Yesterday, we looked at the subject and infertility and eating disorders. Today, let’s discuss some of the important considerations regarding pregnancy for women with a history of eating disorders symptoms…

Pregnancy can pose significant challenges to women with a history of eating disorders as well as those who are struggling with current symptoms. Some of these challenges include the potential for an increase in eating disorder symptoms when pregnant, as well as post-partum.

Numerous studies show (and patients report) that pregnancy-related changes in body shape may increase anxiety about weight gain and lead to a rise in unhealthy eating behaviors. A 2007 study found that pregnancy may increase vulnerability for developing binge eating symptoms, especially for women from lower socio-economic situations. On a related issues, women who gain too much weight during pregnancy risk additional health problems such as hypertension, anxiety and depression, insomnia, and chronic pain.

For women who restrict their food intake during pregnancy, potential maternal complications may include hypertension, vaginal bleeding, cesarean deliveries, anemia, and postpartum depression. In addition, failure to maintain adequate body weight and nutrition during pregnancy can result in the need for hospitalization and intravenous feeding. In addition, women with eating disorders are more likely to have problems with breastfeeding.

With regard to purging symptoms, laxatives, diuretics, and other weight-loss medications can be harmful to a developing fetus and may lead to fetal abnormalities, particularly if they are used on a regular basis. Anorexia and bulimia in an expectant mother can also increase the risk of complications to a developing fetus; complications that can affect a child long after birth. Risk of fetal and infant complications include:

higher rates of miscarriage
infant mortality
premature birth
low birth-weight
low APGAR scores
malformations (including cleft lip and palate)
smaller head circumference
respiratory problems
failure to thrive
delayed development
cognitive, sensory, and physical defects
disturbed feeding behaviors in children
depression in children.

Some studies show that additional variables that may increase the risk of eating disorder symptomatology during pregnancy are a younger age, a history of previous eating disorders, reduced education, poorer housing, employment status, and previous miscarriage.

For all of these reasons, it is very important that mothers with a history of eating disorders receive ongoing collaboration and monitoring from their treatment team throughout the duration of their pregnancy. Mothers should be encouraged to share their eating disorder symptoms with their gynecologist/obstetrician in order to receive the best prenatal and perinatal care. Additionally, mothers should discuss their infants’ food plan with a doctor in order to ensure that their children receive adequate nutrition.

So, what should you do if an eating disorder patient tells you that she is pregnant?

The next edition of Treatment Notes will address that scenario…