Helping Women Manage Eating Disorders during Pregnancy

New Body, New Worries

Being pregnant gets you lots of attention—often unwanted attention. Friends, family members, and complete strangers think nothing of making comments to a pregnant woman such as "Gosh, you're getting big," "You really popped," or "You've gained a lot of weight so far." Not the biggest pick-me-ups for someone already concerned with her bulging belly.

Dr. Gila Leiter, an OB-GYN in New York City says, "It's really remarkable how a pregnant woman becomes public property. Everybody has an opinion. And if somebody's sensitized to these kinds of issues, it can really be detrimental." Leiter estimates that 90 percent of her obstetrical patients are concerned with the weight gain associated with pregnancy.

It's not surprising that the pregnancy weight gain can be especially anxiety-inducing for a woman with a history of an eating disorder. "Rationally and intellectually, they know they're bigger because there's a fetus inside," says Susan Willard, who runs an eating disorders program in New Orleans. "But because of the distorted body image that is associated with the eating disorder, they still perceive the increase in weight and shape as fat."

Ironically, many women with an eating disorder are able to control it during pregnancy. Dr. Ann Kearney-Cooke, PhD, director of the Cincinnati Psychotherapy Institute, explains, "They're in a situation where they're allowed to eat because there's this baby growing inside of them. Sometimes it's like a vacation from the eating disorder for nine months."

Cheryl Guarneri of Long Island, New York estimates she's been hospitalized 25 times for her various eating disorders. She had recently returned to purging and abusing laxatives right before discovering she was pregnant. "As soon as I found out, I started eating normally and not doing any bad behavior," explains Guarneri. "I got scared because I had been abusing my body. And I'm like, 'Oh God! What if I did anything to the baby?'" She eventually gave birth to Anastacia, who is now a healthy five-year-old.

Not Eating for Two

But what happens when a pregnant woman can't stop abusing her body? What toll does that take on her unborn baby? The limited number of studies on this subject, including a Danish one published in January 2004, indicate that pregnant women with active eating disorders are at a much higher risk for delivering preterm babies and low birth weight babies. An earlier Danish study also found a greater risk of perinatal lethality.

The Harvard Eating Disorders Center published research in 2001 that painted a far less dreary picture. David Herzog, president of the Center, explains, "The message is if you've had an eating disorder and you're able to get that eating disorder under control, you should expect to have a normal, healthy pregnancy and a healthy baby." The study did, however, show that women with an active eating disorder appeared to be at greater risk for having a Cesarean section and postpartum depression.