nutrition during pregnancy, postpartum depression and anxiety, and sexual dysfunction are all associated with eating disorders, as well as an earlier cessation of breastfeeding among individuals with anorexia.4 Psychologically there is a broad spectrum of how a woman with an eating disorder might respond to pregnancy. For some, it may exacerbate eating disorder symptoms and trigger depression, while others may see it as an opportunity to recover for the baby and may experience joy and a cessation of behaviors.1, 5 Although some research has suggested that these women are more likely to report experiencing negative feelings upon discovering that they were pregnant, that heightened negativity dissipated by around 18 weeks’ gestation.6
Often women are hesitant to share their history with their obstetrician, so if the doctor doesn’t ask, an eating disorder can be missed entirely, putting both mother and child at risk.1, 3 Eating disorder-sensitive obstetricians currently use the SCOFF questionnaire to screen women for these disorders.7 This five-item questionnaire can point to a possible case of anorexia or bulimia and alert the doctor so they can provide resources and further support to the patient. I am currently piloting an eating disorder assessment tool that will be specific to pregnancy so that clinicians can have a rapid assessment tool for assessing a potential case of anorexia, bulimia, binge eating disorder, or OSFED during pregnancy.
Due to some of the risks inherent in having an eating disorder during pregnancy, as well as general societal expectations of what pregnancy should look like and how a pregnancy should feel, an expectant mother with an eating disorder may experience substantial shame. This shame or stigma may, in turn, prevent her from seeking help. Families and friends can become the greatest allies in helping support the expectant mother by educating themselves about eating disorders and providing support.
Having an eating disorder during or after pregnancy is challenging enough. There is no reason that it is also an experience that has to be gone through alone, without support, or without resources. It is time for this inner battle to have more outside help and support by raising awareness and bringing the lived experience of others in combination with research to the forefront of care.
Some additional resources that may be helpful:
Lift the Shame is a unique support group specifically designed for mothers and mothers-to-be who are healing from eating disorders. Healing Bodies Healthy Babies also acts as a resource to patients, family and loved ones, and clinicians about to provide more information about eating disorders and pregnancy.
- Claydon, E.A., Davidov, D.M., Zullig, K.J., Lilly, C.L., Zerwas, S.C., Cottrell, L. (2018). Waking up every day in a body that is not yours: A qualitative research inquiry on the intersection between eating disorders and pregnancy. BMC Pregnancy & Childbirth, 18(463), 1-13.
- Krug, I., Giles, S., Paganini, C. (2019). Binge eating in patients with polycystic ovary syndrome: prevalence, causes, and management strategies. Neuropsychiatric Disease and Treatment, 15, 1273-1285.
- Zerwas, S.C. & Claydon, E. Eating Disorders Across the Lifespan: From Menstruation to Menopause. (pp. 237-261) In Barnes, D.L., ed. (2014). Women’s reproductive mental health across the lifespan. New York: Springer Publishing.
- Kimmel, M.C., Ferguson, E.H., … & Meltzer-Brody, S. (2016). Obstetric and gynecological problems associated with eating disorders. International Journal of Eating Disorders, 49(3), 260-275.
- Tierney, S., Fox, J.R.E., Butterfield C., Stringer, E., & Furber C. (2011). Treading the tightrope between motherhood and an eating disorder. International Journal of Nursing Studies, 48, 1223-1233.
- Easter, A., Treasure, J., & Micali, N. (2011). Fertility and prenatal attitudes towards pregnancy in women with eating disorders: Results from the Avon Longitudinal Study of Parents and Children. BJOG: An International Journal of Obstetrics and Gynaecology, 118(12), 1491–1498.
- Luck, A. J., Morgan, J. F., Reid, F., O’Brien, A, Brunton, J., Price, C., … Lacey, J. H. (2002). The SCOFF questionnaire and clinical interview for eating disorders in general practice: Comparative study. British Medical Journal, 325, 755–756.