Navigating Pregnancy and Eating Disorder Recovery
Pregnancy is an exciting and transformational time – bringing a baby into the world is a wonderful display of all the amazing things the human body is capable of.
However, pregnancy can also heighten vulnerable emotions and lead to the onset or relapse of disordered eating and eating disorders (EDs). It can be challenging if you are navigating pregnancy AND eating disorder recovery at the same time.
Hormonal fluctuations, rapid growth and unpredictable changes in the body, plus the pressures to have a healthy pregnancy and baby can lead to complex emotions, body dissatisfaction and the desire to control body changes, pregnancy and birth outcomes.
Potential Eating Disorder Triggers in Pregnancy
In fact, studies show that most womxn experience a worsening or relapse of their eating disorder during pregnancy and following birth. Some of the triggers to relapse reported included:
Feelings of worry and shame linked to anxiety and weight changes.
Perfectionism in maintaining an “ideal” pregnancy body (hint: there isn’t one!) and eating the “right” foods (again, there are no right or wrong foods).
Unpredictability of life changes with a new baby, as well as changes to body during pregnancy.
Loss of control around weight gain, schedules, work and other life changes with pregnancy.
Change of appearance and
Loss of identity in becoming a new mum.
Disordered eating behaviours returned in these womxn as a way to regain control over the unknowns of their pregnancy journeys.
Are you anxious about food safety?
Another common trigger of disordered eating behaviours in pregnancy is related to food safety considerations. Certain foods carry higher risks of contamination of listeria and salmonella and are recommended to be avoided whilst pregnant, as infection with these bacteria can be harmful. A strict avoidance of these foods can cause fear and anxiety, and spiral into disordered eating and relapse of eating disorders. Chatting about the risks of food poisoning with your dietitian is important to help make informed decisions about the level of risk, and ensure your mental health remains a priority throughout pregnancy.
It’s an important reminder that these feelings are normal, and you are not alone in experiencing them. There are plenty of tools, strategies and supports available to help you navigate this exciting journey whilst protecting your mental and physical health, the health of your baby, and your relationship with food and your body.
Let’s explore how to manage these complex challenges in pregnancy to help you feel empowered every step of the way.
Risks of Undernutrition in Pregnancy
Adequate nutrition is crucial in pregnancy to support the processes involved and protect the health of both mum and bub. During pregnancy, nutritional needs increase during different stages to support growth and development of the foetus, placenta, and breast tissue to support breastfeeding after birth. This can already make it challenging to meet these additional needs, particularly in early pregnancy with morning sickness and nausea making it harder to eat a variety of foods.
The risk of relapse of EDs during this time can further compromise nutritional intake and can lead to a range of different complications.
Some of these include:
Risks to mum:
Anaemia
Caesarean section delivery
Pre-term birth
Miscarriage
Post-partum depression
Risks to bub:
Pre-term birth
Small for Gestational Age or Low birth weight
Microcephaly (a birth defect where head circumference is smaller than usual)
Genetic changes that can affect health in the long term.
Binge Eating Episodes in Pregnancy
Binge Eating is another behaviour that can be used to cope with the feelings of loss of control during the changes in pregnancy.
A 2011 study found that the onset of Binge Eating Disorder in pregnancy was related to anxiety, depression, low self-esteem and low-life satisfaction5. Food can often be used as a self-soothing strategy or a coping mechanism which pregnant womxn may turn to in times of overwhelm.
It’s important to remember that binge eating often stems from restriction, which can be used as a coping mechanism to maintain control over the unknown. As nutrient needs increase, regular eating can ensure both you and bub receive everything you need whilst stabilising appetite.
Whether you’re struggling with restriction or binge eating behaviours related to your eating disorder, you deserve proper nourishment during pregnancy (and outside of pregnancy too!). Let’s explore how we can nourish you well during pregnancy, whilst supporting you through managing your eating disorder.
Key Nutrients in Pregnancy
Having a balanced diet rich in key nutrients including iron, folate, B-vitamins and omega-3 fatty acids can help to support mum and bub’s physical and mental health during pregnancy.
Iron:
assists in oxygen transport around the body for both mum and bub.
Found in red meat, chicken, fish, legumes and beans, dark leafy greens like spinach.
Folate:
essential for the formation of the neural tube within the first 12 weeks of pregnancy.
Found in spinach, citrus fruits, fortified breads and cereals, legumes and beans.
B-vitamins:
aid the production of energy and synthesis of DNA.
Sources include wholegrains, fortified breads and cereals, milk, eggs, seafood and animal meats.
Omega-3:
plays a role in foetal eye and brain development, and supports mental health in mum.
Found in oily fish including salmon, mackerel and herring, chia seeds, flaxseeds and walnuts.
Working with a dietitian to address disordered eating behaviours that may arise can ensure regular nutrition to meet your needs for pregnancy, birth and beyond.
Supporting Recovery Throughout Pregnancy
ED thoughts and behaviours can creep back in during pregnancy. Sometimes, they can be really sneaky and fly under the radar, going unnoticed for a period of time. Rest assured that this is normal, and you are not alone.
Here are some ways to feel supported in your recovery journey as you navigate pregnancy:
Stay connected with your treating team
Having regular appointments with your GP, dietitian and mental health team can help to identify any red flags for relapse, monitor your health, address any concerns and continue to support you through this journey – remember, you don’t have to do this alone!
Practice body neutrality
Focusing on how your body feels, and all of the wonderful things it’s doing to create life can help to shift the perspective away from how your body looks as it changes during pregnancy.
Flexible eating
Meeting your nutritional needs is crucial to support the health of both you and your baby, however, this can often lead to fear and anxiety around eating and a heightened sense of perfectionism when it comes to eating during pregnancy. Remember, eating for pregnancy does not mean eating perfectly – there is no such thing! Eating enough and including the foods you love can help to nourish mum and bub to thrive.
Practice self-compassion
The recovery journey is never a linear one. Some days are harder than others. Be kind to yourself - remember, you are human and you’re doing your best navigating the unknowns of your pregnancy journey.
Meal and Snack Ideas to Support Regular Eating in Pregnancy
Here are some simple, balanced meals to help maintain regularity in eating during pregnancy:
Breakfast:
Rolled oats with milk, berries, chia seeds and honey
Boiled eggs with avocado and tomato on toast
Omelette with spinach and cheese with wholegrain toast
Lunch:
Wholegrain wrap with chicken and mixed greens
Lentil and vegetable soup with whole-grain bread
Quinoa bowl with roasted vegetables and chickpeas
Dinner:
Grilled salmon with roasted sweet potato and broccolini
Spaghetti with prawns, cherry tomato and spinach
Beef and vegetable stir-fry with brown rice
Desserts:
Chia pudding with milk, topped with mango or berries
Dark chocolate covered strawberries
Peanut butter and banana smoothie
Snacks:
Greek yoghurt parfait with granola, chopped fruit and honey
Apple slices and nut butter
Tuna and avocado on wholegrain crackers
Chopped veggie sticks with tzatziki dip
Mixed nuts and seeds with a piece of fruit
Staying Supported in the Postpartum Period
Life changes with a new bub to care for, and the pressures from society for womxn to “bounce back” after giving birth (spoiler alert, you don’t!) can increase the risk of ED relapse and post-partum depression.
Here are some tips to staying supported after birth:
Keep in touch with your support system:
Lean on family and friends for support during this time to assist with cooking, cleaning or caring for bub. Staying connected socially can also help to maintain a sense of identity following birth. Keeping in touch with your care team for support can help to manage any risks of ED relapse or post-partum depression, ensuring your mental and physical health remains a priority.
Eat regularly:
Regular eating supports recovery following birth and can also help to reduce the risk of disordered eating patterns and behaviours returning. Leaning on loved ones for meal support, or perhaps using a meal delivery service, can ensure you always have meals on hand when things get busy!
Managing recovery during pregnancy can be tough – but remember – you don’t have to do it alone. To quote the NEDC, “Experiencing an eating disorder lapse or a relapse is not a sign of ‘weakness’, ‘failure’ or inability to recover. Rather they are signs that old ways of coping need to be replaced with new ones.”
Staying connected to your treating team, including your GP, dietitian, OB/GYN and mental health professionals can help you feel safe and supported every step of the way.
If you are navigating pregnancy during eating disorder recovery or are experiencing relapse of your eating disorder whilst pregnant, feel free to get in touch and book an appointment with our experienced dietitians.
References:
Sommerfeldt B, Skårderud F, Kvalem IL, Gulliksen KS, Holte A. Bodies out of control: Relapse and worsening of eating disorders in pregnancy. Front Psychol. 2022 Sep 28;13:986217. doi: 10.3389/fpsyg.2022.986217. PMID: 36248571; PMCID: PMC9554489.
Makino M, Yasushi M, Tsutsui S. The risk of eating disorder relapse during pregnancy and after delivery and postpartum depression among women recovered from eating disorders. BMC Pregnancy Childbirth. 2020 May 27;20(1):323. doi: 10.1186/s12884-020-03006-7. PMID: 32460729; PMCID: PMC7251919.
Mantel Ä, Hirschberg AL, Stephansson O. Association of Maternal Eating Disorders With Pregnancy and Neonatal Outcomes. JAMA Psychiatry. 2020;77(3):285–293. doi:10.1001/jamapsychiatry.2019.3664
Sebastiani G, Andreu-Fernández V, Herranz Barbero A, Aldecoa-Bilbao V, Miracle X, Meler Barrabes E, Balada Ibañez A, Astals-Vizcaino M, Ferrero-Martínez S, Gómez-Roig MD, García-Algar O. Eating Disorders During Gestation: Implications for Mother's Health, Fetal Outcomes, and Epigenetic Changes. Front Pediatr. 2020 Sep 17;8:587. doi: 10.3389/fped.2020.00587. PMID: 33042925; PMCID: PMC7527592.
Knoph Berg C, Torgersen L, Von Holle A, Hamer RM, Bulik CM, Reichborn-Kjennerud T. Factors associated with binge eating disorder in pregnancy. Int J Eat Disord. 2011 Mar;44(2):124-33. doi: 10.1002/eat.20797. PMID: 20127938; PMCID: PMC2888703.
nedc.com.au. (n.d.). Lapses & Relapse. [online] Available at: https://nedc.com.au/eating-disorders/treatment-and-recovery/relapse-and-recurrence.