Plump enough for pregnancy?
Women with a history of eating disorders can have a healthy pregnancy if they stay focused on nourishing themselves.
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Basic principles
During pregnancy, a diet consisting of fresh fruit and vegetables,wholegrain bread, lean protein sources and low-fat dairy products will ensure mother and baby receive plenty of the vitamins, protective bioflavonoids, fibre, calcium, iron and essential fatty acids they require.

The only food group to reduce is fats; those chosen should be the 'good' fats, peanut butter and avocado for spreads, and olive or canola oils for cooking.

Regular, gentle exercise helps to prevent cravings, and ensures a healthy appetite so a pregnant woman gains enough weight for her body type (if underweight, normal or overweight before pregnancy)and for each trimester (1.6 kg during the first trimester and 0.44 kg for each week in the second and third trimesters, for a normal-weight woman).

Support system
A woman with a history of eating disorders, who has recovered to the extent that she has ovulated and fallen pregnant, may feel unduly stressed by the weight gain required. This stress may negatively influence foetal development – her baby may be born earlier and/o runderweight, although her diet is adequate.

Karen Horsburgh, a consultant dietician based in Cape Town,believes that many women find it hard to cope with the idea of picking up so much weight during pregnancy. Counselling may be essential for a woman who has recently recovered from an eating disorder.

Studies have shown that women who are supported by their partners, friends and families cope better with stress during pregnancy. There are fewer complications for them and their babies than for women who feel alone. Consultations with a dietician and/or psychologist – in conjunction with the treating obstetrician – are helpful for dealing with any conflicting feelings the mother may harbour regarding her diet, health, her baby and the necessity of adequate weight gain.

Embracing motherhood
In Motherhood and Mental Health, under the section 'pregnancy after recovery', it is reported that many women with a history of anorexia nervosa give birth to healthy babies; in the majority of these cases there is no evidence of excessive depression during or after pregnancy,nor of problems in mothering or breastfeeding.

However, few women fall pregnant in the throes of their eating disorders; food restriction and an unhealthily low body-fat content affect the endocrine system, and this usually causes ovulation to cease.

In most cases where pregnancy did occur, it had a beneficial effect. Two-thirds of the patients in these studies showed an improvement in their restriction behaviours, felt more mature and responsible, and were concerned that their illnesses could damage the foetuses.

Bulimia patients also tend to improve during pregnancy. A study by Lacey and Smith (British Journal of Psychiatry, 1987) reported on 20 bulimic women who became pregnant. All the babies were born at full term and only five of the women were still actively suffering from their illnesses by the third trimester.

The authors argue that the pressure of the enlarging uterus on the stomach makes the cyclical binge-purge behaviour of bulimia more difficult. Some of the mothers admitted that the presence of the baby inhibited the continuation of their eating disorders.

The complications
Low calorie intake in a pregnant woman can result in a breakdown of stored fats and proteins, leading to the production of ketones in her blood and urine. Chronic production of ketones can cause mental retardation in a child (Mother & Child glossary website).

The ANDRED (Anorexia Nervosa and Related Eating Disorders) website and the New England Journal of Medicine (January 2002) reported the following undesirable effects on the foetus, where the mother is actively suffering from an eating disorder:

  • prematurity and/or low birth weight,
  • developmental and neurological problems,
  • lower IQ and learning disabilities,
  • may not reach full adult stature,
  • conservation of energy by the foetus, leading to obesity, heart disease and diabetes in later life, and
  • impaired liver development in the child, which may lead to heart attacks and strokes in adult life.

    In the best interests of the foetus
    Women who are aware of these outcomes are more likely to co-operate with prenatal-care experts to increase the probability of having a healthy baby.

    Antenatal classes also serve the excellent purpose of providing reassuring information on what to expect during pregnancy and childbirth. The American Journal of Clinical Nutrition (May,2004) recommends that if you have had an eating disorder, you should consider whether you can handle the increased nutrition requirements and weight gain required to sustain your pregnancy and produce a healthy child. During breastfeeding, you will also require more nutrients and liquids than usual.

    Health of the mom-to-be
    The medical problems that a malnourished pregnant woman might suffer include:

  • a higher chance of miscarriage,
  • weak, fragile teeth and bones, as your baby's need for calcium takes priority,
  • stress fractures and broken bones, and
  • liver, cardiac and kidney damage.

    A woman in the throes of an eating disorder who finds herself pregnant, should immediately consult both a physician and a dietician specialising in these illnesses. Their recommendations should be scrupulously followed.

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