Young Parents Team
While other nauseous mums-to-be wished their morning sickness would go away, Candice Tay (not her real name) prayed for it to happen when she was pregnant six years ago. The nausea – rationalises Candice, now 44 – would help keep her weight in check. But “unfortunately” for her, the trimesters came and went uneventfully.
So to keep her weight down, she hit the gym and did high-intensity cardio exercises for 1½ hours every day until the eighth month of her pregnancy. Instead of tucking into hearty meals, she kept to a strict pregnancy diet. She would nibble on a little sandwich for lunch and a small meal at night.
“I didn’t want to starve the baby, so I forced myself to eat a little. It could be some vegetables or muesli – just a little something to keep the baby growing,” recalls Candice.
Sometimes when the hunger pangs got too unbearable, she would go on maniac food binges, only to throw up whatever she had eaten afterwards.
Speaking to Young Parents, the stay-at-home mum admits that her actions would sound terrible and silly to most people.
In fact, she knows that other mums would probably be horrified by what she did. But Candice says she simply could not stop herself, even though she wanted to have a healthy baby.
Candice’s shocking behaviour is not uncommon among expectant mums who have eating disorders, say medical experts.
She suffers from anorexia and bulimia. In the former, sufferers starve themselves to maintain their weight, while the bulimic typically binge-eat and then purge themselves.
Candice’s eating disorders have been a chronic, ongoing struggle since she was 20, following an unpleasant break-up with a boyfriend.
Now weighing a feather-light 39kg, she cannot remember how much she weighed during her pregnancy, but says she gained no more than 5kg – less than half what an average-sized woman is expected to put on for a healthy pregnancy.
According to Dr Wee Horng Yen, consultant at KKH’s Obstetrics and Gynaecology department, it is normal for a woman to put on around 11kg to 16 kg during pregnancy. The weight is distributed among the foetus, placenta, uterus, blood and bodily fluids, breast and mother tissue stores.
Medical experts tell Young Parents that most patients they see for such eating disorders are in their teens and early adulthood. While eating disorders are less common in older adults and pregnant women, they are not rare.
There are no official local figures on the number of women who suffer from eating disorders during their pregnancy, but Dr Helen Chen, senior consultant psychiatrist at KK Women’s and Children’s Hospital’s Mental Wellness Service, estimates that they affect about three per cent of pregnant patients she has seen.
Frances Yeo, child psychologist and clinical director of Thomson Paediatric Centre’s Child Development Unit, saw a handful of such cases when she used to counsel pregnant women, but believes that those were just the tip of an iceberg.
“Having an eating disorder is not an easy thing to talk about, so more pregnant mums may be suffering from it and not seeking help,” she says.
Women like Candice, who already have pre-existing eating disorders, are most at risk. They often have body-image issues, says Frances. Women with anorexia also tend to have perfectionist traits and a sense of need for control, Dr Chen adds.
“During pregnancy, the problem may worsen. Obviously, the body puts on weight during pregnancy and they lose control of how their body looks,” says Frances.
Even those who have their eating disorders under control may find them resurfacing during pregnancy.
“Often, for the recovered anorexic, there is still a concern with gaining weight and body-image consciousness. So the natural weight gain during pregnancy can be terrifying for her. She may then restrict her diet,” explains Dr Chen.
“Bulimic mums-to-be may induce vomiting after episodes of binge-eating. Some women ‘comfort-eat’ food that they know are unhealthy, like chips and cakes, because doing so eases the stress and emptiness they feel, especially if they’re depressed.”
According to Frances, guilt is another common emotion that many expectant mums with eating disorders go through during their pregnancies. “They want to have children, but at the same time, they don’t want to put on weight,” she says.
Candice admits her entire pregnancy experience was awful and very difficult. “While I was very happy to have a baby, after going through a previous ectopic pregnancy, I worried about the weight. It wasn’t an ideal situation to be in, but thank God the baby was very healthy.”
Candice’s baby weighed a good 3kg at birth.
EATING FOR YOUR BABY
During pregnancy, a balanced, well-rounded diet is crucial for foetal development. On top of the regular caloric intake, an average-sized pregnant woman will need to consume about 200 to 300 more calories each day, says Dr Wee.
Bad nutrition caused by eating disorders like anorexia and bulimia can be catastrophic during pregnancy.
“The most frequently reported birth complications (in expectant mums with eating disorders) include pre-term delivery, low birth weight and low Apgar score. There have also been reports of stillbirth, fetal abnormality, breech delivery and fetal cleft palate in pregnant women with eating disorders,” warns Dr Wee.
With all the risks, Frances says it is important for women with eating disorders to get proper treatment even before they try for a baby.
Such therapies typically include a holistic approach using medication and psychotherapy. In severe cases of malnourishment, hospitalisation may be needed.
For expectant mums, however, treatment options are few because many doctors do not use medication during pregnancy, says Frances.
Up until today, Candice has been trying to get out of her eating disorders for her daughter’s sake.
“Children imitate, and that’s my worry as a mummy. I have to be extra careful around my daughter and make sure she sees me eat. She knows I’m skinny, but I tell her that’s because I exercise,” she says.
Ironically, while she struggles with body-image issues, Candice wants her daughter to be comfortable in her own skin.
“One day, she told me a kid at school called her fat. I told her firmly that no matter what other people say, she is beautiful on the inside and outside. As a mother, I want to give her the self-confidence to love herself,” she says.