Eating Disorders in Pregnancy

Eating Disorders: What Are They?

Eating disorders are classified as serious medical illnesses/mental disorders that affect a person’s eating behaviors. This is not a choice and can negatively impact both mental and physical health. Signs of an eating disorder include becoming obsessed with weight loss, body weight/shape and actively controlling food intake.1 This can be especially dangerous for women who are pregnant. Both mother and baby need essential nourishment that can be compromised if one suffers from an eating disorder. 

Who is at Risk for Eating Disorders

People of all races, ages, and genders can be affected by eating disorders. There may be those who appear healthy but are struggling with this illness. Looking at someone cannot always prove that there is an eating disorder. While the cause is not understood, researchers believe that a combination of genetic, biological, behavioral, psychological, and social factors can increase the risk of a person suffering from an eating disorder.1

Common Eating Disorders

There are many types of eating disorders. Some of the most common include anorexia nervosa, bulimia nervosa, binge-eating disorder, and avoidant restrictive food intake disorder.1 If you or a loved one have one or more of the following symptoms associated with an eating disorder, seek help from a trusted healthcare provider. 

Anorexia Nervosa

• This eating disorder occurs when someone avoids food altogether, eats very small amounts of certain foods, or severely restricts food intake. Individuals dealing with anorexia nervosa may be underweight and still consider themselves overweight. There are two types of anorexia nervosa, restrictive and binge-purge. 

• Restrictive Anorexia Nervosa: Severely limiting the amount and variety of food consumption.1 

• Binge-Purge Anorexia Nervosa: Binge-eating and purging experiences (eating large amounts of food in a short period, then vomiting or using laxatives to get rid of the food) in addition to severely limiting the amounts and variety of food consumption. 

Symptoms

• Extremely restricted eating 

• Intense/Excessive exercise 

• Extreme thinness 

• Obsession with being thin and unwilling to maintain a normal/healthy weight 

• Severe fear of gaining weight 

• Distorted body image 

• Denying low body weight 

When anorexia nervosa is left untreated, it can lead to many negative health outcomes including osteopenia/osteoporosis (thinning of the bones), anemia, low blood pressure, brain damage, multiple organ failure, and many more health consequences. This illness can be fatal and has an exceptionally high death rate. Suicide is the second leading cause of death associated with people who are diagnosed with anorexia nervosa.1 

Bulimia Nervosa

Bulimia Nervosa occurs when a person has repeated episodes of eating large amounts of food and feeling a lack of control over their eating habits. After binge eating, individuals try to incorporate activities that prevent weight gain such as vomiting, using too many laxatives or diuretics, fasting, extreme exercise, or a combination of these actions.1 

Symptoms

• Persistent inflamed/sore throat 

• Swollen salivary glands in the neck and jaw 

• Worn tooth enamel and sensitive/decaying teeth (due to exposure to stomach acid from vomiting) 

• Acid reflux disorder 

• Intestinal distress and irritation (laxative abuse) 

• Severe dehydration 

• Electrolyte imbalance (can lead to stroke or heart attack) 

Binge-Eating Disorder

Losing control of eating and repeatedly eating large amounts of food are also associated with binge-eating disorder. The difference between binge eating and bulimia nervosa is that binge eating is not followed by vomiting, fasting, or excessive exercise. People with binge-eating disorders are often overweight or considered obese.1 

Symptoms

• Eating large amounts of food in a short time 

• Eating rapidly during binge episodes 

• Eating while full or not hungry 

• Eating until painfully full 

• Eating alone or in secret to avoid embarrassment 

• Feeling ashamed or guilty about eating 

• Regularly dieting 

Avoidant Restrictive Food Intake Disorder (ARFID)

Avoidant restrictive food intake disorder (ARFID) was previously known as selective eating disorder. This is a condition in which people limit the type or the amount of food they eat. They do not typically have a distorted body image or an excessive fear of gaining weight, unlike anorexia nervosa.1 

Symptoms 

• Restriction of types or amount of food that is eaten 

• Limited interest in food 

• Lack of appetite 

• Dramatic weight loss 

• Abdominal pain 

• Upset stomach 

• Excessive picky eating 

Risks and Possible Complications During Pregnancy

Pregnancy can trigger habits and emotions that may worsen eating disorders. If you had or currently have an eating disorder and are pregnant or trying to get pregnant, consult a trusted healthcare provider.2 Pregnant women with a history of eating disorders are at risk for: 

• Infertility/Subfertility (reduced fertility or difficulty becoming pregnant) 

• Stillbirth 

• Premature birth 

• Difficulty breastfeeding 

• Having babies with low birth weight 

Treatment/Management of Eating Disorders During Pregnancy

Comprehensive guidelines that help providers understand and care for pregnant women who suffer from anorexia nervosa focus on behavioral health, obstetric, medical, and nutritional care that supports both mother and baby. While the studies have only been done with pregnant women suffering from anorexia nervosa, the same guidelines can be used with other eating disorders. This treatment is based on the three time frames below.2 

1. Women who have successfully managed their eating disorder. 

2. A suggestion for this woman may be drinking a protein shake to provide nutrients without triggering the mind to eat more. These women will probably also need to monitor their exercise habits to ensure they are properly managing their eating disorder and still living a healthy lifestyle for both mother and baby. 

3. Women diagnosed with an eating disorder while pregnant or trying to get pregnant. 

4. A new diagnosis can be scary but is completely manageable. For women in this situation, education about overall wellness and providing a support/accountability system may be the best first step. It is recommended that women sit with their healthcare providers and create a comprehensive treatment plan to ensure a healthy pregnancy journey. 

5. Women whose symptoms increase during pregnancy. 

6. Pregnancy ignites a change in hormones, nutritional needs, etc, and can be a bit more difficult to manage while dealing with an eating disorder. Looking toward the health behaviors these women can control and connecting them with dieticians could be the empowering factor needed to ensure a better pregnancy outcome. 

Eating Disorders During Pregnancy and Mental Health

Not only can pregnancy trigger eating disorder habits, but those triggering habits can negatively impact the mother’s mental health. Women who deal with eating disorders during pregnancy are at a greater risk of experiencing postpartum depression. If this is you or a loved one, look at the following tips for your mental health:2 

• Talk to your trusted healthcare provider about medication for mental health and be honest about your concerns about an eating disorder. 

• Speak to your trusted healthcare provider BEFORE trying to stop taking medication. 

• Find a supportive healthcare provider who will not only help you throughout your pregnancy, but also take care of you after the birth. 

• Create a support network of trusted family members and friends. 

Eating disorders are treatable before, during, and after pregnancy. You do not have to do this alone. Contact your trusted healthcare provider as soon as possible and openly and honestly discuss your concerns with them. 

If you or someone you know is dealing with thoughts of harming themselves, call the National Suicide Prevention Lifeline at 1-800-TALK (8255). You also have the option to text the Crisis Text Line by texting HELLO to 741741. 

Written by: Taylor Neither, MPH 

Content reviewed by: Dr. Krista Mincey, MPH, Dr.PH, MCHES 

References 

1. National Institute of Mental Health. 2021. Eating Disorders: About More Than Food – National Institute of Mental Health (NIMH) (nih.gov) 

1. UT Southwestern Medical Center. 2022. Managing pregnancy when mom has an eating disorder | Diet and Nutrition | Women’s Health | Your Pregnancy Matters | UT Southwestern Medical Center (utswmed.org) 

1. Tommys. 2024. Eating Disorders in Pregnancy: Risks & Treatment Options (tommys.org)