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

Wed, 17 Jun 2026 19:41:08 GMT

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 questionnaire ¹⁰ 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

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.
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.
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.
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.
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.
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.
Ward VB. Eating disorders in pregnancy. BMJ. 2008;336(7635):93-96.
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.
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.
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.

Perinatal Management for Emergency Medicine Providers

Mon, 08 Jun 2026 14:31:21 GMT

Brief Training for Emergency Medicine Providers serving pregnant and postpartum people.

Perinatal people often interact with Emergency Services throughout pregnancy and the postpartum period. EM Providers may be asked to weigh in on medication safety in pregnancy, or may have to choose an agent to use acutely in pregnancy or breastfeeding. This video offers clinical advice on how to approach perinatal mental health medications in the emergency setting.

How to Access Perinatal Consultation Through VTCPAP

Thu, 07 May 2026 19:34:18 GMT

Download a printable PDF version of this flyer for your clinic, practice, or care team. Click here to learn more about who is eligible to call.

Can We Create Safer and More Thorough PMAD Screening in Vermont?

Tue, 13 Jan 2026 20:59:11 GMT

Perinatal Mood and Anxiety Disorders (PMADs) affect birthing individuals across Vermont—but our data suggest that BIPOC birthing individuals may be under-identified and under-supported .

At VTCPAP, our perinatal service is aiming in 2026 to work with providers to understand barriers and provide evidence-based strategies to improve detection and care for all Vermonters.

What the Data Shows

Vermont Department of Health: 7–10% of Vermonters identify as non-white
VTCPAP consultations (past year): 4 out of 120 involved non-white patients
Research: Non-majority individuals may experience postpartum depression and anxiety at twice the rate of white individuals

The gap: We should be seeing more consultations for BIPOC patients—but the data show otherwise.

Why Are Screenings Missing BIPOC Patients?

Research points to two main factors :

Trust in providers
Limitations in screening tools

1. Trust Matters

Patients are more honest on the Edinburgh Postnatal Depression Survey (EPDS) when they:

Have a trusted relationship with the provider
Receive a clear explanation of the purpose and use of the screening
Are assured the screen is not used to judge parenting competence or reported to DCF

Why this matters for BIPOC patients:

Studies show BIPOC and immigrant birthing individuals may have less implicit trust in their providers , especially in predominantly white healthcare settings
Fear of being seen as “unfit” can reduce honesty on screenings

Best practice:

Build consistent provider relationships before administering screenings; It is most effective if the MA, RN or MD who administers the screening knows the patient
Preface the screening with supportive language about how the results will be used to support them, not judge them, and what will this look like?

2. Screening Tools May Miss Stress-Related Distress

The EPDS may not fully capture stress experienced by BIPOC patients. There may be stigma around mental health conditions, where people don't readily identify with mental health symptoms, but they may identify as having high stress. Research shows:

High stress levels can be as harmful as depression/anxiety
Tools like the Perceived Stress Scale or Everyday Discrimination Scale can complement the EPDS
Stress scores can trigger interventions similar to positive EPDS screens

Key insight: Stress may reflect unrecognized depression/anxiety or distress not captured due to cultural or systemic barriers.

Strategies for Safer, More Equitable Screening

Small changes can make a big difference:

Designate staff (nurses or medical assistants) who a patient knows already to administer screeners with a short preface about purpose and outcomes
Add stress measures (e.g., Perceived Stress Scale or Everyday Discrimination Scale) to identify hidden distress
Engage VTCPAP for consultation:

Dr. Guth can work with your practice to design a tailored plan
Look out for a virtual education session in early 2026

Goal: Improve detection and care for all Vermont birthing people , especially those historically under-identified.

Action Steps for Providers

Introduce screenings after establishing trust with patients
Explain why the screening is happening and how results are used
Consider adding a stress-focused measure alongside the EPDS
Reach out to VTCPAP for consultation or attend upcoming virtual education sessions

References

Armstrong SJ, Small RE. The paradox of screening: rural women's views on screening for postnatal depression . BMC Public Health. 2010;10:744.
Bauman BL, et al. Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression . MMWR Morb Mortal Wkly Rep. 2020;69(19):575–581.
Dwarakanath M, et al. Barriers to Diagnosis of Postpartum Depression among Younger Black Mothers . Res Sq. 2023.
Kannikeswaran AP, et al. Perinatal providers' attitudes towards culturally relevant infant mental health integration . Front Psychiatry. 2025;16:1644836.
O’Mahony J, Donnelly T. Immigrant and refugee women's postpartum depression help-seeking experiences . J Psychiatr Ment Health Nurs. 2010;17(10):917–928.
Skoog M, et al. Screening immigrant mothers for postpartum depression: a qualitative systematic review . PLoS One. 2022;17(7):e0271318.
Sroka AW, et al. Depression screening may not capture significant sources of prenatal stress for Black women . Arch Womens Ment Health. 2023;26(2):211–217.
Tobin C, et al. Recognition of risk factors for postpartum depression in refugee and immigrant women . J Immigr Minor Health. 2015;17(4):1019–1024.

Perinatal OCD Training: July 1, 2026 Register Today!

Tue, 13 Jan 2026 20:59:08 GMT

Perinatal Mental Health: Key Takeaways for Providers

Tue, 13 Jan 2026 20:59:06 GMT

Perinatal mental health challenge are the most common complication of birth in the US, affecting 1 in 5 birthing parents and 1 in 10 partners or fathers nationally, with even high rates in Vermont: up to a quarter of Vermont families are impacted. Symptoms can begin during pregnancy and onset any time within the first year postpartum. These complications can also impact families that grow by adoption or surrogacy. While hormone shifts play a part, individual histories play an important role. Left untreated, postpartum mood complications can lead to lifelong challenges with depression, anxiety and bonding or attachment cycles, which can lead to more challenges for the entire family later on.

Any provider interfacing with pregnant or postpartum parents should watch for symptoms of mood complications, understanding that at times they will be quite obvious (such as psychosis or profound depression), while other times they may be more mild cases that are still very much in need of treatment intervention. Symptoms can be identified using screening tools such as the Edinburgh Postnatal Depression Scale (EDPS), but this cannot be all that we rely on. Often, mood challenges go un- or under-reported for a host of well-researched reasons. Therefore, it’s up to providers to offer an array of support tools, including ones parents can access on their own if they choose. Offering an informational handout with a list of resources to all perinatal patients as a standard of care is a strong first step. And for physicians and providers who are using screening tools, comprehensive follow up for positive screens is critical. We cannot continue to screen if we are unable or unwilling to follow up on positive results in a comprehensive way.

While the landscape for referrals and support in Vermont may seem barren on the surface, Vermont actually scores amongst the higher ranks in the country for perinatal support according to the Policy Center for Maternal Mental Health 2025 Report Cards. Vermont has made commendable efforts to enhance perinatal support and continues to do so with the recent Maternal Health Innovation grant. While the system isn’t perfect, it’s a strong, forward-moving collaborative effort.

For clinicians practicing in Vermont, there are several state and national resources available to families and providers alike. These include:

Postpartum Support International (PSI) provides provider training, a local provider directory, and free peer support resources. The local Vermont chapter is active so don’t hesitate to reach out to psivt@postpartum.net with questions or referrals.

The Vermont Consultation & Psychiatry Access Program (VTCPAP) perinatal service equips perinatal providers with real-time consultation from perinatal psychiatrists, screening resources, and referral support.

Through to Thrive has a variety of books and online classes for parents who do well with individual, self-paced learning as well as training tools for providers. CEUs are available and training tools include concrete resources and can include consultation for individuals and teams.

References