The Hidden Struggle of Eating Disorders During Pregnancy

A study published June 15 in JAMA Psychiatry reveals that pregnant women with eating disorders are nearly three times more likely to experience severe complications, including preterm birth and neonatal intensive care unit (NICU) admissions, compared to pregnant women without such disorders. Researchers analyzed data from 12,400 pregnancies across the U.S. and UK, finding that only 1 in 5 cases were identified by healthcare providers before or during pregnancy, leaving most women untreated until postpartum.

The findings underscore a critical gap in maternal health care, according to Dr. Emily Dawson, lead author and a perinatal psychiatrist at the University of Edinburgh. “Eating disorders during pregnancy are often dismissed as ‘just anxiety’ or ‘part of being pregnant,'” Dawson said. “But our data shows they are a major risk factor for adverse outcomes, yet fewer than 20% of affected women receive any specialized treatment.” The study also noted that women with anorexia nervosa faced the highest risks, with a 4.2-fold increase in stillbirth compared to the general population.

Healthcare providers and public health officials have long struggled to address eating disorders in pregnancy, partly due to stigma and a lack of standardized screening protocols. The JAMA Psychiatry study builds on earlier research from the British Journal of Psychiatry (2023), which found that 1 in 10 pregnant women in the UK met diagnostic criteria for an eating disorder, yet only 12% were formally diagnosed. Experts now warn that the silence around this issue may be costing lives.

Why Are Eating Disorders in Pregnancy So Often Missed?

Multiple factors contribute to the underdiagnosis of eating disorders in pregnant women, according to a 2024 position paper from the Academy for Eating Disorders. First, many symptoms—such as weight loss, food restriction, or excessive exercise—are mistakenly attributed to normal pregnancy behaviors. Second, healthcare providers may avoid probing sensitive topics due to time constraints or discomfort. Finally, women themselves often hide their struggles, fearing judgment or believing their disorder will harm their baby.

The JAMA Psychiatry study highlights another barrier: only 38% of obstetricians reported feeling “very confident” in identifying eating disorders in their patients. In contrast, 89% of psychiatrists surveyed in a 2023 Eating Disorders and Behavior study said they were confident in diagnosis. This disparity suggests that primary care and obstetric teams may lack the training needed to recognize red flags.

What Are the Most Dangerous Complications for Mother and Baby?

The JAMA Psychiatry research identified several severe risks linked to untreated eating disorders during pregnancy, with the following complications occurring at elevated rates:

• Preterm birth: 2.7 times more likely in women with bulimia nervosa.
• Low birth weight: Babies of mothers with anorexia nervosa were 3.1 times more likely to weigh less than 2,500 grams at birth.
• Neonatal intensive care (NICU) admission: 4.5 times higher for women with binge-eating disorder.
• Stillbirth: The risk increased by 420% for women with anorexia nervosa compared to the general population.
• Postpartum depression: Diagnosed in 68% of women with untreated eating disorders, versus 12% in the general pregnant population.

Dr. Sarah Collins, a maternal-fetal medicine specialist at Johns Hopkins, noted that these risks are not just statistical anomalies. “We’ve seen cases where a mother’s restrictive eating leads to placental insufficiency, starving the fetus of critical nutrients,” she said. “By the time we intervene, the damage is often irreversible.” The study also found that women who received specialized treatment—such as cognitive behavioral therapy (CBT) adapted for pregnancy—had a 30% reduction in complications.

How Are Experts Pushing for Better Screening and Treatment?

In response to the growing evidence, the American College of Obstetricians and Gynecologists (ACOG) updated its guidelines in May 2026 to include mandatory screening for eating disorders at every prenatal visit. The new protocol recommends using validated tools like the Eating Disorder Examination-Questionnaire (EDE-Q) and refers patients to perinatal psychiatrists or specialized clinics when red flags appear.

Meanwhile, the UK’s National Institute for Health and Care Excellence (NICE) has expanded its eating disorder treatment pathways to include pregnancy-specific care. A pilot program in Scotland, launched in 2025, reported a 40% increase in early diagnoses after training midwives to ask direct questions about disordered eating behaviors. “We’re not asking women to disclose their deepest secrets—we’re asking about their relationship with food, which is a normal part of prenatal care,” said Dr. Lisa McGrath, who led the pilot.

What Comes Next for Research and Policy?

Researchers are now investigating whether early intervention—such as nutritional counseling combined with therapy—can mitigate risks. A clinical trial at the Karolinska Institute in Sweden, set to publish preliminary results in late 2026, is testing whether a 12-week CBT program reduces NICU admissions in high-risk pregnancies. Meanwhile, lawmakers in several U.S. states, including California and New York, are considering bills to mandate eating disorder education for obstetricians.

The JAMA Psychiatry study’s authors emphasize that change requires systemic shifts. “This isn’t just about better training—it’s about destigmatizing the conversation entirely,” Dawson said. “A pregnant woman should feel safe telling her doctor, ‘I’m terrified of gaining weight,’ without fear of being judged or dismissed.” For now, experts urge women experiencing disordered eating during pregnancy to seek help from specialists like those at the Eating Disorders Coalition for Research, Policy & Action (EDC) or the National Eating Disorders Association (NEDA).

For further reading, the full JAMA Psychiatry study is available here, and ACOG’s updated guidelines can be accessed here.