PREGNANT with her first child but terrified about piling on weight, a 30-year-old housewife in Singapore became obsessed with dieting and exercise.

The former marathon runner ran several kilometres every day even into her last trimester.

But Beth (not her real name) paid the price for her obsession - her baby was born premature and had health problems.

She's not alone. There's now a term to describe the trend of pregnant women with eating disorders - pregorexia.

Pregorexics, as the women are referred to, go to such extremes in their quest to remain trim that they put their baby's health in jeopardy.

In Beth's case, apart from regular exercise, she was also strict with her diet, taking minimal carbohydrates and fat.

She controlled her appetite to the extent that her husband always complained about it during antenatal visits with Dr Peter Chew, a senior consultant gynaecologist at Gleneagles Medical Centre.

Beth eventually went into premature labour. The baby was small and had signs of IUGR (intra-uterine growth restriction), and had to be kept in neonatal intensive care.

Dr Helen Chen, head and senior consultant psychiatrist at KK Women's and Children's Hospital's mental wellness service, said the condition is generally described as anorexia nervosa (or eating disorder) in pregnancy.

It's a small but growing problem around the world.

This week, the New York Times featured a pregorexic woman whose secret obsession caused her child to be born premature, suffer seizures and attention deficit problems.

In March, a documentary on pregorexia, titled The Truth About Super Skinny Pregnancies, filmed by Louise Redknapp, former Eternal singer and wife of former Liverpool footballer Jamie Redknapp, was aired in the UK.

Local doctors said pregorexia is rare in Singapore. The opposite is usually the case here - mothers gaining too much weight during pregnancy.

Dangerous for mum, child

Dr Tan Hak Koon, a senior consultant with Singapore General Hospital's department of obstetrics & gynaecology, said severe dieting during pregnancy has dangerous consequences for both mother and child.

The baby could be premature, suffer from IUGR, have low blood oxygen levels, hypoglycemia, and may suffer foetal anomalies. In severe cases, it may develop brain and spine defects like spinal bifida.

The mother may suffer from dehydration, hypotension, giddy and fainting spells, electrolyte imbalances, and anaemia, all of which have impact on foetal development.

Dr Tan added that malnourished mums are less able to stand the stressful process of labour and loss of blood. They may even suffer from hypotension and heart failure during labour.

'That's why we always tell mothers they should be in the pink of health. It's dangerous to go through labour if the body is not in the best condition,' he said.

Dr Chen added that psychologically, such mums may be at risk of developing depression, which often co-exists with eating disorders.

Why do mums do this?

Given all the consequences, why do these mums-to-be do it?

Dr Chen said those with underlying eating disorders, particularly anorexia nervosa, are most at risk.

These are women who have recovered from anorexia, and regained their fertility - those in the most acute phase are severely underweight, stop menstruating and are not fertile.

But, they continue to struggle with weight and body-image issues.

Dr Chen recalled one patient she saw, who was in her 30s and had anorexia as a teenager. Her symptoms had settled, but she remained weight-conscious.

'During her pregnancy, she was very worried about putting on weight, so much so that she would constantly monitor her weight, and limit her (food) intake, as well as go for long walks to ensure her weight didn't go out of control,' said Dr Chen.

Even though her doctors expressed concern that her baby girl was small and she needed to eat more, she struggled with this.

This echoes a King's College London study last year involving more than 12,000 British women who recently suffered an eating disorder.

It showed that a significant proportion of them continued to diet, use laxatives, exercise excessively and practise self-induced vomiting throughout pregnancy, with more than a quarter of women admitting to making themselves throw up during the first trimester.

In the US, CBS reported that some women may have been 'thin-spired' to be pregorexic, no thanks to images of skinny pregnant celebs with their 'barely-there' bumps, like Nicole Richie and Nicole Kidman. This echoes the influence that skinny celeb images have on teens suffering eating disorders.

So how is pregorexia treated?

Doctors agreed that a multi-disciplinary approach is needed - the gynaecologist for the physical needs of the mother and baby, a dietitian for her nutritional needs, and most importantly, counselling and therapy to deal with the mum-to-be's unrealistic fears and thoughts about weight gain.

Dr Chen said for women experiencing significant depressive symptoms, there are medications that can be considered.

Spouses and loved ones should also get involved to provide support and encouragement.

Dr Chew reminded all mothers-to-be that everything should be done in moderation, whether it's exercise, diet or weight gain.

'The patient should follow the advice of the obstetrician with regards to the well-being of the baby as clinical experience is important in the management of the pregnancy,' he said.

Dr Chen advised family members who notice signs such as excessive dieting or exercising to persuade the mum-to-be to seek help early.

Dr Beh Suan Tiong, a gynaecologist at Thomson Medical Centre, hoped that a mother's love and instinct to protect her unborn child will ultimately prevail.

He said: 'Pregnancy is always a strong motivational factor for women to look after their own health better.'



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Fat babies cute, but unhealthy

MOST mums in Singapore tend to have the opposite of pregorexia - over-eating and putting on too much weight.

Dr Cathryn Chan, a gynaecologist at Gleneagles Medical Centre with almost 20 years' experience, said the ideal weight gain during pregnancy is between 10kg to 12kg, but many hit 15kg, even 20kg. She said 30 to 40 per cent of her patients exceed the ideal weight.

Dr Lee Keen Whye, a gynaecologist of over 25 years at Gleneagles, said about half his patients end up gaining too much weight.

Said Dr Chan: 'They tend to put on weight because they are under the belief they must eat more. They want to eat all the good things, like bird's nest, the sweet things, that their in-laws and parents give them.'

Dr Lee said these mothers go on an 'eating spree' because there is a misconception that the more the mother eats, the more nutrients go to the baby.

'That's not true. Once the requirement for the baby is satisfied, the excess goes to the mother in the form of fat.'

These mothers then struggle to lose the weight after giving birth. Overly-heavy babies could suffer health problems later in life, like obesity and diabetes.

Their size could also make the labour process more dangerous for the mother.

Said Dr Lee: 'I'm usually the one to tell them, 'Please cut down the carbo, be wary of diabetes.'

'It's the Asian culture, kiasuism. Everyone says, 'eat more, eat more'. And they think fat babies are cute.'

His advice to mums-to-be: Slow down and be careful about what you eat.

This article was first published in The New Paper