During pregnancy, a growing baby gets all of its nourishment from its mother’s body. The process requires that a woman consumes additional calories and nutrients, and that she gains weight. While necessary for a healthy pregnancy and healthy infant, the process of gaining weight and watching your body change can be overwhelming and stressful for those with a history of disordered eating.
Disordered eating doesn’t necessarily mean you have a diagnosed eating disorder. It simply means that you may have a complicated relationship with food as a result of distorted body image or the pursuit of optimal health. And it’s a common struggle - a 2011 study estimated that between 21% and 58% of the general population have eating behaviors that are characteristic of orthorexia, a condition that causes an unhealthy obsession with healthy eating. Orthorexia exists on a continuum, and manifests differently from person to person.
Diagnosed eating disorders, including anorexia and bulimia, are less common, but growing in prevalence. A 2019 study by the American Journal of Clinical Nutrition estimated that global eating disorders increased from 3.4% to 7.8% between 2000 and 2018.
Disordered eating can also affect the other stages of pregnancy, from the ability to conceive, to having enough nutritious breast milk to provide to baby. So we’re diving into this topic - how can you best support your pregnancy journey while struggling with, or with a history of disordered eating?
Disordered eating tends to involve behaviors that can disrupt normal reproduction. It absolutely isn’t guaranteed that a history of disordered eating will cause fertility issues - having the ability to conceive is dependent on many factors. But malnutrition, too much exercise, and chronic stress can all be major contributors to infertility as they can disrupt normal ovulation and hormone production.
If you are currently experiencing an eating disorder and thinking about trying to conceive, we encourage you to seek help if you haven’t already. Pregnancy and postpartum are times of tremendous nutrient needs for both mama and baby, and the risks of insufficient nutrition to both are far too high to mess around with. Unmanaged eating disorders in pregnancy can lead to increased risk for C-section, delivering a preterm or low birth weight baby, and suffering from postpartum depression.
Baby relies exclusively on mama for nutrition, so ensuring you are not restricting and getting all of the nutrients and calories that mama and baby need is critical to pregnancy outcomes and the long term health of both mama and baby. Entering into a pregnancy while actively struggling to ensure proper nourishment is doable, but it will be a challenge. We recommend working alongside a qualified therapist and nutrition professional to be sure that you are in a healthy place physically and emotionally. And of course, begin a prenatal vitamin routine right away to ensure proper nourishment and to start to address any nutrient deficiencies that may have been caused by restrictive eating.
Pregnancy involves a tremendous amount of change to the body, and your experience will vary quite a bit by trimester. Here’s how disordered eating might affect you in each trimester:
First Trimester is often marked by fatigue and nausea or vomiting. It’s a time of survival mode for many mamas. There is a good chance your regular routine of eating and exercising will be disrupted. This can be particularly challenging for those who struggle with orthorexia, as they strive to eat in a way that feels ideal to them. Anticipate this struggle, know that it is very common, and very short lived in the grand scheme of things, remember that your body is creating a human from scratch, and give yourself plenty of grace to give your body what it needs, from more carbs to more sleep. Do your best to not judge yourself for your cravings and trust that your normal eating patterns will return to normal very soon.
First Trimester can also be a difficult time for those with a history of eating disorders, as weight loss due to nausea and vomiting can trigger a host of emotions. Do your best to stay nourished and reach out to your provider with concerns of rapid weight loss, dehydration, or relapsing thoughts of restriction or forced vomiting.
In addition, many women struggle with weight gain in the First Trimester. While many sources will say you “shouldn’t'' expect to gain weight in the first few months, the reality is, rapidly rising hormones can cause bloating and water retention, and nausea and food aversions can throw your normal food choices out the window. Remember that pregnancy weight gain is not linear, it fluctuates by woman and by week. It is not unusual to gain weight in the First Trimester, and your weight gain in the First Trimester is no indication as to how you will continue to gain weight throughout the remainder of your pregnancy. Listen to your body and talk to your healthcare provider if you have concerns about what normal weight gain looks like for you.
Second Trimester is the glory time for many mamas. The unpleasant symptoms of early pregnancy typically fade and your belly isn’t yet big enough to experience many of the physical discomforts that tend to come in the Third Trimester (e.g., back pain, hip pain, etc.). However, it can be a challenging time for mamas with a history of disordered eating, as it is also a time when the body starts to change. Your normal clothes don’t fit, but you might not have a defined bump yet, so it can feel like an awkward stage for some. You may also notice changes in your skin color and texture alongside new stretch marks and larger breasts. It can be hard to accept, but it is entirely normal and necessary.
Try to fully enjoy this time feeling well by nourishing your body and moving however feels right to you. Use this time to prepare for postpartum, from lining up support, to communicating anxieties and expectations with your partner, and preparing nourishing meals to freeze for postpartum.
The Third Trimester often marks the most significant physical changes and is the time when discomforts like back and hip pain start to limit movement and disrupt sleep.
Exercise can become a challenge during these later months, so if exercise is a strong mental and physical release for you, anticipate how you might feel when more intense movement isn’t as much of an option for you and find other gentle ways to move, and other ways to release stress, like gentle walks, yoga, and meditation. This will be good practice for postpartum as well, when movement is generally restricted for at least six weeks.
Another challenging aspect of the Third Trimester is the unsolicited but inevitable comments you may get from friends, family, and even complete strangers. We will never understand the reason for comments like “you’re getting really big!” or “you look like you’ve put on a lot of weight!” to make you question whether you’re on track. Or the opposite “you’re barely showing!” or “you’re so tiny! I was so much bigger at that stage” to make you question whether you are nourishing your baby well enough. But they do happen, and they can be quite hurtful or triggering, particularly for those with low body image or a history of disordered eating. Do your best to brush off these comments, as they’re more a reflection of the other person’s lack of awareness or excitement about your pregnancy than about your body. Having a plan for a brief but tactful response, such as “yes, baby is growing right on track and I’m feeling good!” will help acknowledge and move past the comment, however unwelcome it may be.
Prepare and Communicate
It can be a lot to anticipate, but recognizing potential challenges and creating a plan will benefit the health of both you and baby. Here are some tips to prepare and thrive throughout pregnancy with a history of disordered eating:
- Be honest: Be honest with your doctor or midwife regarding past or present struggles with an eating disorder or disordered eating. If they aren’t sensitive to your concerns, look for a provider who will be more considerate of your experiences and open to offering compassionate and effective suggestions for managing your needs throughout pregnancy.
- Advocate for yourself: If you are actively struggling with an eating disorder, extra appointments may be necessary to more closely track the growth and development of your baby. Do not hesitate to request additional screening or care.
- Monitor weight wisely: Your doctor or midwife will need to weigh you to track the health of your baby, but consider how this information will affect you. Depending on your personality and other factors, you may prefer that your provider not share this information with you. Consider standing on the scale backwards and instruct the provider to not share the number with you unless it is necessary for health reasons.
- Plan for postpartum: If you have a history of disordered eating, and are not already seeing a mental health practitioner through pregnancy, we suggest lining up a therapist and potentially nutrition professional to work with postpartum. It can be difficult to find time to seek out and vet a mental health practitioner that you connect with while also dealing with the stresses and sleep deprivation that often come with the postpartum period. Better to have someone you like lined up and later determine it is not needed than to need it and feel too overwhelmed to find a good provider.
Postpartum comes with a variety of challenges - healing from labor and delivery, watching your body continue to change, adjusting to a new identity as a parent, dealing with sleep deprivation, managing the demands of breastfeeding (if you choose to), helping siblings to adapt to a new dynamic, and for many, experiencing some degree of postpartum depression and anxiety.
Research has shown that postpartum is a time when many who have previously experienced disordered eating tend to relapse. But it remains critical in postpartum to nourish yourself well in order to properly recover and replenish nutrients, and to provide sufficient nutrient-dense breast milk to your baby, if you choose to breastfeed.
Expect your hunger to increase, generally even more than in pregnancy, and your nutrient needs to remain very high. Be sure to continue taking your prenatal vitamin, and be mindful that you consume enough nutrient-dense calories.
An exclusively breastfeeding mother generally needs to take in an additional 300-500 calories per day to have enough calories to share with baby. This varies by person, and those with an oversupply may need even more, as every ounce of breast milk requires approximately 20 calories to produce. It can feel strange and even gluttonous to feel so insatiable and hungry at all hours of the day, but it is completely normal. Honor your body and your baby with balanced meals and snacks (plenty of protein, fat, and fiber) when you need them. Restricting calories and limiting foods can impact both the quantity and quality of your breastmilk and also your own postpartum health and wellbeing.
Particularly for those with a history of disordered eating, it can be tempting to want to get right back to your routine and jump into a particular eating routine in an attempt to lose weight or influence your body shape. But restrictive behavior can impact your health in both the short and long term. Restriction can be detrimental to your mood, your nutrient status, and many of your hormones that (ironically) influence your ability to manage stress and weight in the long term.
Consider Long-Term Effects
It’s also important to note that once your child starts eating, they take cues from your relationship with food and your own history can be reflected in how you approach meal times. Research on mothers with eating disorders suggests that they may be particularly controlling of their infants, both during play and at meal times. A controlled cross sectional study of one-year-old children of mothers with eating disorders found that the mothers were more critical of their children and more conflict occurred during meal times than in controls. The children tended to weigh less than controls, and the children’s weight correlated inversely with the mother’s concern about her own body shape. These behaviors can magnify even further as children age.
We share this information to empower and inform, never to add to the mom guilt. There's more than enough of that going around. Your baby doesn't need you to be perfect - no mother is. But, prioritizing your own wellbeing has many beneficial effects for you and your baby's lifelong health, so getting the help you need is paramount.
Honor Your Physical and Mental Health
Conception, pregnancy, and postpartum are already times of heightened emotion, and adding a history of disordered eating can make these times even more challenging.
Know that you are capable of creating and carrying a healthy baby no matter your background or relationship with food. But also that you may require and fully deserve as much extra support and care as you need. Don’t be shy to share your concerns with your provider and partner, and to advocate for yourself and your baby as much as you need.
For a more in depth conversation around orthorexia, check out our conversation around Food and Anxiety: when the pursuit of health impairs broader nourishment.