Eating Disorders During Pregnancy: Risks, Symptoms & Support

What Are Eating Disorders During Pregnancy?

Eating disorders during pregnancy include anorexia nervosa, bulimia nervosa, and binge eating disorder that either continue from before pregnancy or develop during pregnancy. Approximately 5-7% of pregnant women have a current or past eating disorder, with a 30-50% relapse risk for those with a history of these conditions.

Eating disorders are serious mental health conditions characterized by persistent disturbances in eating behaviors and thoughts about food, body weight, and shape. During pregnancy, these conditions take on additional significance because they can affect both the mother's health and the developing baby. The physical and emotional changes of pregnancy can either help some women develop a healthier relationship with their bodies or trigger difficult feelings and behaviors in others.

The three main types of eating disorders seen during pregnancy are anorexia nervosa (characterized by restrictive eating and fear of weight gain), bulimia nervosa (characterized by cycles of binge eating followed by purging behaviors), and binge eating disorder (characterized by recurrent episodes of eating large amounts without purging). Some women may also experience other specified feeding or eating disorders (OSFED), which don't fit neatly into these categories but still cause significant distress and health consequences.

Research from the American College of Obstetricians and Gynecologists (ACOG) indicates that the risk of developing a new eating disorder during pregnancy is relatively low if you have never had one before. However, for women with a history of eating disorders, pregnancy represents a vulnerable period when careful monitoring and support are essential. The hormonal changes, body transformations, and societal pressures around pregnancy weight gain can all contribute to the reactivation of disordered eating patterns.

Why Pregnancy Can Trigger Eating Disorder Symptoms

Pregnancy involves profound changes to a woman's body that can be particularly challenging for those with a history of eating disorders. The expected weight gain, growing belly, and loss of control over body shape can trigger anxiety and distress. For some women, the physical sensations of pregnancy such as nausea, food aversions, or increased appetite may also remind them of or mimic eating disorder behaviors, making it harder to distinguish between normal pregnancy symptoms and disordered eating.

Additionally, the intense focus on nutrition during pregnancy can become problematic for some women. While monitoring food intake is important for fetal health, this heightened awareness can sometimes reinforce obsessive thinking about food and eating in vulnerable individuals. Healthcare providers must strike a careful balance between ensuring adequate nutrition and not triggering harmful behaviors.

How Can Pregnancy Positively Affect Eating Disorders?

Many women experience improvement in eating disorder symptoms during pregnancy. The focus on nourishing the baby, positive hormonal changes, and a new perspective on body function can help women develop healthier relationships with food and their bodies.

For many women with a history of eating disorders, pregnancy can actually be a time of significant improvement and even recovery. Research published in the Journal of Eating Disorders shows that a substantial proportion of women report reduced eating disorder symptoms during pregnancy, with some experiencing lasting positive changes that continue after delivery. Understanding these positive mechanisms can help healthcare providers support women in maximizing these benefits.

One of the most powerful motivating factors is the desire to protect the baby. Many women find that they are able to eat more normally and resist urges to restrict or purge because they understand that their eating behaviors directly affect their baby's development. This external motivation can provide the push needed to maintain healthier patterns that may have felt impossible before pregnancy.

The hormonal environment of pregnancy also plays a role. Increased levels of hormones like progesterone and oxytocin can have mood-stabilizing effects and may reduce some of the anxiety and depression that often accompanies eating disorders. Some women report feeling more connected to their bodies in a positive way, appreciating what their bodies are capable of creating and sustaining.

Finding New Meaning in Body Changes

Pregnancy offers an opportunity to reframe body changes in a positive light. Rather than seeing weight gain as something to be feared or controlled, many women are able to view their changing bodies as evidence of the remarkable process of growing new life. This shift in perspective, while not universal, can be transformative for those who have long struggled with body image issues.

Healthcare providers can support this positive reframing by focusing conversations on health and function rather than numbers and appearance. Emphasizing the incredible work the body is doing and celebrating developmental milestones can help women maintain a positive outlook on their changing bodies.

What Pregnancy Symptoms Feel Extra Difficult With Eating Disorders?

Common pregnancy symptoms like nausea, vomiting, constipation, and food aversions can be particularly challenging for women with eating disorders. These symptoms may trigger old behaviors or make it harder to maintain recovery during pregnancy.

While many women experience improvement in their eating disorder symptoms during pregnancy, certain physical aspects of pregnancy can make things more difficult. Understanding these challenges is important for both women and their healthcare providers so that appropriate support can be put in place early.

Morning sickness and vomiting are among the most challenging symptoms for women with bulimia or a history of purging behaviors. The involuntary vomiting associated with pregnancy can trigger urges to purge deliberately or may blur the lines between illness-related vomiting and eating disorder behaviors. Some women find that nausea serves as a convenient excuse to restrict food intake, while others worry that their history of purging may cause others to misinterpret normal morning sickness.

Constipation, which is common during pregnancy due to hormonal changes and iron supplements, can be particularly distressing for women who have previously used laxatives as part of eating disorder behaviors. The physical discomfort and bloating associated with constipation may trigger body image concerns and urges to use laxatives, which should be avoided without medical supervision during pregnancy.

The loss of physical control over one's body that comes with pregnancy can be deeply unsettling for women with eating disorders. Being unable to exercise as intensively, watching the scale numbers rise, and experiencing unpredictable physical symptoms all represent a loss of the control that many eating disorder behaviors are designed to provide.

Managing Food Aversions and Cravings

Pregnancy often brings strong food aversions and cravings that can complicate eating disorder recovery. Food aversions may limit what a woman can eat, potentially triggering restriction patterns, while intense cravings may feel frightening for those who fear losing control around food. Working with a registered dietitian who understands eating disorders can help women navigate these challenges while ensuring adequate nutrition for themselves and their babies.

When and Where Should You Seek Help?

Tell your midwife or doctor about any current or past eating disorder as early as possible in pregnancy. If you had previous treatment at an eating disorder clinic, consider reconnecting with them. Early support significantly improves outcomes for both mother and baby.

Seeking help for eating disorders during pregnancy is one of the most important steps you can take for your health and your baby's development. The earlier you reach out, the more support can be put in place to help you through the challenges that may arise. Many women feel shame or fear about disclosing their eating disorder history, but healthcare providers are trained to help without judgment, and early intervention leads to much better outcomes.

Your first point of contact should be your prenatal care provider - whether that's a midwife, obstetrician, or general practitioner. Share information about any current eating disorder symptoms or past history of eating disorders. Be as specific as you can about the type of eating disorder, when it started, any treatment you've received, current behaviors or concerns, and how pregnancy is affecting your thoughts about food and body image.

If you have previously received treatment at an eating disorder treatment center, consider reaching out to them again. They already understand your history and can provide continuity of care during this vulnerable period. Many treatment centers have protocols specifically for supporting patients through pregnancy and can coordinate care with your prenatal team.

Specialists Who Can Help

Registered dietitians with experience in eating disorders can be invaluable during pregnancy. They can help you develop a meal plan that ensures adequate nutrition for your baby while respecting your eating disorder recovery needs. Unlike general pregnancy nutrition advice, they understand the psychological complexities of eating disorders and can provide tailored support.

Physical therapists may also be helpful, particularly for women who have used excessive exercise as part of eating disorder behaviors. They can help you understand safe activity levels during pregnancy and develop a healthier relationship with movement that isn't driven by calorie burning or weight control.

What Can You Do to Help Yourself?

Build a strong support network, learn about pregnancy changes to distinguish them from eating disorder symptoms, establish regular eating patterns, and work with healthcare providers who understand eating disorders. Self-care and stress management are also essential.

While professional support is essential, there are many things you can do yourself to support your recovery during pregnancy. These self-help strategies work best when combined with professional treatment, but they can make a significant difference in how you experience pregnancy and maintain your mental health.

Education about pregnancy is one of the most powerful tools. Learning about normal pregnancy weight gain, how the body changes to support fetal development, and what hormones do during pregnancy can help you distinguish between normal pregnancy symptoms and eating disorder triggers. Understanding that your body is doing exactly what it's supposed to do can reduce anxiety and help you resist urges to control or restrict.

Building a support network of people you trust is crucial. This might include your partner, family members, friends, or other pregnant women who understand what you're going through. Having people you can turn to when you're struggling can make the difference between maintaining recovery and relapsing into harmful behaviors.

Establishing regular eating patterns helps stabilize both blood sugar and mood. Aim to eat something every 3-4 hours, even if you don't feel hungry or are experiencing nausea. Regular eating helps prevent the extreme hunger that can trigger binge eating and provides consistent nutrition for your developing baby.

Learning About Nutrition During Pregnancy

While obsessing over food and nutrition can be counterproductive for eating disorder recovery, having accurate information about pregnancy nutrition can actually be helpful. Understanding what your body needs - and why - can help you make choices that feel purposeful rather than frightening. Focus on nourishing your baby rather than counting calories or restricting.

Consider meeting with a registered dietitian who specializes in eating disorders to develop a flexible meal plan. This should not be a rigid diet that triggers restriction, but rather general guidance that helps you ensure adequate intake of key nutrients like folic acid, iron, calcium, and protein without becoming obsessive about details.

What Treatments Are Available During Pregnancy?

Effective and safe treatments during pregnancy include cognitive behavioral therapy (CBT), interpersonal therapy, nutritional counseling, and supportive psychotherapy. Multidisciplinary care involving mental health providers, dietitians, and prenatal care teams provides the best outcomes.

Treatment for eating disorders during pregnancy is not only safe but strongly recommended by all major medical organizations including the World Health Organization (WHO), American College of Obstetricians and Gynecologists (ACOG), and National Institute for Health and Care Excellence (NICE). Untreated eating disorders pose greater risks to both mother and baby than the treatments themselves.

Cognitive Behavioral Therapy (CBT) is considered the gold standard treatment for eating disorders and is completely safe during pregnancy. CBT helps you identify and change the distorted thoughts and beliefs that drive eating disorder behaviors. A therapist trained in eating disorders can adapt CBT techniques specifically for the pregnancy context, addressing concerns about body changes, weight gain, and control.

Interpersonal Therapy (IPT) is another evidence-based treatment that focuses on improving relationships and communication, which can be particularly helpful during the transition to parenthood. IPT can help you navigate relationship changes with your partner and family while managing eating disorder symptoms.

Nutritional counseling from a registered dietitian experienced in eating disorders provides practical support for meeting your and your baby's nutritional needs. Unlike general pregnancy nutrition advice, eating disorder-informed nutritional counseling addresses the psychological aspects of eating and helps you develop a healthier relationship with food.

Working With Your Healthcare Team

The most effective care during pregnancy involves a multidisciplinary team that includes your prenatal care provider (midwife or obstetrician), a mental health professional specializing in eating disorders, a registered dietitian, and potentially other specialists depending on your needs. These providers should communicate with each other to coordinate your care.

During pregnancy, you may need more frequent prenatal appointments to monitor your health and your baby's development. This increased monitoring is not a punishment but a way to provide extra support and catch any potential concerns early when they're most easily addressed.

What Monitoring Is Needed During Pregnancy?

Women with eating disorders may need more frequent prenatal visits, additional ultrasound scans to monitor fetal growth, regular blood tests to check nutritional status, and weight monitoring by professionals who understand eating disorders.

Regular monitoring during pregnancy is important for all women, but additional surveillance may be recommended if you have an eating disorder. This extra attention is designed to ensure the best possible outcomes for you and your baby, not to make you feel scrutinized or judged. Your healthcare team should explain the purpose of each test and involve you in decisions about your care.

More frequent prenatal appointments allow your midwife or doctor to check on your wellbeing more regularly. These visits are an opportunity to discuss any challenges you're facing with eating or body image, address concerns early, and provide extra support. The frequency of visits will depend on your individual needs and may be adjusted as your pregnancy progresses.

Additional ultrasound examinations may be offered to monitor your baby's growth. While all pregnant women typically receive at least one or two ultrasounds, women with eating disorders may benefit from more frequent scans to ensure the baby is growing appropriately. This can provide reassurance and allow for early intervention if any growth concerns are identified.

Blood tests to monitor your nutritional status are particularly important if you have been restricting food intake. These may include checks for anemia, vitamin deficiencies, electrolyte imbalances, and other markers of nutritional health. Addressing any deficiencies promptly is important for both your health and your baby's development.

Weight Monitoring Considerations

Weight monitoring during pregnancy can be triggering for women with eating disorders. Your healthcare team should be sensitive to this and discuss with you how weight checks will be handled. Some options include:

• Having you weigh yourself backwards so you don't see the number
• Having the provider record the weight without discussing specific numbers
• Focusing on trends rather than specific weights
• Discussing weight gain in terms of baby's health rather than appearance

What Happens After Your Baby Is Born?

The postpartum period carries increased risk for eating disorder relapse. Body changes, sleep deprivation, stress, and the emotional adjustment to parenthood can all trigger symptoms. Continued support, planned monitoring, and early intervention are essential.

The period after giving birth is a vulnerable time for eating disorder relapse. Your body has changed significantly, you may feel pressure to "get your body back," and the demands of caring for a newborn can be overwhelming. Understanding these risks and having a plan in place before delivery can help you navigate the postpartum period while maintaining your recovery.

After birth, your body continues to change as it recovers from pregnancy and delivery. These body changes can trigger distressing thoughts about weight and shape, particularly if you expected to immediately return to your pre-pregnancy body. It's important to have realistic expectations and compassion for yourself as your body heals.

The demands of a new baby can make it difficult to prioritize your own needs, including eating regularly and attending therapy appointments. Sleep deprivation and the stress of new parenthood can also lower your resistance to eating disorder urges. Having support systems in place - whether from your partner, family, friends, or professional helpers - is crucial.

Some women find breastfeeding challenging if they have an eating disorder. Concerns about body changes, the physical sensations of breastfeeding, and the need for adequate nutrition can all be difficult. However, many women with eating disorders successfully breastfeed with appropriate support. If you're struggling, seek help from a lactation consultant who understands eating disorders.

Continued Care After Delivery

Before you give birth, work with your healthcare team to create a postpartum support plan. This should include:

• Scheduled follow-up appointments with your eating disorder treatment provider
• Plans for continuing therapy and nutritional support
• Identification of warning signs that suggest relapse
• Contact information for crisis support if needed
• Strategies for managing stress and ensuring adequate self-care

What Complications Can Eating Disorders Cause During Pregnancy?

Active eating disorders during pregnancy can increase the risk of preeclampsia, intrauterine growth restriction, preterm birth, cesarean delivery, and postpartum depression. However, with proper treatment and monitoring, many of these risks can be significantly reduced.

It's important to understand the potential complications of eating disorders during pregnancy, not to frighten you, but to emphasize the importance of seeking treatment and to understand what healthcare providers are monitoring for. Knowledge of these risks can motivate recovery and help you understand why your care team may recommend certain interventions.

How you feel and what you eat affects your overall health and energy levels. If you are not getting adequate nutrition, you may feel tired and lack energy. Active eating disorders can also increase the risk of several pregnancy complications:

• Preeclampsia: A condition involving high blood pressure and protein in the urine that can be dangerous for both mother and baby
• Intrauterine growth restriction: When the baby does not grow as expected, which can have long-term developmental implications
• Preterm birth: Delivery before 37 weeks of pregnancy, which carries its own set of health risks for the baby
• Weak labor contractions: Which may lead to longer labor or need for intervention
• Increased cesarean delivery rates: Particularly if the baby is not growing well or other complications arise

Dental health can also be affected, especially for those with bulimia. Pregnancy already increases the risk of dental cavities, and the acidic stomach contents from vomiting can further damage tooth enamel. If you have a history of purging, extra attention to dental care during pregnancy is important.

Other potential complications include insufficient weight gain during pregnancy or rapid weight loss after delivery, both of which can affect your health and your ability to care for your baby. Nutritional deficiencies can also affect bone health and postpartum recovery.

What Should Partners and Family Members Know?

Partners and family members play a crucial role in supporting pregnant women with eating disorders. Understanding the condition, providing practical help with meals, attending appointments together, and offering emotional support without judgment are all important ways to help.

As a partner or family member of someone with an eating disorder during pregnancy, you may feel helpless or frustrated at times. However, your support can make a significant difference in recovery outcomes. Understanding eating disorders and learning how to help effectively can benefit both the pregnant person and your relationship.

First, it's important to educate yourself about eating disorders. These are serious mental health conditions, not choices or phases. Understanding that your partner or family member is struggling with a real illness can help you respond with compassion rather than frustration. Learn about the specific type of eating disorder they have and how pregnancy may affect symptoms.

Attending prenatal appointments together when possible can be very helpful. This shows your support, helps you understand the medical recommendations, and allows you to be part of care planning. You can also help by taking notes or asking questions that your partner may forget in the moment.

Practical support with meals can be invaluable. This might include taking responsibility for meal planning and preparation, creating a calm and supportive mealtime environment, avoiding comments about what or how much the pregnant person is eating, and being patient and understanding if they struggle with certain foods.

What to Avoid

There are also things that well-meaning partners and family members should avoid:

• Don't comment on their body, weight, or eating, even if you mean it positively
• Don't try to force them to eat or monitor their intake obsessively
• Don't express frustration or anger about eating disorder behaviors
• Don't make threats or ultimatums
• Don't dismiss their struggles or tell them to "just eat"

Instead, focus on expressing your love and support, being patient, and encouraging them to engage with professional help. Remember that recovery is a process, and setbacks may occur.