1. Getting weighed at prenatal appointments

I haven’t owned a scale since I chose full recovery in 2013, and I usually ignore the number at doctor visits. Pregnancy complicates that because providers routinely check weight. I could tell the doctor I don’t want to see it (and I advise my clients to do the same), but I often tell myself I can handle it and forget the number the next day. Still, for people without practiced skills, seeing that number can be a strong trigger. It takes commitment and the ability not to attach meaning to the digits.

Skills you need:

• By now you should have internalized that numbers (weight, calories, etc.) do not control your mood or actions. Numbers can change daily and do not measure your health or worth.
• You have learned to notice intrusive thoughts about weight or image and to move on consciously rather than ruminating.

2. First-trimester growth and others’ perceptions

In early pregnancy you may be getting bigger before you look “pregnant.” People noticing weight gain can stir old fears about “what others will think.” Many who developed an eating disorder wanted to get better but feared weight gain and judgment. Recovery is choosing to accept and love yourself no matter what you look like. Pregnancy and postpartum will test that choice, but they don’t undo the work you’ve already done.

Skills you need:

• You have learned that you can’t control what others think of you. Feeling worthy is an inner job: you choose to see your worth because you exist, not because of external conditions.
• You have learned to trust your body and its differences. Body size, pregnant or not, doesn’t determine health or worth; when your body grows, it is accommodating the baby.

3. Loss of control

You can’t control your body changing, the baby’s health, genetic predispositions, or sudden, unexplained losses — and your life will shift dramatically with a new human. While most pregnant people feel anxiety about the unknown, women who have had an eating disorder are likely to be very anxious people to start with, so the lack of control during pregnancy can be a trigger.

Skills you need:

• You have learned that your eating disorder once helped you cope with uncertainty or difficult emotions like anxiety, sadness, or stress.
• You have learned to feel your feelings: you can embrace the anxiety that comes with pregnancy’s unknowns and choose to trust life even though you can’t control everything.
• You have learned healthier ways to cope with difficult emotions, such as talking to people you trust, releasing emotion through crying, journaling, or exercising.

4. Shifts in hunger

Less hunger: For some, reduced appetite can remind them how “good it felt to not eat.” People who severely restricted food used to feel strength or security in not eating, and that empty-stomach sensation can bring back old thoughts and emotions.

Heightened hunger: Increased appetite or strong cravings can remind those who experienced binge eating of how it used to feel to cope with food in large amounts or to eat quickly. If you’ve been recovered for a while you’ve learned to listen to your body, but pregnancy strong cravings and fullness can still stir memories of bingeing.

Skills you need:

• You have learned to pause, identify, and challenge distorted thoughts about returning to ED behaviors or beliefs. Recovery means you aren’t dealing with ED thoughts daily, but life can bring challenges and old thoughts may return. If you have challenged or ignored ED thoughts before, you can do it again.
• You have learned to listen to your body when hungry and when full, despite the thoughts or emotions you might be having. If for any reason you aren’t getting enough nutrition and you feel weak, seek professional help so your body gets the nutrients needed to keep you and your baby healthy.

5. Nausea and past purging

Nausea is particularly triggering for people who used forced vomiting as a purging method. Unintentional vomiting can recreate sensations that once provided relief, numbness, or calm. Without tools to manage difficult emotions or intrusive thoughts, those sensations can bring back memories of harmful coping.

Skills you need:

• Rely on the healthy coping mechanisms you developed to avoid reverting to vomiting, and seek medical support for nausea when needed.
• Practice self-compassion and trust that your body is doing the best it can. Trusting your body helps you be patient during this phase and encourages you to seek medical help if you feel you are losing nutrition.

Final thought

This post aims to validate how certain aspects of pregnancy can trigger a relapse or make recovery seem fragile. Remember you are always capable of full recovery. If you are experiencing any of these challenges during pregnancy, know that developing and using specific skills can help you embrace your pregnancy while overcoming these triggers. Pregnant women need emotional support, and that’s especially true for those who have recovered from—or are recovering from—an eating disorder.