Eating disorders during pregnancy

While most mums-to be try to nourish their body as much as possible, eating disorders in pregnancy are more common than you might think…

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What is an eating disorder?

Eating disorders are characterised by dramatically altered eating patterns, as well as changes in social behaviour and other symptoms of depression. They sometimes occur as an outwards expression of other anxieties, and finding the underlying cause is a vital part o a patient’s treatment.

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The most common eating disorders are:

  • Anorexia most commonly occurs in adolescent girls, although men and older women can also be affected. It involves excessive food restriction and weight loss, which can also be accompanied by laxative abuse, vomiting and extreme exercising. Sufferers tend to become withdrawn and socially isolated.
  • Bulimia is most common in young women aged between 15 and 25, although it can affect women and men of all ages. Sufferers follow patterns of binge eating followed by vomiting or using laxatives to prevent weight gain. This is often accompanied by feelings of guilt and depression, and low self-esteem.
  • Binge-eating disorder affects both men and women equally and is most common between the ages of 20 and 40. It involves binge eating – often in secret – but unlike bulimia, sufferers do not make themselves sick or take laxatives after bingeing, and so gain weight. This condition is associated with depression, low self-esteem and stress.

How common are eating disorders during pregnancy?

There are no definite figures, but a study published in the International Journal of Eating Disorders in 1999 suggested that as many as 1% of women suffer from some form of eating disorder during pregnancy.

What causes an eating disorder to develop during pregnancy?

The most common reason for developing an eating disorder during pregnancy is having had anorexia or bulimia in the past. On the other hand, however, some women with a history of problems with food give themselves ‘time out’ from the illness during pregnancy. It gives them ‘permission’ to gain weight, as they rationalise that the food is for the baby rather than themselves. Such women may find the illness comes back after they give birth, though, when they have concerns about losing the pregnancy pounds.

Eating disorders usually start when food is used to control feelings. Life-changing events, anxiety and difficulty in coping are often contributing factors – all of which can be caused by the stress and responsibility of having a baby. People who develop eating disorders tend to have limited coping abilities, and the ‘rituals’ of the disorder can make them feel like they’re regaining some kind of control. Dr Alex Yellowlees, psychiatrist and medical director of the Priory Hospital, Glasgow, specialises in treating women with eating disorders. He adds that: “In Western society, women base a lot of their self-worth on their body shape and appearance. If we assess our value exclusively on how we look this places us in a fragile situation when something like pregnancy challenges that…women need to find alternative coping strategies and to reassess the values on which they measure their self worth.”

What treatment is available?

With the right sort of help, most eating disorders are curable and the majority of sufferers go on to lead full lives – even if they’ve had the illness for many years. There is a range of services available, some on the NHS and others through private clinics.

Treatment usually involves addressing both the psychological causes and the physical symptoms of the illness, and so may involve cognitive behavioural therapy or psychotherapy as well as specialist nutritional treatment.

Dieting in pregnancy: the risks

Dieting during pregnancy is potentially hazardous to you and your developing baby. Many weight-loss regimes are likely to leave you low on iron, folic acid and other important vitamins and minerals, as well as lacking in the all important energy you need to nurture your growing baby.

Various studies have been conducted into the effects of eating disorders during pregnancy. While the majority of women monitored had normal pregnancies and healthy babies, it has been shown that the incidence o complications among women with a current or past eating disorder is higher than average. Risks associated with active anorexia and bulimia during pregnancy include increased incidence of miscarriage, still birth, premature birth, low birth weight, cleft palate and breech delivery. Apgar scores of babies born to mothers with eating disorders are generally lower than average.

For some women with a history of eating disorders, pregnancy leads to a temporary cessation of symptoms. Studies suggest, however, that although disordered eating behaviour tends to decrease during pregnancy, it often resurfaces post-delivery and can actually increase in severity. This can lead to problems with bonding and breastfeeding, and a higher likelihood of a woman suffering from postnatal depression. In the longer term, it is thought that children of parents with eating disorders find it more difficult to develop healthy eating habits themselves. Remember, weight gain is one of the most positive signs of a healthy pregnancy. Women who eat well and gain an appropriate amount of weight are more likely to have healthy babies. So if you’re eating a variety of fresh, wholesome foods and adding pounds, relax: you’re supposed to be getting bigger!

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Advice

  • If you do have a history of eating disorders, ensure that the health professionals who you will be seeing during your pregnancy are aware of this so that you can be monitored and offered the right support.
  • Avoid crash dieting during pregnancy and particularly after the birth, as rapid weight loss can trigger an eating disorder to kick in.
  • Be realistic about the fact that your body will change during pregnancy and that you may need time to return to your pre-pregnancy weight.
  • Forget the super-skinny celebs who compete to get their figure back the fastest: they have armies of staff dedicated to keeping them trim, from nannies and housekeepers to personal trainers and dieticians. What is possible for them may not be a sensible goal for you.
  • As yourself if your basing too much of your self-worth on how you look. Dr Yellowlees comments: “Are you ignoring personal attributes of which you can and should be proud, such as your ability as a wife, mother or friend? Perhaps its time to revise the beliefs you hold about a person’s value equating with their size.”

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