Pregnancy and Eating Disorders: Balancing Prenatal Health and Body Image

Moms-to-be on the Main Line and beyond are up against unrealistic body image goals during various stages of pregnancy, and fixating on the scale can lead to dangerous results.



Illustration by Stefano Morri
See also "A Momorexia Action Plan."


Monitoring pregnancy weight gain and loss in celebrities has become a popular form of entertainment in this country—so much so that it’s given rise to a new pop-culture term: momorexia. Worse yet, many women see it as a goal.

“Many Main Line mommies have body-image issues and try to stay as thin as possible,” says Dr. David Ufberg of MLHC Obstetrics & Gynecology Associates in Wynnewood. “One of the most common questions I’m asked by pregnant patients is, ‘How much weight do I really have to gain?’”

It’s a valid question for any pregnant woman to pose. It’s also normal to have trouble accepting the physical changes pregnancy brings, to monitor food intake, to exercise, and to step on a scale regularly. And it’s really not unusual for pregnant women to be vomiting, binge eating and using laxatives.

Knowing when these behaviors do become symptoms of a dangerous problem is the challenge in diagnosing all eating disorders. Further complicating things: Such symptoms are often long-held, deep-seated secrets.

“Women with EDs may not even admit it to themselves,” says Beth Rosenbaum, a primary therapist in the outpatient program at the Renfrew Center’s eating disorder treatment facility in Radnor. “Many women have been restricting food, overexercising and purging since they were teenagers. By the time they’re in their 20s and 30s, they’re very, very good at hiding those behaviors.”

And what about the baby? Neurological development, bone growth, blood-cell maturation and a host of other critical functions of gestation are compromised when mothers rob their bodies of vitamins, nutrients, calories and healthy fats, Ufberg says.

Is being thin really more important than the health of a child? “That’s a logical question. But this is a disease, and you can’t impose logic on a disease,” says Rosenbaum. “These women often can’t control their symptoms, but they absolutely don’t want to hurt their babies.”

To that end, Rosenbaum says, most pregnant women stop purging because they’re afraid of harming their babies. They often curtail calorie restriction for the same reason. At that point, some EDs go into remission. But others simply turn to overexercise and laxative abuse.

Jennifer was one of those women. Thirty years old and a newlywed, she very much wanted to have a baby. But doing so would involve the one thing she could not abide: weight gain.

“The pregnant belly I was OK with, because I knew my child was in there,” she says. “But I didn’t want to gain weight anywhere else—not in my arms, legs, rear end or face. Not one extra pound, not one extra ounce.”

Since age 16, Jennifer had battled an eating disorder. “So I lined up a support system to help me deal with it,” she says. “I had a therapist, my husband, my family and friends.”

But they wouldn’t be able to help Jennifer deal with her pregnancy weight gain. That’s because she lied to all of them. “I had to gain weight to even get pregnant, and I had to go through fertility treatments, so I stopped restricting and stopped exercising,” she says. “But as soon as I was pregnant, I started again. Eventually, I had to have meals and snacks in front of my husband so he could make sure I ate. But exercise was something I could do without him knowing. When he was at work, I ran, walked and snuck in exercise videos.”
 

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Jennifer’s therapist turned to harm reduction. “That was basically saying, ‘Let’s get her through the pregnancy with the least amount of harm to herself and the baby,’” she admits.

But it was too late. Jennifer went into labor 12 weeks early, and her newborn son was just three pounds, five ounces. His prematurity had no lasting effects.

Jennifer was hospitalized for seven weeks due to the damage done by overexercising while pregnant. Doctors recommended a hysterectomy. “I refused a hysterectomy because I wanted so much to have another child,” she says. “I refused to succumb to my disease if I was lucky enough to get pregnant again. But at that point, I was so sick that I didn’t know what would happen to me.”

Jennifer's story is an extreme version of what Ufberg hears every day. “I have patients who come in and say, ‘I’m tracking every calorie, and I’m still gaining more weight than the books say I need to,’” he says. “‘What can I do to stop that?’”

Such questions are warning signs. “Women might be able to hide eating disorders from family and friends,” says Ufberg. “But we’re monitoring their pregnancies so closely that evidence turns up on the scale, and in blood work, urine and other tests. Ob-gyns are very aware of this.”

Rosenbaum isn’t convinced. “I don’t think ob-gyns have been sufficiently educated about the warning signs,” she says. “Women with EDs are so adept at hiding them that I worry about how many aren’t diagnosed.”

Jennifer did get pregnant again. “I listened to my doctors and my husband, and not the disease,” she says. “I wasn’t going to let it control me or compromise my child.”

Jennifer was on bed rest for the entire pregnancy. She didn’t exercise; she ate everything she was served. Her daughter was born six weeks early, but at a healthy eight pounds, two ounces. There were no complications.

Now 43, Jennifer hasn’t fully recovered from her eating disorder. She had a serious relapse several years ago. “Will I have this all of my life? Probably,” she says. “Will I relapse again? Maybe. But I know that I can fight back, because I already have. And I have two beautiful children. My body gave me them, too.”
 

See page 3 to read "A Momorexia Action Plan."
 

A Momorexia Action Plan

What to do if a loved one is struggling.

1. Don’t be afraid to upset her.

2. Don’t try to solve the problem for her.

3. Never comment on her appearance.

4. Don’t tell her she’s acting silly.

5. Avoid gossip.

6. Don’t focus on weight, calories or particular eating habits.

7. Avoid a power struggle.

Source: The Renfrew Center

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