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Pregnancy Complications

Maternal Diseases and Pregnancy

Eating Disorders

The majority of those who will develop an eating disorder are adolescent girls and young women in their childbearing years. The presence of an eating disorder often has negative health consequences that can make it more difficult to become pregnant. If a young woman with an eating disorder does become pregnant, her pregnancy may carry risks if her health and nutritional status have suffered.

Women with eating disorders may have higher rates of miscarriage, premature delivery, and lower birth weight babies. Pregnancy can worsen cardiac, liver or kidney damage a woman may already have developed as a result of an eating disorder. Teeth and bones, already weakened by poor nutrition, could become even more fragile.

The American Psychiatric Association (APA) recognizes two major eating disorders: anorexia nervosa and bulimia nervosa. The APA estimates that in the United States at least 500,000 people are struggling with disordered eating, and the numbers are increasing. Binge-eating is being looked at as a related disorder.

Anorexia Nervosa
Women with a recent history of anorexia are likely to be underweight and poorly nourished. This increases the risk of delivering a premature or low birth weight baby. Having a higher pregnancy weight gain, and eating adequately during pregnancy, can help reduce these risks. You should probably be taking a prenatal vitamin/mineral supplement and you may need extra iron and calcium during your pregnancy.

Anorexia Nervosa is a disease characterized by self starvation. Clinical diagnosis occurs when self-restricted dieting results in a body weight that is less than or equal to 85 percent of normal for age and height. Approximately one in one hundred girls (teens through twenties) suffers with this serious disease. Health consequences can be severe including amenorrhoea (a condition when menstruation stops), anemia, and damage to major organs such as heart, liver and kidneys. Without treatment, death can occur.

Typical Symptoms Of Anorexia Nervosa
  • Significant weight loss
    (15% or more below usual weight)
  • Amenorrhoea
  • Distorted body image
  • Fear of becoming fat
  • Constipation
  • Difficulty maintaining body temperature
  • Fainting
  • Excessive exercise or hyperactivity
  • Hair loss

Treatment for anorexia is twofold. The first is to address physical health and restore body weight to a healthful range. Hospitalization is often necessary if the body weight has dropped below 75% of normal. A physician, nutritionist and psychologist often make up the health care team.

The second part of treatment focuses on preventing relapse and treating the psychological issues associated with the disease. This may involve psychiatric counseling for the anorexic and her family, medication, and ongoing medical monitoring and nutrition counseling.

Bulimia Nervosa
Bulimia nervosa is characterized by eating binges followed by purging activities such as vomiting, laxative use or bouts of excessive exercise. This disorder may be more prevalent among young women than anorexia nervosa. Bulimia may be harder to detect than anorexia because a normal weight may be maintained. Incidence is estimated at 2 to 5 percent of teenage girls and young women.

Signs Of Bulimia Nervosa
  • Eating binges
  • Use of the bathroom right after eating
  • Damaged teeth and gums
  • Overuse of laxatives or diuretics
  • Swollen salivary glands
  • Excessive concern about weight
  • Compulsive exercising
  • Significant weight fluctuations

Complications of bulimia can be severe including damage to the esophagus, organ damage and dehydration. Depletion of key minerals such as potassium can occur from vomiting and laxative use. Vomiting, laxative use, and other purging behaviors, have the potential to disturb your body's electrolyte balance. This electrolyte imbalance can have serious health consequences that impact your ability to have a healthy pregnancy. Pregnancy is a time that all types of purging behaviors should be avoided.

Treatment for bulimia addresses the physical symptoms and the underlying psychological issues. Antidepressants are sometimes used along with individual or group counseling. A physician, therapist and a nutritionist can all be integral parts of the treatment team.

Eating Disorders and Weight Gain
Appropriate weight gain and weight gain rate is important during pregnancy. If you have an eating disorder, you may have issues with your body image and be fearful of weight gain. It may help you to see a therapist during pregnancy to discuss these feelings. Review your weight gain with your provider at each prenatal visit. It may be a good idea to meet with a registered dietitian to review your diet for nutrient adequacy.

Can Women With Eating Disorders Have a Successful Pregnancy?
Ideally, you should wait until you are fully recovered from an eating disorder before becoming pregnant. You should talk to your health care provider about your eating disorder history and any health consequences you have suffered. By giving your health care provider as much information as you can, you help ensure you get the appropriate care for your pregnancy.

If you are planning to become pregnant and you have a history of an eating disorder, here are some things you can do to enhance your chances of having a healthy pregnancy:

Pregnancy Guidelines For Women Or Teens With Eating Disorders
  1. Achieve and maintain a normal weight before pregnancy.
  2. Avoid any purging activities, laxative or diuretic use.
  3. Have a thorough medical check up.
  4. Eat a healthy pregnancy diet.
  5. Continue therapy and support group attendance.
  6. Inform your prenatal care provider about your eating disorder history.

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