Eating Disorders in Pregnancy and Postpartum: Screening, Identification, and Referral Considerations for Perinatal Clinicians

Emily Piazza, MS, RDN, CD, Registered Dietitian Nutritionist, Certified Intuitive Eating Counselor, Birth Doula at Nourished Journey • June 17, 2026

Emily Piazza, MS, RDN, CD, Registered Dietitian Nutritionist, Certified Intuitive Eating Counselor, Birth Doula at Nourished Journey (www.nourishedjourney.co)

Why Eating Disorders Matter in Perinatal Care

Eating disorders (EDs) are among the most lethal psychiatric illnesses and disproportionately affect individuals during their reproductive years. Approximately 5–7.5% of pregnant individuals meet diagnostic criteria for an eating disorder, likely underreported underidentified, due to the overlap between ED symptoms and expected physiological changes of pregnancy.¹,²

 

Restrictive eating, food rituals, excessive exercise, body checking, binge eating, and compensatory behaviors may be dismissed as normal concerns about nutrition, weight gain, or postpartum recovery. Pregnancy and the postpartum period can also precipitate relapse among individuals with a history of anorexia nervosa, bulimia nervosa, binge eating disorder, or other specified feeding and eating disorders.³


The consequences of untreated eating disorders extend far beyond nutrition. A growing body of evidence demonstrates associations between eating disorders and adverse obstetric and neonatal outcomes, including miscarriage, hyperemesis gravidarum, preterm birth, fetal growth abnormalities, cesarean delivery, and low birth weight.⁴,⁵

 

Eating disorders are also strongly associated with perinatal depression, anxiety, obsessive-compulsive symptoms, impaired maternal-infant feeding relationships, and elevated risk of suicidality.

 

Given that eating disorders carry one of the highest mortality rates among psychiatric conditions, early identification and intervention are essential components of perinatal mental health care.⁴,⁶

Screening During Pregnancy and Postpartum

Screening for eating disorders should be considered throughout pregnancy and the first postpartum year, particularly for patients with a history of dieting, weight cycling, body image concerns, fertility challenges, mood disorders, or previous eating disorder treatment.

 

Screening can be incorporated into prenatal and postpartum visits using brief validated tools such as the SCOFF questionnaire10 or through direct clinical inquiry about restrictive eating, binge eating, purging behaviors, compulsive exercise, body dissatisfaction, and fear of weight gain. Clinicians should recognize that pregnancy-related nausea, food aversions, gestational diabetes management, breastfeeding, and postpartum weight changes can obscure disordered eating behaviors and delay diagnosis. A patient's eating disorder history should be viewed as a significant risk factor for recurrence, even if symptoms appear to be in remission.³,⁷


Clinicians should also be aware that eating disorders occur across the weight spectrum and are frequently missed in patients living in larger bodies. Research demonstrates that people with atypical anorexia nervosa and other eating disorders may present with serious medical and psychological complications despite having body weights that fall within or above the "normal" range.⁸,⁹ Weight loss, dietary restraint, or excessive exercise may be inadvertently praised by healthcare providers, reinforcing disordered behaviors and delaying appropriate intervention.

 

For this reason, screening should focus on eating behaviors, psychological distress, body image concerns, and compensatory behaviors rather than body size or weight status alone.

Questions to Ask During Prenatal and Postpartum Visits

Many patients will not disclose ED symptoms unless directly asked. Incorporating a few nonjudgmental questions into routine care can help identify concerns early:


  • Have you ever been diagnosed with an eating disorder or received treatment for concerns related to food,
    eating, weight, or exercise?
  • Do you find yourself worrying about your weight, body shape, or pregnancy-related body changes more than you
    would like?
  • Have you been intentionally restricting food, skipping meals, or avoiding certain foods in an effort to control your
    weight or shape?
  • Have you experienced episodes of feeling out of control with eating or eating large amounts of food?
  • Have you used vomiting, laxatives, excessive exercise, fasting, or other methods to compensate for eating?
  • How are you feeling about changes in your body during pregnancy or postpartum?
  • Has feeding yourself felt stressful, overwhelming, or emotionally difficult recently?


These questions can be particularly valuable when caring for patients with a history of eating disorders, infertility, gestational diabetes, mood disorders, trauma, or significant body image concerns.

Referral and Treatment Considerations

Effective treatment of perinatal eating disorders requires a multidisciplinary approach that may include obstetric providers, primary care clinicians, mental health professionals, psychiatrists, and Registered Dietitian Nutritionists (RDNs) with specialized training in both eating disorders and perinatal nutrition.


Major eating disorder organizations, including the Academy for Eating Disorders (AED), increasingly recognize the importance of weight-inclusive approaches that focus on health-promoting behaviors, nutritional rehabilitation, and psychological recovery rather than weight-focused interventions. This approach is particularly important during pregnancy and postpartum, when body changes are expected and medically necessary. 


Early referral and coordinated care can improve maternal mental health, support infant feeding outcomes, and reduce the risk of long-term complications for both parent and child.

Resources for Patients and Families

The following organizations provide evidence-based education, support, and referral resources for individuals experiencing eating disorders during pregnancy and postpartum:


  • National Eating Disorders Association (NEDA) – Screening tools, treatment referrals, educational materials, and recovery resources.
  • Postpartum Support International (PSI) – Perinatal mental health support, provider directories, and online support groups. PSI offers specialized support groups for individuals experiencing perinatal mood and anxiety disorders and can assist families in finding local treatment providers.
  • Project HEAL – Access to treatment resources, support groups, and financial assistance programs for eating disorder care.
  • ANAD (National Association of Anorexia Nervosa and Associated Disorders) – Free peer support groups, mentorship, and recovery support.
  • Local Registered Dietitian Nutritionists and therapists with expertise in eating disorders and perinatal health.

Key Takeaways for Clinicians

  • Eating disorders are common during pregnancy and postpartum but frequently go undetected.
  • Pregnancy-related symptoms and postpartum body changes can mask eating disorder behaviors.
  • Eating disorders occur across the weight spectrum and should not be ruled out based on body size.
  • Eating disorders are associated with adverse obstetric, neonatal, and mental health outcomes.
  • A history of an eating disorder is one of the strongest predictors of symptom recurrence during the perinatal period.
  • Routine screening and early referral can improve outcomes for both parent and infant.
  • Patients do not need to meet diagnostic criteria to benefit from treatment
  • Whenever possible, refer patients to eating disorder-informed providers who practice from a weight-inclusive, non-diet approach.

References

  1. Bulik CM, Von Holle A, Hamer R, et al. Patterns of remission, continuation, and incidence of broadly defined eating disorders during early pregnancy in the Norwegian Mother and Child Cohort Study (MoBa). Psychol Med. 2007;37(8):1109-1118.
  2. Berg CK, Torgersen L, Von Holle A, Hamer R, Bulik CM, Reichborn-Kjennerud T. Eating disorders, pregnancy, and the postpartum period: Findings from the Norwegian Mother and Child Cohort Study. Norsk Epidemiologi. 2015;24(1-2):51-62.
  3. Knoph Berg C, Torgersen L, Von Holle A, et al. Course and predictors of maternal eating disorders in the postpartum period. Int J Eat Disord. 2012;45(2):253-262.
  4. Das Neves MDCC, Teixeira AA, Ferreira LV, et al. Eating disorders are associated with adverse obstetric and perinatal outcomes: A systematic review. Rev Bras Psiquiatr. 2022;44(2):201-214.
  5. Martínez-Olcina M, Rubio-Arias JÁ, Hernández-García M, et al. Eating disorders in pregnant and breastfeeding women: A systematic review. Nutrients. 2020;12(8):2399.
  6. Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality rates in patients with anorexia nervosa and other eating disorders: A meta-analysis of 36 studies. Arch Gen Psychiatry. 2011;68(7):724-731.
  7. Ward VB. Eating disorders in pregnancy. BMJ. 2008;336(7635):93-96.
  8. Harrop EN, Mensinger JL, Moore M, Lindhorst T. Restrictive eating disorders in higher weight persons: A systematic review of atypical anorexia nervosa prevalence and consecutive level of care admissions. Int J Eat Disord. 2021;54(8):1322-1341.
  9. Sawyer SM, Whitelaw M, Le Grange D, Yeo M, Hughes EK. Physical and psychological morbidity in adolescents with atypical anorexia nervosa. Pediatrics. 2016;137(4):e20154080.
  10. Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: a new screening tool for eating disorders. West J Med. 2000 Mar;172(3):164-5. doi: 10.1136/ewjm.172.3.164. PMID: 18751246; PMCID: PMC1070794.