September 29, 2010 Jeanne Rust

Pregnant and Bulimic

It's very dangerous, but it's not at all uncommon. Women in their twenties have the highest pregnancy rate; they also have the highest incidence of bulimia nervosa.

When a woman is actively bulimic, she has an increased risk of complications during pregnancy. These complications may include lower birth weight, abnormalities in the baby's development, smaller head size, breech presentation, miscarriage, premature delivery, and postpartum depression. A recent study of pregnancy and bulimia found that 26% of patients with bulimia suffer a miscarriage.

Physicians who know their patients are bulimic frequently recommend hospitalization because of the high risk for miscarriage. This creates a window of opportunity for bulimic women, who may become motivated to recover in order to protect the lives of their unborn children.

Several years ago, one of my patients found a creative way to launch her recovery while she was pregnant. She had been trying for years to have a baby, and this pregnancy was the miracle she'd been waiting for. She tried many different strategies to keep herself from purging, including tried baths, walks around the block, singing and journaling. But for her, the best therapy was digging holes! Every time she felt like purging, she would go out and dig holes in her back yard. "Hole-digging" was her magic bullet. Seven months later, she delivered a perfect baby girl to the delight of us all!

This patient was one of the lucky ones. Unfortunately, many bulimic women become pregnant and continue the dangerous cycle of binging, purging and compulsive eating.

It's easy for family members and doctors, even therapists, to become quite judgmental during this time. "What do you mean you can't stop?" "What are you doing to yourself and your baby?" "You just don't care!" "How can you be so selfish?"

If your daughter, wife or friend is bulimic and pregnant, remember that she deserves a lot of compassion during this time. Most women I've met consider being pregnant a special time in their lives. They are almost all willing to do whatever it takes to protect their child.

Here are positive ways you can help her and her child:

1) Make time to talk. Set aside a time to talk privately with your loved one. Make sure you talk in a quiet place where you won't be distracted.

2) Tell your friend about your concerns. Be honest. Tell her you're worried about her eating or exercising habits. Tell her you are concerned and that you think these things may be a sign of a problem that needs professional help.

3) Ask your friend to talk to a professional. Make sure your family physician knows that your loved one is bulimic. Encourage her to talk to a your doctor or an eating disorder therapist. Consider residential treatment if the eating disorder is severe. Offer to help her find the help she needs, to make an appointment, and to go with her to that appointment.

4) Avoid conflicts. If your loved one won't admit that she has a problem, don't push. Be sure to tell her you are always there to listen if she wants to talk.

5) Don't place shame, blame, or guilt on your friend. Don't say, "You just need to eat." Instead, say things like, "I'm concerned about you because you won't eat breakfast or lunch." Or, "It makes me afraid to hear you throwing up."

6) Don't give simple solutions. Don't say, "If you'd just stop, then things would be fine!"

7) Let your her know that you will always be there for her, no matter what.

I speak with so many women who need eating disorder treatment but have no money, no insurance, and no one to support them. Please don't let your wife, daughter, or friend be among the many pregnant women living lives of quiet desperation who feel too hopeless to move, let alone seek out the help they need.

Morgan, J.F., Lacey, J.H., Chung, E. (2006) "Risk of Postnatal Depression, Miscarriage, and Preterm Birth in Bulimia Nervosa: Retrospective Controlled Study". Psychosomatic Medicine 68: 487-492.