A recently published study reports that women with a history of eating disorders can take longer to get pregnant and are twice as likely as non-eating disordered women to need fertility treatments. The findings confirmed what a lot of eating disorders professionals have seen first-hand. It is sobering news for many patients, I'm sure, but I hope gives women with eating disorders who dream of becoming a mom the strength they need to jump-start their recovery.
The British study, published in the latest issue of BJOG: An International Journal of Obstetrics and Gynaecology, examined the pregnancy history of more than 11,000 women involved in a longitudinal study. Among those with long-term anorexia or bulimia, pregnancy rates were lower six months after the study began. A year after beginning the study, the rate of pregnancy of all women in the study was the same. Yet the long-term anorexics and the women with long-term anorexia and bulimia were more than twice as likely as the non-eating disordered women to have needed fertility treatment. Among those study subjects with a long-term anorexia or bulimia, 39.5% of them took longer than six months to conceive.
We know that long-term adult anorexia, if not reversed, is likely to lead to infertility. But you should by no means take this latest news as the end of your dreams of motherhood if you are struggling with either bulimia or anorexia. There are numerous reports of severely low-weight, even chronic anorexics becoming pregnant. (So girls and women, don't think just because you're severely low weight you can't possibly fall victim to an unwanted pregnancy.)
In our book, we note that little is gained by telling young anorexics, who often worry that they might not be able to have children) that they will face infertility as adults. Instead, assure them that if their disorder is treated and resolved, they can expect to bear children if they choose to. Handled sensitively, a discussion of the results of this British study can be used as a motivational aid for young women.
Another fact we suggest deploying as a motivational tool to end a course of anorexia before a teen reaches adulthood is that there is evidence of higher rates of premature and low-birthweight births among mothers with a long history of anorexia.
A separate consideration for pregnant women with a history of eating disorders is that women who are recovering or who have been recovered for a long period, is that pregnancy itself can stir up all kinds of old eating-disordered behaviors, particularly bingeing and purging.
One of Marcia's former patients, whom she had treated years earlier for anorexia and bulimia, returned to see Marcia after she had graduated from college, married and was pregnant with her first child. A serious bout of morning sickness had landed her in the hospital, and the patient knew herself well enough to recognize that she was in danger of relapse. Pregnancy alone, with its attendant hormonal, shape and weight changes-not to mention the anxieties surrounding new motherhood-might have been enough to put this patient in danger. But the sudden loss of fluid, volume and weight of serious morning sickness can-as it did in this patient's case-compound the danger to a susceptible pregnant mom, even one who has been symptom-free for years.
Marcia encouraged her patient to return to her tried-and-true food plan, this time tailored to the increased nutrient needs of pregnancy. Her patient delivered a beautiful, healthy baby girl, and Marcia saw the patient several more times after her baby was born, just to make sure the new mom's eating patterns were back on track.
Marcia Herrin and Nancy Matsumoto are co-authors of The Parent's Guide to Eating Disorders. Marcia is the author of Nutrition Counseling in the Treatment of Eating Disorders