Abstract
Pregnancy has presented unique challenges in eating disorder treatment, as well as constraints on maternal success. Body image dissatisfaction is a leading cause of disordered eating in women, and when coupled with anxiety around motherhood and physical changes, it can exacerbate preoccupations with food in weight in women with or without prior eating disorders. Additionally, concern for fetal health may lead to a decrease in disordered eating habits in women who suffered from an eating disorder prior to conception. This chapter will dissect the many studies that discuss the effect of eating disorders on women in the gestational period and postpartum. Furthermore, discussion of prenatal screening will also be examined, although no clinically-based screen for eating disorders in pregnant women has been developed. Lastly, this chapter will emphasize the need for obstetricians to receive better education on detecting disordered eating during pregnancy, and the importance of implementing a comprehensive plan upon identification of an eating disorder.
TopThe Prevalence Of Eating Disorders In Pregnant And Postpartum Women
According to the Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition (DSM-V), eating disorders are defined as “severe disturbances in eating behavior,” leading to a preoccupation with food and body weight. The accompanying weight gain and change in body shape with pregnancy can lead to a recurrence or worsening of an eating disorder, or the development of disordered eating habits postpartum. Conversely, the eating disorder may improve because of the woman’s worries about adverse fetal health (Ward, 2008). Research findings suggest that the postnatal period may be a vulnerable time for mothers with eating difficulties as concern for fetal health is no longer applicable. Pregnancy and birth constitute important life experiences resulting in substantial changes to a woman’s self-identity. The dramatic change in a woman’s body has the potential to influence their sense of self, their relationship with partners, and their developing relationship with their infant (Wheatcraft et al., 2007). The present chapter will focus on the adverse mental effects of pregnancy in women with active anorexia nervosa and bulimia nervosa. Furthermore, the development of disordered eating after giving birth will be discussed in conjunction with the effect of these disorders on the infant-mother relationship. Treatment for women with active eating disorders in pregnancy and the postpartum period will be analyzed in the context of current medical practice.
Key Terms in this Chapter
Body Image: One’s way of seeing one’s self and the perception of how one is viewed by others.
Bulimia Nervosa: An eating disorder characterized by regular, often secretive bouts of overeating, followed by self-induced vomiting or purging, strict dieting, or extreme exercise, associated with a persistent and excessive concern with body weight.
Food Avoidance Emotional Disorder: Refers to a childhood disorder of emotions in which food avoidance plays a prominent part, but which does not meet diagnostic criteria for anorexia nervosa.
Eating Disorder Inventory (EDI): A self-report questionnaire used to assess the presence of eating disorders, (a) anorexia nervosa; (b) bulimia nervosa; and (c) eating disorder not otherwise specified including binge eating disorder.
Pregnancy: The condition between conception, or fertilization of an egg by sperm, and birth, during which the fertilized egg develops in the uterus. The period in which a fetus develops inside a woman’s womb or uterus.
Lactation Period: Begins in pregnancy when hormonal changes signal the mammary glands to make milk in preparation for the birth of your baby. This period is hormonally driven and will continue as long as milk is being removed from the breasts.
Amenorrhoea: The complete cessation of a menstrual period for more than six months. This is usually a sign of a disturbance in the pattern of secretion of ovarian hormones.
Affective disorder: A set of psychiatric disorders, also called mood disorders.
Selective Eating: Refers to a childhood disorder characterized by the eating of a very restricted range of foods.
Eating Disorder: Behavioral conditions characterized by severe and persistent disturbances in eating behaviors and associated distressing thoughts and emotions.
Anorexia Nervosa: An eating disorder defined by the restriction of nutrient intake relative to requirements, which leads to significantly low body weight. Patients with this eating disorder will have a fear of gaining weight along with a distorted body image with the inability to comprehend the severity of their condition.
Body image dissatisfaction: The negative attitude towards one’s own body resulting from a perceived discrepancy between the actual body image.
Postpartum: The period just after childbirth lasting about six weeks.
Breastfeeding: The process of feeding a mother’s breast milk to her infant.
Apgar score: A scoring system that describes the condition of the newborn infant immediately after birth and, when properly applied, is a tool for standardized assessment. This test includes color, heart rate, reflex irritability, muscle tone, and respiration.
Dyadic reciprocity: Implies a correlation between relationship effects.
Secondary Amenorrhea: Refers to an absence of a menstrual period in women who previously had spontaneous periods.