Risks When Anorexia and Pregnancy Collide

Dovie Salais

Pregnancy can trigger all kinds of insecurities about your growing body — and fears about gaining weight. Although the higher number on the scale typically means you’re nourishing your body and baby, some people limit their caloric intake and exercise to excess in an attempt to prevent weight gain during […]

Pregnancy can trigger all kinds of insecurities about your growing body — and fears about gaining weight.

Although the higher number on the scale typically means you’re nourishing your body and baby, some people limit their caloric intake and exercise to excess in an attempt to prevent weight gain during pregnancy.

This can be dangerous to you and your baby. Here’s a closer look as to why.

Pregorexia is a pop culture term the media coined to describe pregnant people who reduce calories and exercise in excess to control pregnancy weight gain.

Unfortunately, the term went viral in 2008, after print publications and television news media started using it to talk about the lives of fashionable New York City women anxious to achieve a perfect pregnancy body.

Although some people outside of the mental health and medical community may use this term, Kecia Gaither, MD, MPH, FACOG, double board-certified in OB/GYN and maternal fetal medicine, director of perinatal services at NYC Health + Hospitals/Lincoln, says it’s important to point out that pregorexia is not a medical term.

“Pregorexia, which is a combination of two words — pregnancy and anorexia — is used to describe a person who has an unnatural fear of gaining weight during pregnancy,” she says. Because of this fear, Gaither says an expecting parent may not adequately nourish themselves or their developing fetus.

Even though pregorexia is not a medical condition, it’s well known that many people ruminate upon their weight and engage in extreme diet and exercise routines while pregnant. Moreover, a small percentage of these individuals will deal with an eating disorder during pregnancy.

Some of the more common symptoms and warning signs that indicate you may be dealing with an eating disorder while pregnant include:

  • excessive exercising to the point of exhaustion
  • unwillingness to modify your exercise routine
  • restricting food intake
  • compulsive calorie counting
  • binge eating
  • purging — self-induced vomiting or laxative use
  • feeling shame and guilt about weight gain
  • eating alone
  • weighing yourself several times a day
  • gaining little or no weight
  • expressing fears about body weight, shape, or size
  • chronic fatigue
  • dizziness and blacking out

Additionally, Heather Maio, PsyD, assistant vice president of clinical and admission services at The Renfrew Center, says individuals with eating disorders in pregnancy may:

  • avoid social situations with family and friends
  • avoid going to routine doctor’s appointments
  • feel disconnected from the baby growing inside the womb

“The combination of these factors can lead to an increase in depression, anxiety or excessive fears about the health and welfare of the fetus,” she adds.

Although there’s no clear cause for this, Maio says mental health professionals see these behaviors in certain pregnancies.

“We tend to see behaviors like trying to control weight through extreme forms of restriction and exercise in people who are currently struggling with an eating disorder, someone who has previously struggled with an eating disorder, or those who haven’t been diagnosed but may have struggled with significant body image disturbances or a drive for thinness throughout their lives,” she says.

As your body begins to change through pregnancy, Maio says you may feel pressure from partners, family members, peers, and society to gain a minimal amount of weight and remain “healthy” by keeping a strict fitness route throughout the 9 months.

Dealing with an eating disorder during pregnancy can make those 9 months seem like an eternity.

Between managing the physical and emotional symptoms of pregnancy, prepping for childbirth, and planning for the arrival of a new baby, many expectant parents find themselves exhausted and facing the challenges of managing an eating disorder.

Because of this, a caring conversation with a therapist or doctor may help you understand the effects disordered eating can have on both you and your baby.

Some of the more serious outcomes for both of you, according to Gaither, include bone loss in you, the possibility of growth restrictions in your developing fetus, potential of fetal developmental problems, and low birth weight due to lack of nutrients.

“People dealing with disordered eating or excessive exercise may experience more fatigue than the average pregnant person,” says Leela R. Magavi, MD, a Hopkins-trained psychiatrist and regional medical director at Community Psychiatry.

Due to electrolyte abnormalities and dehydration, you may also experience dizziness and syncopal episodes. Magavi also says diminished weight and nutrients could increase the risk of prolonged labor and miscarriage.

The idea of gaining weight may be terrifying, but it’s a critical step in the pregnancy process.

According to the American College of Obstetricians and Gynecologists (ACOG), “the amount of weight gained during pregnancy can affect the immediate and future health of a woman and her infant.”

While each body is different, the average weight-gain recommendation during pregnancy is between 11 and 40 pounds, which primarily depends on your pre-pregnancy body mass index (BMI), according to the ACOG.

The higher-end average weight gain reflects the recommendation for a person starting their pregnancy at a lower body weight, which equates to a BMI of less than 18.5.

The lower-end average weight gain reflects the recommendation for a person who has a pre-pregnancy diagnosis of obesity, which equates to a BMI of 30 or above.

If you’re trying to limit caloric intake or exercise in excess, you may be gaining less than the recommended amount of weight in pregnancy.

When this happens, the Centers for Disease Control and Prevention (CDC) says you’re at a higher risk for delivering a baby that’s too small, which could result in:

  • difficulty in starting breastfeeding
  • an increase risk for illness
  • developmental delays

Asking for help is something many people struggling with an eating disorder avoid at all costs. And being pregnant only compounds the desire to hide your fears and anxieties about food, exercise, and your body.

But it’s important to ask for help if you’re struggling with body image or disordered eating during pregnancy.

Maio recommends being open and honest with your significant other or support network and your OB/GYN about any depression, anxiety, or fears you may be experiencing. “Be specific with your doctor about what you are and are not eating, and exactly how much you’re exercising. Don’t wait for them to ask you,” she says.

An OB/GYN can monitor your physical health as well as the baby’s health, while they assist you in finding a mental health therapist that specializes in treating disordered eating.

If you’ve worked with a therapist in the past, consider making an appointment to discuss your concerns.

If these issues are new and you’re not sure where to look for help, the National Eating Disorders Association (NEDA) has provider directories that you can search based on your location.

They also have a wealth of information on:

  • eating disorders
  • exercise addiction
  • other body-image-related issues

If you choose to start therapy, attend your scheduled appointments and make sure all your providers communicate with each other.

Maio also suggests educating yourself on your baby’s nutritional needs and consult with a registered dietician, preferably one who has experience with eating disorders, if more nutritional support is needed.

Beyond medical and mental health treatment, Maio recommends finding ways to connect with the baby growing inside your body, helping you love and accept your pregnant body. You can start by talking to your baby.

“The more connected you feel with the baby growing inside of you, the less distress you may feel about the changes associated with it,” says Maio. It’s also helpful to find reassurance in knowing your body changes are temporary.

After baby is born, Maio says it’s helpful to meet with your dietitian and therapist to discuss healthy ways to nourish your body, especially if you’re breastfeeding.

“Enroll in prenatal yoga or low-impact aerobic activities, specific to the needs of pregnant people, to keep your body strong for delivery, and remember to pamper yourself when you can — do things that make you feel good and aid in relaxation,” she says.

Although “pregorexia” isn’t a medical term, it does bring awareness to the importance of weight gain during pregnancy.

Engaging in behaviors such as excessive exercise, restricting calories, or avoiding social settings involving food could be indicative of something far more serious.

That’s why it’s essential to talk to your doctor, midwife, or therapist about any concerns, anxiety, or fears you’re experiencing.

Remember, you’re not alone.

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