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There is a common misconception that eating disorders somehow disappear during pregnancy; that becoming a mother stops all those silly worries about being slim and attractive. This is not necessarily the case, and unfortunately, there is a lot of stigma associated with talking about disordered eating behaviours during pregnancy. Openly admitting to it is an invitation, it seems, to being called selfish and vain. The implication is that eating disorders are something only young girls struggle with, and that pregnancy and motherhood are such big and important things that they should be enough to overcome an eating disorder.

In a large population-based study of 12,254 pregnant women in the UK, over 4% of women experienced past or present eating disorders (Micali et al., 2007). In this study, Tierney and colleagues wanted to find out how those women with present or past eating disorders experienced pregnancy and early motherhood.

They interviewed eight women between the ages of 17 to 37 about their experiences during pregnancy and (if applicable) motherhood. Some women were expecting their first child while others already had three. Five out of eight women were interviewed post pregnancy (from 2 months to 24 months post pregnancy). All had an eating disorder prior to becoming pregnant. All except one developed their eating disorder during their teens (one developed AN after the birth of her second child).

The authors identified for subthemes which fell under a major theme of divided loyalties between putting their child first and heeding to their eating disorder:

THEME 1: FEAR OF FAILURE

Breast-feeding was a common area where mothers felt inadequate:

Many women were not open with their partners about their eating disorder behaviours (such as purging) because they felt that they were letting down their spouses. Some participants avoided socializing with other mothers because they were uncomfortable talking about weight gain/gain.

Participants were also worried about how others would judge them, fearing others would not understand their compulsive need to engage in behaviours as a coping mechanism.

THEME 2: TRANSFORMING BODY AND EATING BEHAVIOURS

Interviewees varied in how they felt about their changing bodies. Some hated it because they were at their heaviest, whereas others were fine with it after it became obvious that they were pregnant (and not “getting fat”.)

Some loved their baby bumps. One participant said it was the happiest she had ever been with her body, “valuing its productiveness.”

Many participants said they felt that their food intake was closely monitored by their partners, at work, or by professionals. Many struggled to eat an adequate amount of food and put on sufficient weight. One participant continued to eat small portions of low fat food and exercise rigorously. Some, however, were able to overcome their anxieties.

THEME 3: UNCERTAINTIES ABOUT CHILD’S SHAPE

Participants worried about their child becoming obsessed with food, but they also worried about their child becoming obese. As a result, the women tried to hide their own anxieties about food and weight, and attempted to eat as a family, even though this often increased their anxiety levels.

(I’m really curious if other mothers relate to this?)

THEME 4: EMOTIONAL REGULATION

Eating disorders are a powerful way to modulate (or suppress) emotions. Women in this study struggled with anxiety and depression through-out their lives, and some admitted to suicide attempts in the past. Unfortunately, low moods persisted for some during pregnancy and/or after giving birth.

Many women reported using exercise as a way to regulate negative emotions during pregnancy, but others relied on their eating disorders.

Several participants also engaged in self-harm during and after pregnancy. One participant found it hard to adapt to motherhood. She said that she loved her child, but didn’t want him, feeling that she wasn’t capable of caring for him (“because she struggled to understand what he needed when he cried.”) One woman cut her abdomen several times during pregnancy as she struggled with her changing body.

Some participants did not experience an immediate connection with their child, in part because of the guilt they felt for engaging in eating disordered behaviours and self-harm during pregnancy. For others, motherhood was a turning point: for one participant, the birth of her child was a catalyst in helping her finally begin to recovery from her eating disorder.

SUMMARY

The authors suggest that for many women, pregnancy and motherhood result in a “conflict between doing the best for their child and heeding to the demands of their eating disorder.”

They also suggest that there were three broad categories of women in this study. Women in the first group “seemed unable to cease their dangerous behaviours during pregnancy”; women in the second group “appeared able to put these on hold, but could be vulnerable to relapsing after giving birth”; and finally, women in the third group “relinquished their weight control during pregnancy and saw this as a long rather than a short-term break from such practices.”

This was an interesting paper and I’m becoming more interested in how women with eating disorders experience pregnancy and motherhood, and what treatment teams can do to help expecting and new mothers, so expect more on this topic in the future.

Not being a mother or ever being pregnant, it is hard for me to comment on the paper, and so I’m especially curious to find out if any of the material in this paper resonates with the readers of this blog. As always, I’d love to hear your thoughts!

Written by Tetyana

Tetyana is the creator and manager of the SEDs blog. She has an Honours BSc and an MSc in Neuroscience from the University of Toronto. In graduate school, she studied synaptic development and motor circuitry in C. elegans. Tetyana was diagnosed with restricting AN but has experienced diagnostic crossover more times than she can count.

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