Most medical studies of pregnant women with eating disorders are chilling. Mothers-to-be who gain too much weight experience a higher risk of hypertension and gestational diabetes, conditions which, in turn, are linked to birth defects and miscarriages. Pregnant women who are severely underweight at conception or gain too little weight during pregnancy are more at risk for giving birth to premature or to low-birth-weight babies.
Neonatal doctors link low birth weight to everything from infant blindness to developmental delays to fibrosis of the lungs. Low birth weight also equates, on average, to slightly lower IQs. At the very worst, a fetus born to an emaciated mother can be born with birth defects or die soon after delivery. Ironically, in a study of underweight pregnant rats, the pups were born underweight and went on to become obese. Being starved in the womb might program overconservation of calories, so that underweight newborns would be predisposed to obesity later on.
Since this study has not yet been done in humans, the connection between underweight moms and children prone to obesity cannot be supported scientifically. But the animal studies do add to an overall message: what a pregnant woman does to her body affects the metabolism of her child, perhaps for life. With this in mind, consider the possible impact on the fetus from a condition known as "hyperemesis gravidarum," characterized by excessive nausea and vomiting during pregnancy. Women with this condition are usually hospitalized for dehydration, electrolyte imbalances, or worse. It turns out that women with bulimia are diagnosed with the condition one hundred times more often than women without eating disorders. So, too, are women who have induced ovulation because of infertility.
Is it possible that these women are vomiting deliberately? The phenomenon has raised the suspicions of some obstetricians. But most doctors do not know when their patients have a history of bulimia. As noted earlier, these women don't tell. Such was the case of Lauren, 41, who had a history of bulimia as a teenager. When she became pregnant, she vomited so much that she ended up in the hospital. Was her throwing up a normal consequence of her pregnancy or something more sinister? Lauren blamed her nausea on her pregnancy. Only she knew the truth.
Whether an eating disorder was the culprit or not, her case shows how easy it would be for a pregnant woman with bulimia to say, "I am nauseous and I throw up every morning," and then to go on purging intentionally. In this way, she eases her guilt about getting fatter while, at the same time, keeps her eating disorder under cover. To be fair, societal pressure on mothers-to-be can be intense and inexorable. On the one hand, our culture smothers a pregnant woman with care, support, and concern. For many, particularly women with eating disorders, such an outpouring is the first and greatest in their lives.
On the other hand, woe to the mother-to-be who does something wrong. It is easy to fall off the pedestal. Media headlines castigate mothers who smoke or drink during pregnancy. While the chastisements for these behaviors might be warranted, it is hard to evaluate how reprehensible eating disorders really are. Still, by maintaining the behavior, a pregnant mother with an eating problem can be endangering her unborn baby's life. Again, numerous studies show that one of the most common risks of eating disorders is miscarriage - even if the mothers-to-be are symptom-free during pregnancy.
No one can ever say that any one miscarriage is caused by the symptoms of any one eating disorder, past or present. In fact, many healthy women miscarry, especially in the first trimester. But eating disorders specialists can say that women with eating disorders tend to miscarry more often than those without eating disorders, and they suffer multiple miscarriages at a higher rate. Even more tragic than the miscarriage itself are the psychological consequences of a miscarriage on women with histories of eating disorders: "These women are at a much higher risk of feeling shame and loss or blaming themselves," Srikameswaran says. It is not surprising that they often turn to the eating disorder for succor.
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