Starving for Two: Eating Disorders Put Pregnant Women & Their Babies at Risk

By Hugh C. McBride

Throughout most of Kate Dean’s pregnancy, the 24-year-old Welsh woman spent an inordinate amount of time hunched over the toilet bowl. But unlike many other mothers-to-be, Dean wasn’t suffering from excessive morning sickness – she was forcing herself to “purge” in an effort to remain ultra-thin.

“I desperately wanted to eat well for my baby but didn’t know how to eat normally,” Dean told Catherine Brunton, a writer with the British newspaper The Times. “Anything I did eat I’d throw up straight away. … I gave up diet pills and used laxatives on a couple of occasions. It wasn’t that I didn’t care about the effect of the [eating disorder] on my baby, it’s just that the [disorder] was winning.”

THE SCOPE OF THE PROBLEM

As Brunton noted in the Aug. 18, 2008 article in which she reported on Dean’s story, struggling with an eating disorder while pregnant is not the anomaly that many believe it to be.

According to a survey sponsored by Tommy’s, the British baby charity, 2 percent of all pregnant women in the United Kingdom suffer from eating disorders. Writing in the Aug. 31, 2007 edition of The Daily Telegraph, reporter Rebecca Smith extrapolates this data to conclude that “with more than 600,000 babies born annually in the UK it could mean there are about 12,000 women who develop anorexia or bulimia while pregnant.”

Other sources claim that the number of pregnant women who suffer from eating disorders is even higher:

• In Brunton’s Times article, John Morgan of the Yorkshire Centre for Eating Disorders was quoted as estimating that one in 20 pregnant women (5 percent) may have an eating disorder.
• The Epigee Women’s Health website claims the condition is much more prevalent, with “close to 20 percent” of pregnant women suffering from some type of disordered eating (most likely bulimia or binge eating).

The true scope of disordered eating among pregnant women may be virtually impossible to determine, Morgan told The Times. “Women with eating disorders do not readily disclose their disorder to their obstetrician,” he said, “and have been reported to ascribe their behaviors to symptoms of pregnancy, such as hyperemesis gravidarum [excessive morning sickness].”

While experts continue to debate whether eating disorders among pregnant women are on the rise, or simply being diagnosed more effectively, the issue has also gotten considerable media attention in the United States. News outlets such as the New York Daily News and CBS’s“The Early Show” are among those that have devoted column space and airtime to a phenomenon that some have termed “pregorexia.”

EFFECTS ON MOTHER & CHILD

Though there may be a wide range of opinions regarding the prevalence of eating disorders among pregnant women, virtual unanimity exists when it comes to the dangers that the conditions pose to both mother and child.

As the pregnancy and eating disorders section of the Something Fishy website indicates, the threats to mother and fetus can be both life-altering and life-threatening:

• Risks to the baby include low birth weight, delayed fetal growth, abnormalities such as a cleft palate or cleft lip, respiratory distress of the baby immediately after birth, higher death possibility to the baby in the last trimester of pregnancy or within 1 month after birth (perinatal mortality), and low Apgar scores (analyses of the babies’ skin color, heart rate, movement, breathing and reflexes, taken at one and five minutes after birth).
• Risks to both mother and baby include miscarriage, gestational diabetes, preeclampsia (toxemia), low amniotic fluid, placental separation, complications during labor (such as a breech birth), spontaneous abortion, and damage to the kidneys and heart.

On the website of the nonprofit Renfrew Center Foundation for Eating Disorders, the following statistics are indicative of the impact disordered eating can have:

• Actively restrictive pregnant anorexic women gain an average of 15.8 pounds during pregnancy, nearly 40 percent less than the 25 pounds that an average non-anorexic woman gains during pregnancy.
• Active bulimics gain an average of 5.7 pounds during pregnancy (almost 80 percent below average).
• The average birth weight of a baby born to an active purging anorexic is 4.9 pounds [According to data collected by the U.S. Census Bureau, the median birth weight in the United States is 7 pounds, 7 ounces.]
• A long-term Danish study discovered that prenatal mortality was nearly six times greater, and incidence of low-birth-weight babies twice as high, among women with anorexia than among non-anorexic mothers.

Pregnant women with eating disorders also put their children at greater risk of neurological and developmental disabilities. ANRED (Anorexia Nervosa and Related Eating Disorders) advises women with eating disorders that their conditions may result in premature or underweight babies who may be more likely to develop learning disabilities, cerebral palsy, anxiety disorders, and Attention Deficit Hyperactivity Disorder. “The more premature the baby, and the lower its weight, the more likely the disability,” ANRED reports.

Health conditions and abnormal results like the ones described above can result from a number of disordered eating behaviors, including self-starvation, bingeing and purging, the ingestion of laxatives, and excessive exercise.

GETTING HELP

Women who are struggling with eating disorders are advised to discuss their condition with their health care provider before attempting to conceive. Though many women have given birth to healthy babies while dealing with their own disordered eating, the physical and emotional risks to both mother and child are considerable.

In Kate Dean’s case, finding help was quite a challenge, as the nearest eating disorder clinic was more than 150 miles away from where she and her husband lived, and she told The Times that the support she received from her doctor was “completely inadequate.”

Hopefully, the wealth of resources that exists today will help ensure that experiences like Dean’s become less and less common. In addition to meeting with an obstetrician or gynecologist, women can also educate themselves at their local libraries or by visiting websites such as Something Fishy or Eating-Disorder.com.
Some women who suffer from eating disorders may be able to be treated on an outpatient basis, while others may need to spend some time at a residential treatment facility. Regardless of the manner in which a woman and her health care provider decide to treat her eating disorder, the decision to get help is an important initial step on the journey back to health for her and her children.

As Dr. Holly Phillips advised during her Aug. 11 appearance on The Early Show, “Everything you do during pregnancy – including your diet and exercise – should be for your health, not for your weight.”