Eating Disorders and Pregnancy
Folks who have or have had eating disorders have a unique set of challenges when it comes to pregnancy. In this article, we’ll explore some of these challenges, offer up some considerations if you’re pregnant and have struggled or do currently struggle with disordered eating, and provide some ways to find support.
Getting Pregnant in the First Place
A lot of folks with eating disorders assume that they cannot get pregnant because they’re not having regular periods. Many folks with bulimia or anorexia report not having their period for months at a time, and thinking that they won’t get pregnant; many also don’t use protection (contraception or barrier methods) during sex. However, research shows that fertility problems are not any more common for those with eating disorders than those without, and that pregnancy is definitely still possible if having unprotected vaginal sex where sperm is involved. Therefore, sometimes pregnancy can be a surprise, especially because a clear sign of pregnancy–not having a period–is already happening for many people with eating disorders. If you don’t want to be pregnant, it’s important to use contraception during sex even if your period is irregular. If you are seeking pregnancy, tracking your menstrual cycle to determine when you are ovulating can be more difficult if your period is irregular or not coming at all. Consider tracking your cervical mucus or body temperature—learn how here!—or use ovulation test strips to help determine when you’re most likely to get pregnant.
Because the risks of disordered eating during pregnancy are high for both the pregnant person and the fetus, it is best if you can get some help navigating your eating disorder before getting pregnant. Eating regular, nutritious meals and ensuring with your healthcare provider that your body is able to sustain and survive a pregnancy will significantly decrease the likelihood of complications during pregnancy, which can arise due to the pregnant person not getting enough nutrients. These complications can include poor fetal development, premature birth, and feeding difficulties for the fetus, and dehydration, severe depression, heart problems, and the development of diabetes and high blood pressure for the pregnant person.
However, getting healthcare and other help beforehand is not always possible. Or maybe you’ve managed to develop affirming coping strategies to manage your eating disorder behaviors, but the process of pregnancy reawakens some old habits. You can still have a safe pregnancy if you didn’t get prenatal care or help, so long as you can find and are willing to get support and manage the potential triggers during and after pregnancy.
Potential Eating Disorder Triggers During Pregnancy
Being pregnant means a ton more doctor's appointments and a constant focus on your weight and eating. This can be challenging for anyone, but is particularly challenging for those with current or past eating disorders. To support a growing fetus, pregnant folks need to eat a bit more, and healthcare providers will ask about and advise on eating habits during pregnancy. This focus on eating and food can trigger tendencies to calorie count or otherwise hyperfocus on what you’re eating. Healthcare providers will explain that especially during pregnancy, eating too little is not helpful or safe for the pregnant person or the fetus since having sufficient nutrients is what supports a growing fetus and the pregnant person. Instead, eating a variety of foods with as much fresh food as possible—and avoiding unsafe foods that can harm the fetus—can ensure that you and the fetus develop safely.
Binge eating during pregnancy is also common for everyone, regardless of whether you have a history of eating disorders. We see so many examples in the media that feature pregnant folks eating anything and everything–remember the lunch scene from the movie Juno? This prevalence in the media can make it seem normal to binge eat during pregnancy and can reawaken or strengthen tendencies to overeat. However, binge eating can cause medical problems for both the pregnant person and developing fetus. Choosing nutrient-rich foods that provide long-lasting energy can help you feel full longer, and getting support from a doctor, therapist, or other healthcare provider for managing tendencies to overeat can be helpful to ensure a safe and healthy pregnancy.
It’s also important to know that some weight gain is necessary during pregnancy. Author Angela Garbes in Like a Mother: A Feminist Journey Through the Science and Culture of Pregnancy reminds us that during pregnancy, our bodies are developing an entire extra organ–the placenta–that feeds the fetus, gets rid of waste, helps fight infections, and builds immunity to keep the fetus healthy. When the placenta is laid out flat, it is approximately 150 square feet or 14 square meters–the size of an average office cubicle. So pregnancy weight gain is due to our bodies growing the placenta and producing the extra water, blood, and tissues needed to support a growing fetus.
Many healthcare providers routinely weigh you during your pregnancy check-ups. If you’d rather not be weighed, you can decline and discuss your options with your doctor by using a “Don’t weigh me card” or by simply saying, “I would prefer not to be weighed, unless it is absolutely medically necessary.” You can also ask to be blindly weighed, where you turn away from the number on the scale and the healthcare provider will not inform you of the number. Discussing your concerns with your healthcare provider about being weighed can be helpful; often there are other ways to test for the health and safety of you and the fetus that don’t involve getting on the scale.
Gaining weight during pregnancy can activate body image issues, contribute to disordered eating, and reawaken previous eating disorders. Dominant Western culture is deeply anti-fat, which can lead to negative thought patterns about our bodies and ourselves. Seeking support from healthcare providers and other people you trust and practicing affirming coping strategies can be helpful to navigate your changing body and the feelings that arise during those changes. Remember that there is support out there for you, and you are not alone.
Some folks with eating disorders may have tendencies to overexercise. Movement while pregnant is generally a great idea, but it must be done with caution and in moderation. You may have to make some adjustments to your existing kinds of movement or exercise. For example, abdominal workouts that include full sit-ups, double leg lifts, or activities where you lie on your back should be avoided to reduce pressure on the abdomen and prevent complications. Also, about 50% of pregnant folks develop something called diastasis recti, in which the right and left sides of your abs widen and separate creating a ridge. Doing only pregnancy-safe abdominal exercises, and waiting until the condition heals after pregnancy before doing an ab workout, will help you heal if you have this condition. Really, all exercise must be done in moderation, avoiding activities that make you dizzy, overheated, or likely to fall. If you notice you’re struggling with overexercising, try asking a buddy to help you moderate your activities. Be mindful of your thought processes surrounding exercise and remember that weight gain is normal and healthy. Some people with histories of eating disorders have suggested that if weight gain is dominating your thoughts, you can try to distract yourself with activities like creating art or poetry to display around the baby’s bed or preparing for the logistical aspects of having a baby. If your pregnancy is unwanted, try other forms of distractions such as spending time with friends or finding a new hobby, and consider trying meditation or mindfulness exercises to reframe negative thought patterns.
Postpartum Eating Disorders
There is a lot of pressure for recently-pregnant folks to look like they did before they were pregnant. Global media tends to show us a lot of examples of recently pregnant celebrities who have the time, money, and ability to focus on their bodies with professional help and look very different after pregnancy than the rest of us. However, the assumption that folks with uteruses pop out a baby and then their bodies immediately go back to what they were before is not accurate. Our bodies take time to recover from the physical challenge of giving birth, and they may always look different after pregnancy and delivery—and that’s absolutely ok.
You might be surprised to learn that most of us will look pretty much the same as when we were pregnant, in terms of shape, right after we have a baby. This is because our uterus has become enlarged to accommodate a fetus–check out this TikToker who shows us how large the uterus becomes during pregnancy–and your uterus needs time to reduce back to its original size. Your body also has leftover fluids and fat stores that nurtured the fetus during pregnancy that may or may not go away with time. Some people may want to quickly resume movement and exercise routines right after birth, but note that experts recommend not attempting exercise for the first six weeks after giving birth. Others may be perfectly content with their new body. Check in with yourself and your healthcare providers about finding affirming ways to ensure you’re safe, getting enough nutrients, and taking care of yourself.
For folks with a history of disordered eating, previous patterns and obsessions with food intake and weight may reawaken in this postpartum period. Pay attention to any tendencies you may have to fall back into habits like overexercising, obsessive calorie counting, restricting, binging, or purging, which can have short- and long-term effects on you and baby. Remember to give yourself grace—giving birth and/or having a new baby is tough for anyone—and visit a healthcare provider regularly during this period to ensure you and the baby are safe. If you are breastfeeding, making sure that you’re getting enough nutrients is especially important. Sometimes it may feel tempting to avoid or prolong breastfeeding to try and help control body weight or to use breastfeeding as a purging method. However, remember that your baby relies on the nutrition in breastmilk to grow up healthy and strong.
Managing & Getting Help
During your pregnancy journey, it’s important to pay attention to any signs of disordered eating. If you experience any of the following, it’s best to visit a healthcare provider to get some help and support:
- Preoccupation with food, dieting, calorie counting, etc.
- Avoiding mealtimes, skipping meals, or otherwise restricting
- Exercising excessively
- Thinking negative, obsessive thoughts about being fat, hating your body, or thinking you look ugly
- Vomiting or feeling the need to vomit after meals (purging)
- Eating large amounts of food in a short amount of time (binging)
If you do struggle or have struggled with eating disorders, it’s important to find healthcare providers with whom you can be honest. Telling them about your past or present experience with an eating disorder can get you the help you need with managing your eating disorder(s) during and after pregnancy.
Having a therapist or joining a support group can be especially helpful. Check out these support groups if interested: Facebook group: Prenatal Depression and Anxiety Support, US-based: ANAD, UK-based organizations, Global: FEAST. Many countries also have free hotlines that provide support, resources, and treatment options.
Many people with eating disorders have also shared that mindfulness — practices of accepting ourselves exactly how we are, intentionally paying attention to thoughts that arise, and reframing harmful or unproductive thoughts in ways that better serve us — has been helpful for them. Check out these resources if you’d like to learn more:
- Thich Nhat Hanh: books and audio
- Modern Mindfulness by Rohan Gunatillake
- Top 25 Best Meditation Resources
And don’t forget to identify who is in your support network and ask them for help! During your pregnancy, try to identify some people in your life who you trust and can rely on for support. Do you have friends, family, or other adults you trust who could help drive you to the store to pick up prenatal vitamins or baby clothes? Or make you a meal after you give birth? Or perhaps hold your hand during your doctor’s visits? Find your people and don’t be afraid to ask them for what you need.
Navigating pregnancy with a past or current eating disorder can be very challenging. But with support and daily work, it is possible to cope, survive, and even thrive. You are amazing!
- Prenatal Depression and Anxiety Support group on Facebook
- Fighting Eating Disorders in Underrepresented Populations: A Trans+ & Intersex Collective
- Transmasculine Birth Ritual podcast
- DisAbility Maternity Care
- Disability, Pregnancy, & Parenthood
- Preparing for Pregnancy as a Non-Binary Person
- Like a Mother by Angela Garbes
- What to Expect When You're Expecting by Heidi Murkoff