Practical advice for caring for women with eating disorders during the perinatal period.

Pregnancy is a critical time for women struggling with disordered eating and weight concerns. For the majority of women with eating disorders, symptoms improve during pregnancy. Other women, particularly those with either subclinical or binge eating disorders, are at risk for an escalation of pathologic behaviors, putting both mother and fetus at risk for negative birth outcomes. Routinely screening for eating disorders will help identify those women who will most benefit from specialized care. Attention must be paid to possible harmful comorbid behaviors found in women with eating disorders, such as smoking, alcohol use, abusing laxatives or herbal supplements, and self-injurious behavior. This article reviews the mixed research findings of the impact of eating disorders upon pregnancy and identifies key times in prenatal care where nutritional counseling and specific interventions will increase the likelihood of positive pregnancy outcomes. The postpartum period is another critical time for provider intervention that may lower women's risks for eating disorder relapse, postpartum depression, and breastfeeding difficulties.