A Perfect Storm
By: Hannah Meeks
Pregnancy, especially an unplanned one, can be a stressful time for women with eating disorders due to amplified feelings of body dissatisfaction and anxiety about gaining weight. This, coupled with a lack of support and screening from clinicians who may not understand the intersection of eating disorders and pregnancy, creates a perfect storm for women with eating disorders.
While these unpleasant feelings normally dissipate to that of women without eating disorders after 18 weeks’ gestation, they can be even more overwhelming for women whose pregnancy is unplanned. Easter, Treasure and Micali (2011), notes that rates of unplanned pregnancy for women with eating disorders are higher than that for women without eating disorders, with women who have anorexia being twice as likely and women with bulimia being 30 times as likely to experience an unplanned pregnancy.
Many women with eating disorders experience amenorrhea and oligomenorrhea and can incorrectly assume that also means they are infertile. Amenorrhea is characterized by the absence of a menstrual period for at least three months and is often seen in women with anorexia nervosa(Amenorrhea, 2019). Oligomenorrhea is characterized by infrequent menstrual periods and can be seen in women with both anorexia nervosa and bulimia nervosa. The belief that this reduces fertility is incorrect and can be one potential explanation for why rates of unplanned pregnancy are so high in these groups.
Another possible explanation for these high rates of unplanned pregnancy among women with eating disorders could be an increased participation in risk-taking behaviors. Women with eating disorders may be more likely to engage in risky sexual behaviors such as a lack of using contraceptives such as condoms (Tabler & Geist, 2016). This coupled with an assumption of infertility can lead to greater risk for unplanned pregnancy.
Eating disorders during pregnancy already pose health risks to both the mother and baby, and many women will often not disclose their ED status with healthcare providers. Therefore, it is necessary to become more aware not only of the signs of eating disorders in pregnant women but also how best to approach things like weight and weighing processes during visits in order to better support patients who may have an eating disorder. This is one of the reasons for establishing Healing Bodies Healthy Babies, to help provide resources to the women affected, clinicians, and even family members of women with eating disorders.
Amenorrhea. (2019, July 25). Retrieved from https://www.mayoclinic.org/diseases-conditions/amenorrhea/symptoms-causes/syc-20369299
Tabler, J., & Geist, C. (2016). Young Women with Eating Disorders or Disordered Eating Behaviors: Delinquency, Risky Sexual Behaviors, and Number of Children in Early Adulthood. SOCIUS, 2, 1-14. https://doi.org/10.1177/2378023116648706
Easter A, Treasure J, Micali N. Fertility and prenatal attitudes towards pregnancy in women with eating disorders: results from the Avon longitudinal study of parents and children. BJOG. 2011;118(12):149–8. https://doi.org/10.1111/j.1471-0528.2011.03077.x.