Will she be able to have children? If your daughter developed an eating disorder as a teen or young adult, that question may have gnawed at you before she was ready to address it. Chances are your relationship with your daughter is complex. Your emotions pertaining to her health and future tend to run deep; add to that the prospect of change-of her becoming a mother and your becoming a grandparent-and it’s only natural that you are experiencing a whole spectrum of intense feelings (excitement, joy, fear, anger, sadness), many of them mixed. Understandably, you have many questions. Can she get pregnant? Will the pregnancy make her eating problem worse? Will her baby be healthy?

When a woman does not take in enough nourishment, her body tries to protect itself against starvation by making some changes, one of which is to channel fuel that was formerly available for the reproductive system to the life-sustaining heart and lungs. Under these circumstances, the hormone system that perpetuates the menstrual cycle slows down and the woman’s periods stop. The absence of periods (amenorrhea), a defining feature of anorexia nervosa, results from a combination of factors, including undereating, overexercise, low weight, and particularly insufficient body fat. Infertility can occur as a complication of anorexia nervosa.

In order to reactivate her hormones and resume her periods, the patient needs to regain the weight and fat tissue that her treatment team recommends. If she continues to maintain adequate nutrition, her overall health will be better, increasing the likelihood that she will be able to get pregnant.

As you might expect, pregnancy can be challenging to an individual who struggles with or has recovered from an eating disorder. Although some moms with a history of this type of illness recall pregnancy as a positive experience, others report troubling thoughts and feelings. “For the entire nine months and beyond, I continued to see my treatment team,” states Sybil. “Without therapy, I’m not sure I would have been able to accept the changing shape of my body. Even with professional help, it was hard to hold my abnormal eating habits in check. On one level, I knew that I had to eat right and gain weight, and I took these responsibilities very seriously, even posting handwritten reminders such as ‘I can and will eat healthy,’ and ‘I can be proud of my progress,’ around the kitchen. On another level, the tyrant in my mind was never quiet. My perception that my belly and breasts were puffing up made me more irritable than ever at the sensation of clothes against my skin. Early in the pregnancy, I was constantly tired, and that bothered me because I’d always pushed myself hard, and napping during the day made me feel lazy, spoiled, and good for nothing.

“Intellectually, I was aware that it is normal and necessary for a woman’s appetite to increase during pregnancy. When I’d get a hankering for a snack, the rational part of me said, ‘That’s good.

Listen to your body.’ But no sooner would I down the snack than the dark side of me would yell, ‘Bad!’ My mind would tell me that my snacks were supposed to be bigger than those I’d taken in before my pregnancy, but my feelings would tell me that what I’d just eaten was much more than I deserved. I’d scold myself for being ‘a pig.’ Then my old, excruciating urge to make myself vomit would come over me. I’m not saying that I purged every time I sensed that I’d overeaten. I’d induced vomiting enough in the past to know that it can lead to dehydration, and I was so nervous that my disordered eating would somehow harm the growing baby that I couldn’t afford to take any chances. My therapists explained that if negative thoughts about my body arose, I should talk about them instead of acting on them. While pregnant, I was mostly able to follow that advice and managed to keep my vomiting to a minimum.

“Preventing myself from vomiting was one problem. Getting myself to eat enough was another. For the most part, I stuck to the meal plan advised by my nutritionist, but there were times I slipped. Darren and I decided that, until I was three months along, we’d keep the news about my pregnancy a secret from everyone except our parents and health care providers. The downside of our privacy policy was that I began gaining weight before most people knew I was having a baby. I was sure that when friends saw me, they’d deem me ‘bad’ for eating more than I should have and ruining my looks. This wasn’t just a passing worry. It grew so intense that I avoided neighbors and friends and became almost as self-conscious about eating in social situations as I had been when my eating disorder had ruled my life. One evening, when I was 10 or 11 weeks pregnant, Darren and I went to a holiday party at the home of a couple we’d known for years. There was a relaxed buffet dinner that I ordinarily might have enjoyed. But when Darren and I walked up to the center table to get our food, I selected tiny portions because something inside me insisted that if I helped myself to what I really wanted, the other guests would look at my plate and conclude, ‘No wonder she’s getting fat.’

“Luckily, the body image troubles in my first few months of pregnancy gave way to a quieter stretch of time. Though I continued to have ‘I’m fat and bad’ thoughts, they now seemed fainter and less disruptive to my everyday life. When I felt the baby moving inside me and my pregnancy started to show, the challenges I was facing as a new mother became more real. In the past, I’d often considered myself a ‘nothing.’ Now that I was having a baby, I felt more like I was becoming a ‘something.’ Having a healthy baby and being a responsible mom gave me a purpose in life and, along with it, a stronger determination to take care of myself.

“This isn’t to say that all was fine and dandy; in fact, at about seven months, my negative body thoughts came back worse than ever. I had gained weight in keeping with my obstetrician’s recommendations, and I felt disgusted by my size. To me, my belly looked like a huge mountain jutting out from the rest of my body.