Eating Disorders During Pregnancy
Published: 16 March 2022
Published: 16 March 2022
Weight gain is an entirely natural aspect of a healthy pregnancy. However, for some women, their changing body shape can trigger heightened anxiety along with the emergence, or return, of an eating disorder.
Eating disorders typically affect women of childbearing age (Bye et al. 2018), and if left unmanaged, can be associated with adverse outcomes for both mother and baby. Good nutrition is essential during pregnancy and even though eating disorders such as anorexia nervosa, bulimia nervosa, and binge eating disorder are well recognised, their management remains a challenge (Fogarty et al. 2018).
Currently, in Australia, about 15% of women will experience an eating disorder at some point in their lives (National Eating Disorders Collaboration 2015). Charbonneau and Seabrook (2019) estimate that at least 5% of women will experience an eating disorder whilst pregnant. This means that a significant number of women will require specialised assessment and care during their pregnancy to ensure adequate nutritional intake.
There are four eating disorders described by the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) that can threaten the wellbeing of both the mother and fetus (National Eating Disorders Collaboration 2015).
The three most common eating disorders are:
(SA Health 2020; National Eating Disorders Collaboration 2015)
Eating disorders not otherwise specified (EDNOS) tend to be characterised by fewer, milder symptoms but are still technically considered to be eating disorders (The Royal Women's Hospital 2015).
Both mother and baby are at risk when there is prolonged poor nutrition during pregnancy. Before pregnancy, women with eating disorders may present with menstrual dysfunction, low bone density and sexual dysfunction. Once pregnant, however, they are at increased risk of many obstetric complications such as miscarriage, preterm delivery or a low birth weight baby (Arnold et al. 2019).
Relatively little current research is available, however, in 2019 Charbonneau and Seabrook investigated available studies on the effects of eating disorders in pregnancy and found that there was an association between eating disorders and preterm birth in 36% of the studies, and small for gestational age babies in 63%.
These are the most common adverse outcomes, but other specific risks include:
(Eating Disorders Victoria 2021)
Bye et al. (2018) describe five main barriers to disclosing eating disorders in pregnancy, as perceived by women:
They also identified the following four themes, which were seen as barriers to identifying eating disorders both during and after pregnancy:
The combination of a rapidly changing body shape along with a susceptibility to eating disorders, or a history of previous disorders, can leave some women feeling vulnerable as their body image changes in ways that are beyond their control during pregnancy (Fogarty et al. 2018).
As Bye et al. (2018) suggest, midwives and health visitors are ideally placed to identify and support these women, as they are often the primary point of contact during the antenatal and postnatal periods.
Screening women for increased eating disorder symptoms, especially if they have had past symptoms or are expreriencing current difficulties, is key to offering practical and effective support, as past difficulties tend to resurface during pregnancy, albeit usually in a milder form (Arnold et al. 2019).
Where possible, access to an interprofessional team should be made available during pregnancy, including a midwife, family doctor, dietician, eating disorder specialist and obstetrician. Care should also be extended into the post-partum period, as the risk of relapse or postnatal depression can be particularly high at this time (SA Health 2020).
One tool that is commonly adopted to help identify eating disorders in the antenatal period is the SCOFF questionnaire. This is a simple screening tool that midwives can use during antenatal visits to help identify women who may need further monitoring or referral to specialised services. Answering ‘yes’ to two or more of the following questions can be an early indicator of anorexia nervosa, bulimia or binge eating disorder:
(SA Health 2020)
Eating disorders seldom disappear completely at the end of pregnancy and it’s important that any support initiated during antenatal care is maintained into the postnatal period to avoid any ‘red flag’ times when discontinued care may leave a woman vulnerable to further relapse (Fogarty et al. 2018).
Although the care pathway for women with eating disorders may seem multi-faceted and complex at times, it’s important that every opportunity is taken to help them overcome the disorder. Without this help, not only is the mother’s health at risk, but also the short and long-term health of the child, who may become at greater risk of developing an eating disorder themselves in later life (Arnold et al. 2019).