At some point, most of us have been told to “eat healthy.” Sounds simple enough, right? But what that means may look different from person to person. For some, it’s about cutting back on junk food and adding more fruits, vegetables and whole grains. For others, it may mean watching sodium intake, choosing foods that support heart health, or managing cholesterol levels.
Regardless of your health history, eating well is something we’re all encouraged to do, especially during pregnancy and while breastfeeding, when your body supports both you and your baby.
But if you’re living with an eating disorder, pregnancy or breastfeeding can add extra layers of complexity. It’s not just for What to eat anymore: questions about How many to eat how often to eat and how to manage hunger cues or body changes can feel overwhelming. These challenges are real and deserve thoughtful, compassionate support.
A few years ago, I received a call from a woman named “Alice.” She called MotherToBaby because she was taking medication for high blood pressure and wanted to know if it would affect her pregnancy. After some discussion, she told me that her blood pressure was high because she was rapidly gaining a lot of weight from overeating. He said he had been eating for a long time and didn’t know how to stop. She was worried about how this would affect not only her health, but also the health of her baby. When I asked what her health care provider suggested, she said she was afraid to talk to her midwife about it.
What is an eating disorder?
An eating disorder is a mental health disorder that leads to severe eating behavior disorders. There are many different eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder, and pica. Each disorder has its own symptoms and effects. In the United States, 9% (28 million) of people will have an eating disorder in their lifetime.
- Anorexia nervosa – severely restricts the amount of food eaten, resulting in very low body weight.
- Bulimia nervosa – binge eating (eating large amounts of food in a short period of time and feeling out of control over eating) followed by purging (vomiting, not eating, excessive exercise, abuse of laxatives or diuretics).
- Binge eating disorder – binge eating without purging.
- Pica – craving and eating substances with no nutritional value (such as ice, clay, paper or dirt) for at least a month. The number of women affected by pica is unknown, but it is much more common in pregnant women than in non-pregnant women. it is also more common in developing countries than in the US.
Eating disorders can be difficult to identify under any circumstances, and this can be even more true during pregnancy and after a baby is born. So much focus is placed on weight changes, appetite changes, and body changes during this time that warning signs can easily be overlooked or dismissed as “just part of pregnancy.” Also, not all health care providers receive specialized training in recognizing eating disorders, especially in pregnant or postpartum patients. This means that symptoms can sometimes go unnoticed, even during regular prenatal or postpartum visits.
There is also a lot of stigma around eating disorders. Some women may feel ashamed, embarrassed, or afraid to talk about their struggles. Others may worry about being judged or not being taken seriously. All of this can make it incredibly difficult to admit that something is wrong.
Can eating disorders affect my pregnancy?
A healthy, well-balanced diet during pregnancy is important for the growth and development of a fetus. It can also help minimize some pregnancy symptoms such as nausea and constipation. Some eating disorder behaviors can cause problems during pregnancy and may require hospitalization or other specialized care. For example:
- Not eating and/or restricting calories can cause low energy and nutritional gaps for the mother and low birth weight for the baby.
- Vomiting can cause dehydration, electrolyte imbalances, sore throat, stomach pain, tooth damage, gum disease and esophageal rupture in the mother.
- Laxative/diuretic use can cause dehydration, electrolyte imbalances, laxative dependence, and organ damage in the mother.
- Excessive exercise can lead to fatigue, muscle soreness/pain, dehydration and overheating in the mother.
- Overeating can lead to excessive weight gain, gestational diabetes, high blood pressure (and other complications) in the mother, and high birth weight for the baby.
- Eating non-nutritive substances (pica) can interfere with the absorption of nutrients and may contain dangerous substances that could be harmful to the mother or baby. See our fact sheets on toxoplasmosis and lead.
- Mental health issues such as depression or anxiety go hand in hand with eating disorders. Learn more about how mental health disorders can affect pregnancy and breastfeeding.
What about breastfeeding?
Getting enough ‘high quality’ calories is important for everyone. During breastfeeding, the body needs energy to produce enough milk, and not getting enough calories can make it more difficult. For pica, non-foods may contain something potentially harmful to the baby, such as lead.
Studies have shown that women with eating disorders may be more likely to stop breastfeeding within the first 6 months. However, it is possible to breastfeed successfully with an eating disorder, even if they are taking medication. The key is to find support, which you can get from health care providers (doctors, nurses, lactation consultants), family, friends, and support groups (online, by phone, and in person).
Help is available
If you have been diagnosed with an eating disorder or think you may have one, talk to your health care provider. You are not alone. There are resources available to help you and your baby be as healthy as you can be.
Talk to your healthcare provider to discuss how many calories per day are right for you. There are many resources available to help educate people about good dietary choices, such as the American College of Obstetrics and Gynecology’s Frequently asked questions about healthy eating during pregnancy. The National Institutes of Health has information about what foods/drinks to limit/avoid, the appropriate amount of weight to gain and the recommended amount of exercise.
And finally…
So what happened to Alice? She called many times during her pregnancy and while breastfeeding. After our first conversation, she told her midwife everything. Alice did develop gestational diabetes, but under the care of her midwife, nutritionist and counselor, she was able to stop gaining weight and control her blood sugar and blood pressure. She gave birth to a healthy baby and continued to work with her team while breastfeeding. She thanked me for suggesting she get help and said she was closer to finding something we’re all looking for – balance.
Originally written by Chris Stallman on August 2, 2018, edited by Bridget Maloney, Certified Genetic Counselor at MotherToBaby Arizona on February 17, 2026.
