Anorexia, infertility and pregnancy complications

Is your diet isolating you from your friends?
Does the mere sight of food fill you with dread?
Does food denial make you feel in control of your body?
Do you feel proud every time you see the scale reading go down and further down?

If you answered ‘Yes’ to any of these questions, you may want to talk to your GP. You may or may not have anorexia but it could be the beginning of an eating disorder. In individuals with anorexia nervosa, the way food generates uncomfortable feelings of nervousness, resulting in extreme weight loss, is perhaps the most puzzling symptom of this condition. Yet, it is also the earliest sign of the disease.

What does anorexia nervosa mean?

The term ‘anorexia nervosa’ was defined in 1873 by Sir William Gull, one of Queen Victoria's personal physicians. The term is of Greek origin: ‘an-’ is a prefix denoting negation, ‘orexia’ means ‘appetite/eating’, and ‘nervosa’ refers to an obsession or fixation. Thus, anorexia is an eating disorder and psychological condition characterised by a severe obsession about food restriction in order to maintain weight as low as possible.

Anorexia nervosa is diagnosed by all of the following features:

• A body weight at least 15% below that considered normal for a person’s age and height, and refusal to maintain weight at a normal leve

  Tip: At your MINIMUM normal weight, your BMI (Body Mass Index) is 18.5kg/m2

  So, your MINIMUM normal weight= 18.5kg/m2 x (your height in metres)2

  For example, let’s say you weigh 45kg at a height of 1.60m.
  Your MINIMUM normal weight is [18.5kg/m2 X (1.60m) 2] = 47.4Kg
  A body weight 15% below your normal weight would be 40.3kg

  So, at 45kg, you may not be 15% below your normal weight but you ARE still underweight and that may lead to numerous health problems. Please talk about this to any healthcare provider you know.

• An intense fear of gaining weight or becoming fat

• A distorted perception of one’s body weight and shape, for example a conviction that one is overweight, and ideas of self-image and self worth that are strongly influenced by body weight

• Amenorrhoea (the absence of menstrual periods) in female patients, for at least three consecutive months

Keep in mind: If you think you have a disordered relationship with food, please contact a registered dietitian or any healthcare provider EVEN if you don’t meet the criteria above.

What are the health risks of anorexia?

Due to overly restrictive diets, people with anorexia develop numerous severe health problems such as:

• Hormonal changes - cause irregular or absent menstruation which may lead to infertility
• Thinning of the bones due to mineral losses (osteopenia) or more severe bone loss (osteoporosis) - increased risks of bone fractures
• Damage to the structure and function of the heart - blood flow is reduced and heart muscles starve which may lead to death from heart failure
• Brain damage - may cause disordered thinking and seizures as well as memory losses
• Anaemia
• Bloating and constipation
• Multi-organ failure - often results in death

I really want to have a baby. Can anorexia affect my chances?

First, you must be aware that all eating disorders, including anorexia, have been implicated as a major cause of infertility in women of child-bearing age. Here’s why:

• Women with anorexia often have such a low percentage of body fat that their body can no longer produce the levels of hormones necessary to stimulate ovulation.
  No ovulation = No pregnancy.

• A low body weight and extreme weight loss cause the ovaries to dysfunction.

• Severe weight loss and undernourishment causes your body to activate an emergency state and you will not menstruate if you are just barely surviving. If your body remains in this state for a prolonged period, it may lead to infertility.

What effects would anorexia have on my baby?

Foetal health lasts a lifetime.

Poor maternal nutrition during pregnancy severely undermines foetal development and an eating disorder during a pregnancy puts your baby at even greater risks of:

• Being born with a low-birth weight or prematurely;
• Developing numerous illnesses at birth (e.g. respiratory illnesses) and later in life (e.g. diabetes);
• Brain damage, liver disorders, blindness, and other physical defects abnormalities;
• Mental disorders including a lower IQ and learning disabilities;
• Death from malnutrition or stress caused by your eating disorder.

Anorexia during pregnancy: What happens to the mother?

Anorexia takes an enormous toll on the body and for many women suffering from this condition, dealing with the required weight gain during pregnancy is extremely unsettling and depressing as they begin to feel increasingly out of control. Pregnancy may not only add to the psychological problems you experience with your eating disorder but it can also worsen your health.

Briefly, here’s how:

• Your baby will be taking all the nutrient it needs from YOU and if you’re not eating sufficiently, you will become even weaker and may experience difficulties breathing and walking.
• You may suffer from increased bone loss, which may lead to osteoporosis, as your baby will also take the calcium it needs from you. Your teeth may also become more brittle.
• If you are already suffering from heart, liver, or kidney damage, your condition can worsen during pregnancy.
• You may experience complications when giving birth and may have to do a caesarean section.

Get help today before it’s too late.

How can I get help?
If you have eating problems or believe you may have anorexia, it is important to seek help NOW. Talk to someone you trust, perhaps family or friends and ask them to accompany you at your GP’s.

How can I help someone else?
If someone close to you shows signs of an eating disorder, seek advice on how to help that person recognise he/she has a problem. Be supportive but do not criticise.

Links to sites that might help you find specialist help:
Beat: www.b-eat.co.uk – a network of UK-wide self-help groups with lots of information on eating disorders and where to get help, including support groups, help lines and online self-help courses for carers.
Freelance Dietitians: www.freelancedietitians.org – database of experienced registered dietitians who can help you with medical or health problems.

Can I get better? Will I then be able to conceive?

Yes, you can. Seeking help to overcome your struggle with anorexia is the best step you can take for your reproductive and pregnancy health. Approximately 80% of women who successfully treat their anorexia will regain their ability to conceive and can have healthy babies IF they maintain a normal weight gain throughout pregnancy.

Guidelines for women with anorexia who are trying to conceive or have discovered that they are pregnant:

• Consult your OBGYN for a pre-conception check-up or schedule a prenatal visit as soon as you know you’re pregnant. Do inform your healthcare provider about your eating disorder.

• Ask to be referred to a registered dietitian specialising in eating disorders. She will work with you to:

  • Gradually increase your calorie intake to achieve and maintain a healthy weight.
  • Start a fertility-booster diet if you’re trying to conceive or a healthy pregnancy diet if you’re already pregnant.
  • Address your concerns with food.

• Seek individual and group therapy sessions to tackle your eating disorder and any underlying concerns.

• Avoid purging.
  Purging may cause severe dehydration, worsen malnutrition and lead to serious electrolyte imbalances which will affect your health and that of the foetus.

• Throw or give away all laxatives and enemas you may have.
  These will not prevent your body from absorbing calories from food and may cause electrolyte imbalances. Enemas can lead to infections and even rupture the colon when administered incorrectly.

• Do not use diuretics.
  Diuretics cause the body to lose essential fluids, not calories or fat, so any weight loss observed after using them is due to water losses, which the body will subsequently do its best to replace. Diuretic abuse can lead to impaired functioning of the heart, liver and kidneys, and even organ failure in both yourself and the baby. Damaged organs will significantly reduce your chances of being able to conceive.

Remember: Your baby is TOTALY dependent on YOU...

What should I do after I give birth?

• Continue therapy sessions to strengthen your physical and psychological health.
• Continue your sessions with a registered dietitian to help you manage your weight, eat healthy and take care of your baby’s nutrition.
• Talk about your eating disorder and your increased risk of postpartum depression with your spouse, family and friends. Request their presence after you give birth.
• Contact a lactation consultant to help with early breastfeeding.

Your body is a precious jewel.

Yep, you read well. Your body is precious because YOU’RE the one living in it. Don’t live your whole life hating yourself because there’s SO much you can accomplish and SO much you can do for the world. Because you’re unique in your own special way. Embrace yourself. Say good-bye to your eating disorder. See your whole self as a work-of-art. The decision is yours: only your opinion of yourself truly counts. Are you precious? YES!

• References

  American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th Ed.) United States of America: American Psychiatric Association.

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