Pregnancy and Eating Disorders

Reviewed by Clinical Director, Jillian Walsh, RD, RP

Pregnancy can be an exciting time in an individual’s life and one that requires a great deal of physical, psychological, and emotional support. To nourish a growing fetus, it is expected that the person giving birth will gain weight. However, folks who are living with an eating disorder (ED) may find body changes and gaining weight especially upsetting.

Eating Disorders and Amenorrhea

Oftentimes, folks who are living with an ED have irregular menstrual cycles and some report experiencing amenorrhea1. Amenorrhea is defined as missing one or more menstrual periods, in people of childbearing age. Amenorrhea can be further classified into two subtypes: primary and secondary. Primary amenorrhea is the absence of one’s period by the age of 15. Secondary amenorrhea is the absence of three or more periods in a row by someone who has already had a period in the past2.  It is estimated that 66-84% of folks living with Anorexia Nervosa (AN) and 77% living with Bulimia Nervosa (BN) who had a history of AN also experience amenorrhea3.

Do Eating Disorders Affect Fertility?

To become pregnant, one must be ovulating, therefore, individuals who are experiencing amenorrhea cannot become pregnant4. However, this does not mean folks who have had a history of amenorrhea will never become pregnant in their lifetime. In fact, research suggests that weight restoration in those who have recovered from AN leads to the normalization of reproductive function. Furthermore, with appropriate treatment, their fertility returned to what it was before their reported malnutrition and amenorrhea5

Additionally, a different study showed that 75% of 173 women who reported having a history of BN and menstrual irregularities eventually became pregnant which suggests that menstrual irregularities are common, but BN appears to have less impact on one’s ability to conceive6. Overall, with the return of menses and pursuit of full recovery from one’s eating disorder there is still a chance for folks who experienced amenorrhea in the past to conceive and give birth to a healthy baby.

History of an Eating Disorder and Pregnancy

With the high prevalence of EDs, you or someone close to you will likely be affected by an ED at some point in their life. It has been shown that birthing persons with a history of AN, BN, and atypical eating disorders have a higher rate of miscarriage, small for gestational age babies, low birth weight babies, babies with microcephaly, intrauterine growth restriction, and premature labor7. Additionally, mothers experienced an increased risk of psychological upset, postnatal depression, anemia, and risk of hyperemesis gravidarum7. Although having a history of an ED could result in high-risk pregnancy, there are health professionals to provide quality care in these situations. Many individuals can experience a high-risk pregnancy, not just folks who have lived with an ED.

Baby wrapped in a blanket with a white background

Does Pregnancy Affect Eating Disorders?

Increasing body weight and changes in body shape during pregnancy could contribute to the return or even worsening of an ED. However, an ED could also improve once becoming pregnant because the pregnant person’s focus is shifted toward providing nutrients to the baby for optimal growth. They can also have increased awareness about the effects the ED could have on their unborn baby.  

It has been shown that symptoms of folks living with BN improved during pregnancy8 while symptoms of folks living with AN were more likely to relapse postpartum9,10. In general, the evidence is variable, and pregnancy is an experience that is different for everyone. Therefore, folks with a history of an ED or who are living with an ED should be monitored closely during pregnancy and postpartum to ensure the birthing person and baby are not at risk.

Pregnant and Living With an Eating Disorder

If you or a loved one is living with an ED, it is important to seek help and receive treatment to assist with your reproductive and gestational health. Most pregnant individuals can give birth to healthy babies if they have normal weight gain during their pregnancy11. Here is a list of considerations for folks who are pregnant and living with an ED:

  • Schedule a prenatal visit early in your pregnancy and share ED history with your provider 
  • Ask for blind weights 
  • Meet with a registered dietitian/nutritionist to discuss positive pregnancy food choices
  • Strive for positive weight gain

Oftentimes when an individual is pregnant, people tend to make comments related to the pregnant person’s body shape and weight. If you or a loved one is living with an ED and is pregnant, please refrain from making any comments about body image/shape. These comments can be triggering, and the focus of the pregnant person should be on nourishing the growing fetus during pregnancy, not worrying about their body shape.


If you or someone you know are living with an ED and have concerns about pregnancy, click the link below to book a free consultation call with one of our Team Leads. Pregnancy can be a difficult time for anyone, but we are here to support you! 

References

  1. Ackerman, K. E. & Misra, M. (2022). Functional hypothalamic amenorrhea: Pathophysiology and clinical manifestations, UptoDate. Retrieved October 6, 2022 from https://www.uptodate.com/contents/functional-hypothalamic-amenorrhea-pathophysiology-and-clinical-manifestations
  2. Puckett, L., & Written by Leah Puckett. (2022, July 5). Amenorrhea in eating disorder patients: Anorexia & missed periods. ACUTE. Retrieved October 7, 2022, from https://www.acute.org/blog/amenorrhea-absence-menstruation-eating-disorder-patients
  3. Kimmel, M., Ferguson, E., Zerwas, S., Bulik, C., & Meltzer-Brody, S. (2015). Obstetric and gynecologic problems associated with eating disorders. International Journal of Eating Disorders, 49(3), 260–275.
  4. Mayo Foundation for Medical Education and Research. (2021, February 18). Amenorrhea. Mayo Clinic. Retrieved October 7, 2022, from https://www.mayoclinic.org/diseases-conditions/amenorrhea/symptoms-causes/syc-20369299
  5. Saldanha, N., & Fisher, M. (2022). Menstrual disorders in adolescents and young adults with eating disorders. Current Problems in Pediatric and Adolescent Health Care, 52(8), 101240. https://doi.org/10.1016/j.cppeds.2022.101240
  6. Crow, S. J., Thuras, P., Keel, P. K., & Mitchell, J. E. (2002). Long-term menstrual and reproductive function in patients with bulimia nervosa. The American journal of psychiatry159(6), 1048–1050. https://doi.org/10.1176/appi.ajp.159.6.1048
  7. Koubaa, S., Hällström, T., Lindholm, C., & Hirschberg, A. L. (2005). Pregnancy and neonatal outcomes in women with eating disorders. Obstetrics and gynecology105(2), 255–260. https://doi.org/10.1097/01.AOG.0000148265.90984.c3
  8. Larsson, G. and Andersson-Ellström, A. (2003), Experiences of pregnancy-related body shape changes and of breast-feeding in women with a history of eating disorders. Eur. Eat. Disorders Rev., 11: 116-124. https://doi.org/10.1002/erv.497
  9. Rocco, P. L., Orbitello, B., Perini, L., Pera, V., Ciano, R. P., & Balestrieri, M. (2005). Effects of pregnancy on eating attitudes and disorders: a prospective study. Journal of psychosomatic research59(3), 175–179. https://doi.org/10.1016/j.jpsychores.2005.03.002
  10. Blais, M. A., Becker, A. E., Burwell, R. A., Flores, A. T., Nussbaum, K. M., Greenwood, D. N., Ekeblad, E. R., & Herzog, D. B. (2000). Pregnancy: outcome and impact on symptomatology in a cohort of eating-disordered women. The International journal of eating disorders27(2), 140–149. https://doi.org/10.1002/(sici)1098-108x(200003)27:2<140::aid-eat2>3.0.co;2-e
  11. Healthy pregnancy. American Pregnancy Association. (2021, December 9). Retrieved October 7, 2022, from https://americanpregnancy.org/healthy-pregnancy/ 

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