In light of the Jun. 11 decision by President Obama to not oppose the over-the-counter sale of emergency contraception pills to teenagers under the age of 17, it is important to look into some cases of unplanned pregnancy that could occur within this population. Also known as the ‘morning after pill,’ this is commonly used in cases of rape, unprotected sex, or malfunction of contraceptives.
However, for a subset of this population, it may not seem imperative for women to seek emergency contraception. There is a commonly held – and ultimately dangerous – belief that women suffering from eating disorders cannot get pregnant, especially in cases of anorexia or low body mass index (BMI). Unfortunately that is not true and even in a state of amenorrhea (not menstruating regularly), women with anorexia can still ovulate and conceive.
Because of this disconnect between belief and reality (which is often not well communicated by health professionals to patients), there are incredibly high rates of unplanned pregnancies and abortions among women with anorexia. In a sample of over 60,000 mothers, half of those women with anorexia (62) reported having an unplanned pregnancy compared to a rate of 19% among mothers without anorexia.
This is a compounded problem because not only are these women faced with having a child they were not expecting and are not ready to have, but the changes concomitant with pregnancy (weight gain and bodily changes) are almost certain to exacerbate their disease. Due to these fears, the majority of women with eating disorders react negatively upon finding out they are pregnant. Of course, there are a subset of women who use pregnancy as a reason to strive for recovery, but they are not in the majority.
Another worrying aspect of this perfect storm is that these same women are unlikely to report their eating disorder to their gynecologist or during their prenatal visits. Since there is no regular screening of eating disorders in prenatal clinics, these women simply fall under the radar. Their medical file might list low BMI, but other than that, the mental and physical concerns that could affect the mother and the extensive complications to the baby are not anticipated.
Clearly this is a less than optimal situation both considering maternal and fetal health. It is essential, therefore, that medical professionals start asking the hard questions by routinely screening for eating disorders and properly informing women with amenorrhea that they could still become pregnant. Additionally, gynecologists, nurses, and midwives should have adequate training regarding eating disorders and how they could potentially impact a pregnancy. Nutritionists and mental health professionals will also have to be part of the equation throughout the pregnancy to support the mother’s mental and physical health so she can safely carry her child to term if that is her wish. Until then we cannot hope to provide appropriate care and assistance to mothers suffering from eating disorders.
