Melissa Henriquez grabbed her favorite Joe's jeans from her bedroom dresser. It was 7 a.m. and mid-July, but still dark outside. Kalamazoo, Mich., rests so close to the Central time zone divide that even though the city follows Eastern time, the sun does not.
She slid her legs into her jeans, but as she pulled them up around her waist, she stopped. The pants would not button. Melissa felt her unborn child starting to push its way across her waistline, interfering with all hopes of wearing tight-fitting designer denim.
Melissa hates fat. If it were any other time, Melissa would go for a long run to burn extra calories; she would only eat grilled chicken and vegetables for lunch. But, she folded the jeans and put them away, without remorse.
Melissa, who is 30, had never been pregnant before, though she'd always welcomed the thought of changing diapers and answering to Mommy one day. Now motherhood beckoned. Yet part of her squirmed when she thought about the weight gain.
Should I be eating for two people? 4,000 calories a day? How many meals are enough?
At the first doctor's visit last May, she was told not to dramatically change her diet; she would only need to eat between 200 and 500 calories more per day. Melissa vowed to accept the weight gain and emotional stress with it in order to have a healthy daughter.
But she neglected to tell her doctor about her eating disorder -- a situation all too common for women with the condition.
Pregnant women in general have a more exaggerated sensitivity to changes in their body shape, but for those suffering from an eating disorder, the heightened sensitivity can trigger life-threatening behaviors like starvation or purging. An eating disorder puts a pregnancy at high-risk if the mother does not nourish herself properly.
Just as a normal pregnant patient would battle pneumonia or flu, some professionals believe a pregnant woman with an eating disorder is sick. "It's an illness, disorder, disease and temporary psychosis," says Dr. Katy Aisenberg, a Massachusetts-based psychotherapist.
Some experts estimate that as many as one in 20 women suffer from an eating disorder while pregnant. But shame, secrecy and denial are inherent in eating-disorder patients, so the numbers do not account for those who are unwilling to describe symptoms to their obstetricians.
Visible symptoms can arise when the mother does not gain an adequate amount of weight (generally 25 to 35 pounds) or experiences hyperemesis, a severe form of morning sickness causing excessive vomiting and nausea. Pregnant mothers who purge can easily hide their behavior by blaming it on normal morning sickness or nausea.
Pregnant women with eating disorders are also prone to obstetric complications. Many have increased rates of difficult labor, like breech delivery, using forceps and Caesarian sections. Most commonly, when the mother acts on an eating disorder during pregnancy, a fetus will experience a low birth-weight, growth retardation and vitamin deficiencies, which can lead to more severe conditions.
Some pregnant women have two competing forces demanding medical attention: the baby and the eating disorder. Who or what demands priority of treatment can differ depending on whom you ask -- the obstetrician or the therapist.