By Meghan Vivo

Many of us have seen her: the round-bellied pregnant woman at the gym who works out hard every night in aerobics class or on the treadmill and whose pregnancy is virtually undetectable from most angles. Or we have a pregnant friend who grazes on fruits and vegetables in minimal portions, consuming less than half the food a non-pregnant woman would eat in a typical meal. 

Many of us respond with words of congratulations or secret musings of envy at her ability to maintain her ultra-thin physique during pregnancy. Those who know better, like Maggie Baumann, MA, a therapist at The Victorian of Newport Beach – a world-renowned eating disorder and co-existing substance abuse treatment center in California – see a deeply tormented woman who may be plagued by a life-threatening eating disorder. 

“Pregorexia,” as the media calls it, is a disorder marked by preoccupation with weight control through extreme dieting and exercise while pregnant. Experts estimate that as many as one in 20 women suffer from an eating disorder during pregnancy, and that number may be increasing as more women begin emulating Hollywood starlets who are getting pregnant, gaining very little weight, and losing every ounce of “excess” weight within days or weeks of delivery. 

Celebrity or not, expectant mothers are between a rock and a hard place when it comes to diet and exercise: Gain too little weight and risk poor fetal growth, low birth weight, birth defects, neurological problems, and vitamin deficiencies – not to mention the risk to the mother of miscarriage, irregular heart rhythm, and other complications. But women who gain too much weight risk gestational diabetes, high blood pressure, and premature birth. Finding the ideal middle ground can be difficult for any woman, particularly if she has struggled with eating disorders in the past. 

Over-Exercising and Under-Eating 

Maggie Baumann is acutely aware of the signs and symptoms of the disorder because she herself experienced the anguish of pregorexia while pregnant with her two daughters. Although Baumann gained 33 pounds and followed her doctor’s orders during her first pregnancy, she felt emotionally tortured by her lack of control and vowed to do things differently with her second pregnancy. Despite a near miscarriage, appeals from her doctor, and gaining a total of just 18 pounds, Baumann maintained her rigorous diet and exercise regimen throughout her second pregnancy. 

While a moderate amount of exercise during pregnancy can improve the mother’s mental and physical health and aid delivery and recovery, doctors suggest that women avoid starting an exercise program for the purpose of controlling their weight. Depending on the woman’s physical condition, doctors generally recommend staying active with 30 minutes of moderate cardiovascular activity like brisk walking, cycling, and swimming four days a week.

But doctors strongly advise against strenuous activities such as aerobics and extended workouts, particularly in the last trimester, because a lack of oxygen can lead to neurological defects in the baby. Since the woman’s body is already working harder than normal to pump blood to both mother and baby, arduous workouts can lead to dizziness and palpitations in the mother, and may restrict the baby’s growth.

Throughout Baumann’s struggle with anorexia, she felt incredibly alone. No one, including Baumann herself, knew what was happening to her. The devastation she experienced spread to her children and her husband of almost 25 years. Baumann’s second daughter was born weighing only five pounds, experienced seizures at four months old, and was diagnosed with Attention Deficit Disorder (ADD) as an adult – all as a result of poor nutrition in the womb, according to doctors.

Like most mothers, women with pregorexia want what’s best for their babies, but their eating disorder is so consuming it controls every area of their lives. Despite their best intentions, they can’t nourish their babies without support. For Baumann, her motherly instincts kicked in the moment her children were born. 

“As soon as my daughters came out, I immediately switched into the nurturing and loving mom I knew I could be,” she said. “I just needed them outside of my body to get there.” 

Baumann is certainly not alone in her struggles with pregorexia. In an episode of “The Morning Show with Mike and Juliet,” Baumann shared her story, along with a woman named Brie, who also suffered from pregorexia. Brie got pregnant two months after completing treatment for her anorexia and instantly knew she was not strong enough in her recovery to overcome the feelings of powerlessness that permeated her pregnancy. “I didn’t know how to eat normally for one, not to mention for two,” she told television hosts Mike and Juliet. 

Eating tiny amounts of healthy food and working out excessively, Brie actually lost weight – 16 pounds during her first 16 weeks of pregnancy – at a time when most women are steadily gaining weight. Six months into her pregnancy, her doctor put her on bed rest because her body had become so damaged from starving herself since age 15. 

While doctors recommend that most pregnant women gain 25 to 35 pounds over the course of a 9-month pregnancy, Brie gained a grand total of nine pounds, bringing her up to a size 4. Remarkably, her baby was born weighing in at eight pounds. Every time she forced down her 200 calories per day, she would tell herself, “This is for my baby.” 

More Than a Quest for Thinness 

Eating disorders are complicated and unpredictable, with a staggering range of causes. For Baumann, her eating disorder wasn’t simply about looking thin or feeling attractive. It was her way of coping with a series of hardships from her past, including her adoption as an infant, the death of close family members, her mother’s alcoholism and emotional detachment, and some difficult personal decisions from her high school years. 

Both Brie and Baumann’s destructive behaviors were reinforced by well-intentioned friends and family who would repeatedly remark about how great she looked. Baumann recalls that even as she was being rolled into surgery on a gurney to deliver her baby by C-section, the delivery nurses were congratulating her for maintaining her figure.

Another eating disorder sufferer, author and former British television presenter Liz Fraser, admitted in Marie Claire that she was bulimic during her second pregnancy. Like Baumann, Fraser explained that her eating disorder didn’t stem from a desire to be thin: “Pregnancy is a frightening and disorientating time and new motherhood is for many women an assault on identity and on everything you’ve ever known. Some women get depressed, others get eating disorders. Many get both.”

Increasing Awareness, Inspiring Hope 

Because pregorexia is a condition steeped with guilt and shame (How could a mother harm her child?), many sufferers are afraid to speak out. And most aren’t being offered the support they need to get well. Most obstetricians ask women about their cigarette smoking and alcohol intake during pregnancy, but fewer than 50 percent of doctors ask about depression, body image, and disordered eating habits. 

“I've never understood why, when so many women have hang-ups about food, we all assume that pregnant women are somehow different,” Liz Fraser told British newspaper The Times. “We need to be so much more open about eating disorders in pregnancy. That way more women will feel empowered to ask for help.” 

After months of treatment in a residential eating disorder facility, Baumann learned to surrender control, find positive ways to cope with painful memories and experiences, and develop a healthy relationship with food and exercise. Years later, she became inspired to help people in the same way she had been helped. She became a therapist and began working with eating disorder sufferers at The Victorian of Newport Beach. 

Not all women with eating disorders experience pregnancy the way Baumann, Fraser, Brie, and thousands of other pregorexics did. Some women take their eating disorder into pregnancy, while others do not. If you or a loved one is pregnant or considering becoming pregnant and you’re concerned the mom-to-be may not take good care of herself or her baby, Baumann recommends talking with the woman’s doctor. She also advises that pregnant women with disordered thoughts or behaviors see a psychologist and nutritionist, forming a support team of professionals who will help her recognize whether or not she is doing the right thing for herself and her child. 

Baumann also advises women struggling with eating disorders to reach out to eating disorder support groups and to give treatment a try. The Victorian hosts an Anorexics and Bulimics Anonymous open meeting Monday evenings and Overeaters Anonymous open meeting Tuesday evenings, which anyone in the public can attend. 

In addition, eating disorder treatment programs like The Victorian help women forge trusting bonds with other women, overcome feelings of shame and low self-worth, and learn to grocery shop, cook, and exercise healthfully. In a warm, nurturing setting, women suffering from anorexia, bulimia, binge eating, and other forms of disordered eating receive the care they need to build stable, meaningful lives. 

For thousands of women, residential treatment is the only way to recover from an eating disorder. According to Baumann, “So many women are afraid to take that step because they never think they’re sick enough. But it’s not a matter of being sick enough – you just have to be willing to try.”