When Pregnancy and Eating Disorders Mix

March 22, 2011— -- 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.

For the obstetrician, the baby takes precedence over the mother's psychological state. Dr. Clarissa Bonanno, an obstetrician who deals with high-risk pregnancies at Columbia University, argues there is a weak correlation between the mother's weight gain and the baby's weight because the baby takes what it needs to grow, regardless of how much weight the mother gains.

Bonanno says eating disorders often go undetected during pregnancy because many patients don't tell and obstetricians don't receive special training on eating disorders in medical school. "We probably grossly under-diagnose it," she says.

Years before she became pregnant Melissa struggled with her eating disorder. She recalled sitting in her car outside a gas station in Kalamazoo, tearing open candy wrappers. As soon as she took the first bite and felt it soften in her mouth, she spit out the intruder.

Chewing up the "bad" food and then spitting it out gave her the taste she craved, but not the satisfaction. From 2006 to 2009, she hid in her car, under her desk and even in an airport bathroom stall to spit out candy and cookies.

It had been over a year since Melissa chewed and spit, but watching the number on the scale increase during pregnancy while she ate and exercised the same startled her. At six months pregnant, she continued to focus on her growing unborn child though some days were a struggle.

"I blame myself for everything I went through," Henriquez says. "My disorder was a mind set, but I knew I needed to change how I thought about things in order to have a baby."

Melissa had a pleasant childhood growing up in Vernon, N.J., as the oldest child of three. Her red hair and heavier build distinguished her from her peers. Her parents would joke that she was born hungry, since she always had food on her mind. As a kid, Melissa ate what she wanted with no regard for counting calories or measuring portion sizes.

She listened to her body by gauging hunger and fullness. Her biggest concern about the food on her plate was how it tasted.

"I sometimes feel as if Melissa thought she had to perform more, or perform better, to make sure she was still recognized," says her mother, Sue Marion.

When she met her soon-to-be husband, Luis, during her senior year in college, Melissa was the heaviest she had ever been at 5 feet 5 inches tall and weighed slightly over 175 pounds. She was grateful Luis appreciated curvaceous women.

But in 2004 Melissa started to change the way she thought about her body. She joined Weight Watchers and began to lose a pound or more a week until she had lost 35 pounds by Christmas that year. She was ecstatic and proud of her weight loss; her hourglass figure had evened out, making her broad shoulders, tiny waist and hips follow a more symmetrical line.

By 2006 she had married and moved to Kalamazoo, Mich. But the stress of moving to a new city, a new marriage and a new job heightened Melissa's anxiety. She felt her Weight Watchers program was no longer providing enough control.She gradually became obsessive about keeping off additional pounds. She shunned all food but her Weight Watchers portions. She worked out twice a day and missed going out with her friends if it meant losing time at the gym. When Luis surprised her for a weekend getaway one Friday morning, she cried hysterically and refused to go because she had not had a chance to go to the gym that day.

Melissa's mom remembers how obsessed Melissa became about dieting, which made her visits home very stressful. "She would announce to us all that she was only going to take a few bites of a sandwich because then she could enjoy her dessert later," recalls Sue.