Eating Disorders in Pregnancy: What You Need to Know

I’ve been a therapist for 10 years– and I’m an eating disorders survivor myself. Three years ago, I had my first child. When I went through the process of pregnancy, I was already in a place of solid recovery for many years, which I consider a huge privilege and am forever grateful for the work I did (alongside my therapist and dietitian) in my early 20s as it continues to protect me from big life changes- like pregnancy.

Eating Disorders Try to Protect Us

However, even being solid in my recovery for many years prior to pregnancy, navigating all the changes in my body was really hard. Your body changes more in pregnancy than any other part of your life (Daigle, 2020). In pregnancy you are faced with high-stakes uncertainty, new food restrictions and aversions, distressing physical symptoms like nausea, intense mood shifts (thanks hormones), and the feeling that everything about my body was being closely monitored.

Like many birthing parents with similar histories, this was incredibly activating for the dormant eating disorder part of me, the part that tries to protect me from any body-based uncertainty or scrutiny.

Shame, Silence and the Taboo Nature of Eating Disorders in Pregnancy

As I went through my pregnancy journey, I also realized just how taboo it is to discuss eating disorders in pregnancy. It’s not a common topic even in the eating disorder field. I remember feeling nauseous ALL DAY during the first trimester and old purging triggers resurfacing, and then a wave of shame- how could I even have that urge while I am growing a life?

But the nausea was unbearable, it was hard to focus on anything else, let alone eat. My brain was just looking for quick relief in a familiar way. Thankfully I had support in place including my own therapy, access to medication like Zofran, a wonderful partner, and loving friends who were already mothers and who knew exactly how I felt.

These things protected me from going back down the slippery slope of eating disorders. But that isn’t everyone’s story. Many people with eating disorders suffer in silence and shame during pregnancy and postpartum. It’s too awful and shameful to admit that growing a human life doesn’t always overpower an urge to hurt your body. So, let’s talk about how and why eating disorders might show up in this time period, and what to do to bolster up protective strategies to keep you and your child as safe as possible.

How Common are Eating Disorders in Pregnancy?

Eating disorders do not just magically go away when one finds out they are pregnant. For many (60-70%), there is a period of remission during pregnancy- often described as a magical shift from those who experience this (Daigle, 2020). However, this isn’t the case for everyone- and it doesn’t make you any less worthy or good of a parent if you did not go into remission. Eating disorders are not a choice.

Even for those that do go into remission during pregnancy, the majority of those people end up relapsing by 18 months postpartum. This makes sense, since eating disorders are not about willpower. There might be just enough present moment intrinsic motivation for pregnant birthing parents to cut back on restriction, purging, or bingeing- but unless someone does the deeper work around the roots of their eating disorder, the behaviors are likely to come back after the baby is born. I say this not to be negative, but to highlight the importance of not overlooking new and expecting mothers in their struggles with food and body. Unfortunately, many women who experienced the temporary remission end up terminating therapy and dietitian services, only to find that in postpartum they have lapsed and now have no specialized support in place.

For this reason, it is important to at least keep some level of checking in with your treatment team so that you have support in place should you need it later in your journey. A team that knows you can help you spot early warning signs that you may miss- and intervening then is a lot easier than intervening when things have already spiraled out of control.

More Data on Eating Disorders in Pregnancy

Several large scale clinical studies give us information about eating disorders in pregnancy, including sub-clinical eating disorders (OSFED) which can be just as life threatening as full blown eating disorders. This data is intended to help you feel less alone if you are currently struggling, as well as serve as a wake up call to anyone working in the perinatal community who may otherwise overlook the presence of disordered eating in pregnancy.

Here are several patterns of eating disorders in pregnancy:
(Data from the Policy Center for Maternal Mental Health, Easter et al.’s 2013 study, and Watson et al.’s 2014 study)

• Active Eating Disorders: Between 5% and 7.5% of women meet the full diagnostic criteria for an active eating disorder while pregnant. For context, this is striking when compared to Harvard’s research reporting that 9% of people in the U.S. will experience an eating disorder in their lifetime (Deloitte Access Economics, 2020).
• Disordered Eating: Up to 23.4% of pregnant women exhibit high-risk, dysfunctional eating behaviors- such as severe shape and weight concerns or loss-of-control eating (Easter A, et al., 2013).
• Body Image Anxiety: Over 40% of pregnant women report high levels of anxiety regarding their changing bodies, fetal weight targets and gestational weight gain.
• Binge Eating Disorder (BED): Affects up to 4.8% of pregnant people, according to the large-scale Norwegian Mother and Child Cohort Study (Watson, H et al., 2014).
• Anorexia Nervosa (AN): Found in exactly 0.5% of the pregnant cohort (Easter A, et al., 2013).
• Bulimia Nervosa (BN): Found in exactly 0.1% of the cohort during pregnancy, dropping from 1.0% in pre-pregnancy baseline data, which demonstrates the “magical remission window” effect (Easter A, et al., 2013).

Sadly, I could not find any sound research on pregnancy and ARFID– but I can imagine that ARFID challenges would absolutely increase in pregnancy with food aversions being such a central part of both experiences.

What this data shows is, if you find yourself struggling with eating disorder thoughts, behaviors, and urges during pregnancy, you are far from alone. Just like birthing parents are screened for depression and anxiety in postpartum- eating disorders should be screened for at all stages of the perinatal period from trying to conceive, pregnancy, and throughout postpartum.

These are emotionally delicate and uncertain chapters of a person’s life. Let’s take a look at some specific triggers and what you can do to try to cope ahead and protect your recovery.

Why Eating Disorders Can be Triggered in Pregnancy

Life Transitions

Eating disorders commonly spike up during life transitions- whether that be a break-up, starting college, a move, marriage, or starting a family. People with eating disorders commonly struggle with uncertainty, and eating disorders provide structure and predictability. My suggestion here is to work with an eating disorder specialist to help you process the grief and fear that pregnancy might bring up.

Doing some sort of grief ritual to your pre-pregnancy life can be SO helpful. Personally, I made collages of my “cool girl era” in an effort to say goodbye to the carefree, spontaneous, adventurous chapter that was my 20’s. This helped me process and honor who I was and where I was going next.

Body Changes

Regardless of your body size pre-pregnancy, your body WILL change during pregnancy. Internally, you are not only growing a tiny human, but you’re also growing a new organ inside your body- the placenta. To make space for your placenta and your uterus expanding, everything inside your abdomen shifts and is more crammed together. Externally, your belly grows of course, but so do your hips, legs, chest, most people’s face becomes fuller and even the feet can go up in size! Your blood volume doubles, which also makes you feel more swollen in general. A full-term fetus plus a placenta is roughly ~30 lbs, but you can expect to gain more than that due to blood volume, fat storage increase, and so much more. Genetics also play a role in how much you gain. Many women gain 50lbs + over the course of pregnancy.

In other words, it’s not a matter of if but when your body gains weight in pregnancy. While this is not a bad thing at all, it’s a lot for the brain to get used to, especially with an eating disorder, body image issues, or body dysmorphic disorder.

Please, please be gentle with yourself in this process. It is hard, and you’re not alone. Your body is creating a whole human, and even if it wasn’t, bodies change throughout life and weight is supposed to fluctuate and increase- we are not meant to wear the same size clothes as we did when we were teenagers!

If seeing the number on the scale at every OB appointment is triggering, ask for blind weights and let your provider know you struggle with an eating disorder and any comments on weight put you at risk for relapse. If you do blind weights, make sure they remove the weight number from your chart online and discharge paperwork too. Providers often forget that step.

Less Bodily Autonomy

Hand in hand with weight and body size changes, is the feeling of losing bodily autonomy. You may feel like you have less control of your body than ever before in pregnancy. And while it is for such a beautiful reason, it can still be incredibly triggering. Everyone seems to have a say on what you should/ should not be doing with your body in pregnancy, and this can feel invasive and activating. The birthing experience is also a time where it feels mothers are stripped of their autonomy. Oftentimes providers have to make quick decisions and don’t provide full, ongoing, verbal consent about which interventions they are utilizing (for example: induction methods or pain management interventions).

Strategies to Increase Autonomy

I found it really helpful to research all the possible interventions throughout my pregnancy so I knew what I was up against when the time came. I also found it helpful to reiterate to each provider that consent is extremely important to me, and that I need to be explained properly what my options are whenever an intervention is being decided upon.

I printed out several one-page documents to give to each provider and nurse at the time of labor that had my do’s and do not’s. It can also be helpful to have a support person who is aware of your preferences and boundaries who can speak up on your behalf if you’re having a hard time saying anything during the excruciating experience of contractions.

Relationship Shifts

People treat you differently when you are pregnant. Some people distance themselves, others can be over bearing. Even your closest relationships are often tested in pregnancy. This is something I personally did not anticipate. It was really painful when certain friends slowly faded from my life, when I needed them more than ever. It was equally challenging to feel like I was on a different planet than my partner. While he is incredibly supportive and compassionate, he couldn’t fully relate or understand what I was going through in pregnancy. It felt like my life completely changed overnight, while his day-to-day life stayed relatively the same, until our baby was born of course. These relationship shifts can be a trigger for old attachment wounds and thus, eating disorders. What feels like neglect or rejection may just be a temporary inability to fully relate. It can be lonely, nonetheless.

Coping with Relationship Shifts in Pregnancy

I found it crucial to surround myself with other expecting birthing parents. Even if you don’t know anyone in your day-to-day life who is also pregnant, following values-aligned creators online who are going through pregnancy can be helpful, as well as joining support groups for new and expecting parents. Postpartum Support International has some incredible, free, online support groups that I highly recommend. Relationship therapy and individual therapy can also be really useful in coping with the inevitable challenges this season brings.

Lack of High Quality Maternal Mental Health Care

The way pregnant people are treated is shocking to say the least. Society really invisibilizes pregnant people, seeing them as a burden to capitalism or reducing their entire identity to ‘just a mom’ when pregnant people are also full people with needs, feelings, opinions. I can’t believe I even have to write that; shouldn’t it be obvious?

But I never realized how much society neglects mothers until I became one. This is reflected in the medical system too. For example, mothers typically get one postpartum check-up where you are asked to rate your mood (among other things). But that’s it. One visit. I remember feeling odd that the doctor didn’t even need to examine me internally at that visit. I just had a baby. My entire inner organs shifted and re-shifted. Surely that deserves some kind of exam? Guess not.

I also remember being asked to take a brief survey about my mood and anxiety, but the providers themselves didn’t bring anything up or ask me directly. It’s easy to see how one would feel disregarded with such limited and brief treatment during one of the most vulnerable times of a person’s life. Again, for someone with an eating disorder history or active eating disorder, this can amplify underlying wounds around worthiness of needs being met and experiences of neglect.

It’s important for me to name that I am someone with a decent amount of privilege, I am in a straight sized body, I have access to health insurance, I am in a hetero-passing relationship, and I am light skinned. According to a study from the Center of Disease Control (2026), Black birthing parents face the highest mortality rates out of all birthing parents in the United States– up to 3x the mortality rate that non-black birthing parents experience. This statistic sickens me. Quality, inclusive, maternal health care quite literally saves lives, and that extends to overall well-being and prevention of eating disorders.

Food Restrictions and Aversions

Sushi, undercooked meat, lunch meat, hot dogs, caffeine, raw sprouts, soft cheese, raw milk, etc – are supposed to be restricted in pregnancy (though the science behind this is not clear, read Expecting Better by Emily Oster for a breakdown of the science). Further, many birthing parents experience food aversions. Things you normally love may suddenly sound awful and unbearable. Any time a food rule exists, the risk of an eating disorder increases. It can be really triggering to go from trying to incorporate all foods to suddenly having rules again. This gets extra complicated if you have gestational diabetes. If you’re struggling with this particular trigger, working with an eating disorder informed and perinatal specialized dietitian can be really supportive. I also found it helpful to deep dive into the research and science and make my own decisions about what I would/would not restrict.

Physical Symptoms that Mirror Eating Disorder Side Effects

Last but certainly not least, there are many physical side effects of pregnancy that feel eerily reminiscent of having an eating disorder. The bloating, the constipation, the nausea, insomnia, exhaustion…it’s incredibly uncomfortable and it makes sense to feel activated by this, even years into recovery.

I recommend working with your treatment team and healthcare providers to find accommodations for these symptoms to make them less intense and easier to cope with. Things like Zofran, peppermint oil, Unisom, heating pads, etc– can make it slightly more manageable to cope. Reminding yourself that the reasons for these symptoms are very different from the eating disorder can also be a helpful reframe.

Even with support and accommodations, this part of pregnancy is just hard. Be easy on yourself and know that it will not last forever, even though it feels that way in the moment.

Seeking Help for Eating Disorders in Pregnancy

If you resonate with any of this, I hope you found some relief in at least knowing you are not alone. Pregnancy is hard. Pregnancy with an eating disorder is REALLY hard. Now is not the time to put treatment and recovery on the back burner, even if you have the magical pregnancy remission experience, staying on top of recovery-oriented things will help protect and prepare you for postpartum.

If you’re looking for an eating disorder therapist in San Diego or a virtual eating disorder therapist throughout all of CA, FL, MD, TN, UT & WA – Allyson’s practice is a judgement free space for birthing parents navigating recovery. Reach out to schedule a free 15 minute consultation call to see if we are a good fit for you!

Allyson Inez Ford, MA, LPCC is an Eating Disorder and OCD therapist with lived experience. Allyson is multiracial, queer and neurodivergent, which fuels her intersectional and feminist approach to food and body healing. Allyson provides virtual therapy services, runs a group private practice in San Diego, and is passionate about serving her community both in and outside the therapy room. Allyson has a passion for integrating anti-oppressive principles throughout her practice and has a podcast available on Apple and Spotify called Body Justice. You can find her on Instagram at @bodyjustice.therapist and her website: eatingdisorderocdtherapy.com