Eating
Disorders
Pregnancy and Eating Disorders
by Joel P. Jahraus, MD
Director of Primary Care
Remuda Ranch Programs for Anorexia and Bulimia
Eating disorders affect women at their peak age of reproductive functioning.
It's no surprise that eating disorders profoundly impact the entire
reproductive process. The bottom line is simple: If a woman has
anorexia or bulimia nervosa,
she will have a harder time becoming pregnant and carrying a child, and a
greater likelihood of either
miscarriage or birth defects.
Pregnancy is often difficult to achieve due to the
menstrual
abnormalities experienced by women with eating disorders. Women with
anorexia, by definition, do not have a menstrual period-a condition known as
amenorrhea. Fifty percent of women with bulimia have either scanty or
absent menstrual periods. This disruption of the menstrual cycle is a result of
caloric restriction, excessive exercise, and/or psychological stress and it
makes pregnancy unlikely. Therefore, in women with eating disorders
pregnancy is far more likely to take place through medication-induced ovulation
than through natural means. Even if ovulation and subsequent fertilization
occur, the uterine environment is often not conducive to implantation. As a
result, one study showed that nearly one in five female patients at an
infertility clinic had eating disorders.
If pregnancy is achieved, the risk is high for obstetrical complications.
Pregnant women who continue to practice their eating
disorder have a higher incidence of first-trimester miscarriage, still
births, low infant birth weights, breech babies, and congenital malformation.
Their infants' APGAR scores-which measure infant health immediately following
birth-are lower than the scores of babies born to healthy women.
Pregnancy also poses a variety of physical and emotional difficulties for
the woman herself. Physical complications include more vaginal bleeding during
pregnancy, a higher likelihood of caesarean deliveries, and greater difficulty
healing in the episiotomy area. With anorexia, the woman will most likely
experience little weight gain. With bulimia, the woman will often gain a great
deal of weight, placing her at risk for severe hypertension. The pregnant
woman's expanding and changing body often causes profound anguish and emotional
conflict. Some women manage to maintain health throughout the pregnancy for the
sake of their unborn child, then make a radical return to their eating disorder
immediately after delivery. Others cannot maintain health during pregnancy and
must be hospitalized. In such cases, tube feeding may be required to ensure the
health of both baby and mother.
Following the birth of the child, women with eating disorders also have a
higher incidence of postpartum depression than other women. They have more
problems breast feeding, including insufficient lactation or negative reactions
to breast milk in their babies. Inadequate breast milk is often the result of
dehydration. For these reasons, women with eating disorders are more likely to
discontinue breast feeding prematurely.
Many women with anorexia and bulimia
deny that they have an
eating disorder. The desire to become pregnant or pregnancy itself does not
alter this secrecy. For example, women with bulimia sometimes claim that their
vomiting is due to morning sickness rather than their eating disorder.
Therefore, medical professionals must take great care with patients who may
have eating disorders. If anorexia is suspected, attention must be paid to
maternal weight gain and regular ultrasounds must be conducted to determine
fetal growth and development. If bulimia is suspected, particularly if
excessive vomiting may be present, maternal electrolyte levels and hydration
must be medically monitored to protect the health of mother and child.
There is good news too. If a woman with an eating disorder manages to gain
normal weight throughout her pregnancy, she will not experience a higher risk
of pregnancy complications or birth defects. Sometimes, by focusing on the
health of her developing baby and her wish to be the best mother she can for
her new baby, a woman will discover the desire--and make a commitment--to
recover from her eating disorder. The power and beauty of motherhood can have
long-lasting, life-changing effects.
Professionals specializing in eating disorders, including binge eating,
can be located by contacting
Remuda Ranch Programs for Anorexia and Bulimia at
1-800-445-1900.
This article is part of a continuing series of monthly columns. To be
notified of updates, please sign up for the
HealthyPlace.com Eating Disorders Community Newsletter.
Other column's include:
Concerned about whether you might have eating
disordered behaviors?
Take the Eating
Attitudes Test.
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