Anorexia and Pregnancy Don't Mix, Docs Say

While most expectant mothers marvel at the site of their growing baby bumps, Maggie Baumann says she was "horrified."


"As my stomach began to grow, I remember being in the shower and my bump was sticking out and I looked down at my body and I thought, 'I don't even want to be in this body,'" said Baumann.

Baumann, a 48-year-old mother of two, says she struggled with an eating disorder during her pregnancies, a condition sometimes referred to as "pregorexia."

"I wasn't even thinking about the baby," said Baumann of her first daughter, Christine, who is now 23. "It wasn't that I didn't want the baby, it was just that I could not stand the sight of my body."

Baumann, who lives in Laguna Niguel, Calif., told ABCNews.com that she struggled with anorexia since her high school years, but that it worsened after she got married and began having children.

"I feared my pregnancy," said Baumann, who gained a normal 33 pounds during her first pregnancy. "I refused to buy maternity clothes and our neighbors didn't even know I was pregnant until the ninth month. I hid it well."

Kathleen Rasmussen, a committee chairwoman at the Institute of Medicine who said there has been virtually no research done on pregorexics, said it's not uncommon for expectant mothers to experience a range of emotions regarding their growing figure.

"Women have very different psychological reactions to pregnancy," said Rasmussen. "Some are just thrilled with their new body and the marvelous things it's doing and others are humiliated."

The Institute of Medicine recommends that women of normal weight gain 25 to 35 pounds during pregnancy, and that those mothers-to-be who are underweight when they become pregnant should gain 28 to 40 pounds.

Baumann says that it was during her second pregnancy when she gained a measly 3 pounds that she saw her anorexia worsen.

"When I got pregnant with Whitney, I was just petrified to go through the changing body thing again and was scared to lose control," said Baumann, referring to her younger daughter. "I remember that I lost my waist really quickly and thinking to myself, 'Here it goes again.'"

Pregorexia Can Hurt the Baby

Dr. Robert Zurawin, an associate professor at the department of obstetrics and gynecology at Houston's Baylor College of Medicine, said that expectant mothers' fear of gaining weight is all too common.

"Women who are pregorexic -- or don't eat when they're pregnant because they're afraid of gaining weight -- need to think about their baby," said Zurawin.

"There are so many fad diets out there with no carbs and women are so obsessed with body image that they don't want to gain weight during their pregnancy because they're afraid of not being able to lose it afterward," said Zurawin.

"Women think that if they starve themselves during pregnancy, they won't look bad when they're done," said Zurawin.

Zurawin added that maintaining a well-balanced diet -- and not exceeding your doctor's recommendations for exercise -- are important for pregnant women to keep in mind, more so than whether they fit into their favorite jeans.

"It boils down to an expectant mother putting the needs of her unborn baby first," said Zurawin.

"What we'd like women to know is that what you eat affects how well your baby grows and how healthy your baby is," echoed Rasmussen. "This is a time in your life where it's really, really important to eat appropriately."

Baumann began over-exercising to try and quell her growing belly. An hour and a half of cardio -- running, biking and even volleyball -- was typical for her up until she gave birth.

"My rigidity and control got really strong during my second pregnancy," she said. "I was so oblivious to my disorder."

According to the National Institute of Mental Health, an estimated 0.5 percent to 3.7 percent of females will suffer from anorexia during their lifetime and an estimated 1.1 percent to 4.2 percent will suffer from bulimia.

Even when Baumann almost miscarried Whitney at the beginning of her pregnancy, cutting out exercise and increasing her daily caloric intake was not an option.

Baumann said that while she always ate -- she had to in order to keep up with her exercise regimen -- she was sure she was burning more calories than she was consuming.

Believes Pregorexia Caused by Her Adoption

"Whitney is so lucky to be here and I can only say that now that I realize what I had done at the time, back then I was in such a different world," said Baumann. "You think that [nearly miscarrying your baby] would probably hit most women as a warning that they have to be careful, but for me, I just kept going on my little path."

Baumann carried Whitney to term, when she was born at just over 5 pounds. During the first few years of her life she suffered from seizures that doctors suspect were caused by poor nutrition in the womb. Later on, Whitney was diagnosed with Attention Deficit Hyperactivity Disorder, another complication Baumann wonders whether she caused by her poor pre-natal care.

According to Zurawin, Baumann's daughter could have been much worse off than she was.

"You can seriously harm your baby by dieting and over-exercising during pregnancy," he said.

"You're setting yourself up for a growth-retarded baby and down the line, a baby with psychical and mental disabilities," said Zurawin.

Soon after Baumann gave birth to her second daughter, the anorexia she didn't think could get any worse spiraled out of control.

"I would work out for at least three hours a day," said Baumann. "My feet would be bleeding as I was running but I kept going. I was like a machine.

"I lived by the beach and couldn't stop and look at the waves," she said. "I wouldn't let myself. I was this machine and I had to complete the task.

"Or if my family went to church, they would go in the car and I'd run, then I'd stand at the back all sweaty, and to me, that was not abnormal," she said.

Finally suffering from chest pain, Baumann went to the emergency room and after doctors told her that her organs were failing, checked into an in-patient treatment center in Arizona.

"I weighed about 111 pounds," said Baumann, who is 5' 8". "For me, I thought I weighed so much. My husband said I looked like a skeleton."

After more than 10 years of therapy, Baumann has now faced how her adoption at just 6 months old and the abortion she had in her early 20s may have contributed to her anorexia. Baumann's birth mother, who is deceased, also struggled with an eating disorder.

Today, Baumann maintains a healthy weight and lifestyle and is proud that both her daughters live similarly healthy lives.

"It was never my intent to hurt my babies," said Baumann. "I forgive myself for what I did, but I'll never forget what I did."
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Pregnancy Weight-Gain Guidelines Updated to Reflect More Obese Moms

Obese women should only gain between 11 and 20 pounds when they become pregnant, according to updated guidelines from the Institute of Medicine.

The recommendation builds on the agency's earlier advice that overweight women gain 15 to 25 pounds, normal-weight women add 25 to 35 pounds, and underweight women pack on 28 to 40 pounds during pregnancy.

While the adjustments for the three existing weight categories were relatively subtle, the decision to add a separate category for obese women was necessary because both obesity and weight gain during pregnancy have both surged among women across the country, the authors of the report say.

Central to the guidelines are body mass index ranges. BMI, a ratio of weight to height, is a common formula used to measure obesity.

The new guidelines use BMI ranges set by the World Health Organization and the National Heart, Lung and Blood Institute; the 1990 guidelines instead used recommendations from Metropolitan Life Insurance tables. The new ranges are more conservative, with the underweight category starting at a BMI of 18.5 instead of 19.8.

"Because of the shift in BMI in the population towards more overweight and obese, those criteria have shifted now for the obese category," said Dr. Patrick Catalano, chair of obstetrics and gynecology and professor at Case Western Reserve University in Cleveland, Ohio. Catalano was part of the committee that developed the new guidelines.

"With the new criteria, we're just trying to be consistent with what everybody else is using," he said.

The guidelines are "not dramatically different from what was reported in 1990, but they are sort of progressive," said Dr. Michael Katz, senior vice president for research at the March of Dimes, which co-sponsored the study.

"They illustrate the substantial increase in obesity," Katz said.

While the guidelines are specifically intended for pregnant women, they may have implications as well for those hoping to get pregnant.

Catalano said it will be easier to achieve the new recommendations if women attempt to get within normal BMI range when they're trying to conceive. This will result in better outcomes for both mom and baby, he said, since it is "remarkably clear that pre-pregnancy BMI is an independent predictor of many adverse outcomes."

IOM Guidelines for Pregnancy Weight Gain May Encourage Some

Interventions in diet and exercise -- both before and during pregnancy -- will be essential in helping women meet the guidelines, especially those who are obese, he said.

"The idea is that it will require an effort by many people," Catalano said. "It's not just something that one health care provider during pregnancy can do. It includes a host of other people, including a nutritionist, dietician, and even an exercise physiologist."

Women's Health Experts Split on New Guidelines

Katz said the aims of the report are on target, but "the effects are very difficult to achieve."

"Here the motivation is stronger because [pregnant women] are strongly motivated to protect their child," he said. "But to have a concerted effort like this will be difficult."

While Katz said the new guidelines are more conservative than those of the past, others say they are not conservative enough.

"It's been well shown that such a patient can lose weight in pregnancy and still be fine," said Dr. Jacques Moritz of St. Luke's-Roosevelt Hospital in New York. "[The guidelines] are still concerned with small babies. That was a problem when women smoked and drank in pregnancy. Now it's just the opposite."

"Women don't need to eat for two but for 1.1," he said.

The authors of the new recommendations noted that good outcomes for both mother and child are achieved "within a range of weight gains." Also, different factors for individual women should be considered, they said.

That means the guidelines should be used "in concert with good clinical judgment as well as a discussion between the woman and her healthcare provider about diet and exercise," they said.

For example, a patient with a BMI of 30 can gain closer to the 20 pounds at the higher end of the range, said Dr. Laura Riley, medical director of labor and delivery at Massachusetts General Hospital in Boston. On the other hand, a pregnant woman with a BMI of 40 "should get closer to the 11 pounds," she said.

Riley said that the major issue behind the new report is that women need to pay closer attention to the guidelines during pregnancy.

Adherence to Pregnancy Weight Gain Guidelines Key

"Most women don't listen to the guidelines that were out in 1990," she said. "If they had listened to those guidelines, we would have better outcomes at this point."

The report also calls for further study of pregnancy in obese women, as well as the impacts of gestational weight gain on outcomes for mothers and babies.

More Guidelines for Special Cases

Other updates include:

Though there was not as much evidence as there was for singletons, the researchers made provisional guidelines for women giving birth to twins. Normal-weight women should gain 37 to 54 pounds, overweight women should gain 31 to 50 pounds, and obese women should gain 25 to 42 pounds when they're having twins. There was insufficient information for underweight women.

Shorter women don't need to gain toward the lower end of the range for their pre-pregnant BMI. The researchers said there was not sufficient evidence to continue to support this 1990 recommendation.

There is no continued support for women under 20 who become pregnant to gain on the lower end of their range, as younger adolescents often need to gain more to improve their chances of a healthy birth.
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