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Table 4 First and second order themes related to the experience of post-pregnancy for those with an eating disorder as reported in the primary papers

From: The experience of women with an eating disorder in the perinatal period: a meta-ethnographic study

Publication Theme 1 Theme 2 Theme 3 Theme 4
Journal Publications     
 Namer et al. 1986 [50] All lost pregnancy related weight gain, some weighted less.
All concerned and struggling with their weight.
Post pregnancy weight loss “allowed” and given permission to lose weight therefore it was hard to control weight loss.
No longer eating 3–4 meals or quantity of food eaten during pregnancy. All returned to anorexic thinking within several weeks of giving birth. Anxiety about breastfeeding.
Anxiety about not eating enough to breastfeed.
No desire to breastfeed as wanted to be able to lose weight.
 Patel et al. 2005 [27] Loss of pre-pregnancy self
 - Fear of not losing pregnancy weight.
 - Distress about changes and lack of return to pre-pregnancy weight.
Feeding relationship with infant
 - Anxiety and discomfort (need to eat to provide milk).
 - Using breast-feeding to lose weight.
Relationship with family members
 - Comments about post pregnancy body by partner viewed as derogatory or critical.
 Shaffer et al. 2008 [28] Post-partum panic and fear
 - Concern, fear, worry or panic about their bodies post birth
Preconception with body image Worsening of eating disorder symptoms after birth.  
 Stapleton et al. 2008 [54] Benefits for not breastfeeding
 - Choice not to breastfeed to be able to engage in eating disorder behavior.
Perceived positives for breastfeeding
 - Breastfeeding was motivated by the belief it would help with weight loss.
 - Increase in caloric expenditure from breast feeding allowed consumption of additional food (used as a compensatory mechanism instead of purging)
 - Feeling that breastfeeding assuages some of the guilt eating disorder women felt about potential damage done to the child because of the mothers eating disorder.
 - Desire to bottle-feed to ensure child’s nutritional needs are met.
Distress about post pregnancy shape and weight.
Resumption of eating disorder behaviours post pregnancy.
 Taborelli et al. 2015 [49] Loss of the pre-pregnancy body identity, loss of pregnant identity.
 - Distress at post birth body shape
Urge to lose weight increases and is compelling post-birth.
Subsequent pregnancies
Less dissonance between eating disorders and pregnancy in subsequent pregnancies.
 Tierney et al. 2011 [8] Fear of failure
 - Unable to breast feed due to poor mild supply
Emotional regulation
 - Return to exercise quickly post birth to help regulate negative emotions
 Willis & Rand 1988 [55] Majority returned to their pregnancy binge/vomiting levels Extreme distress about post partum body shape prompted relapse.   
Case Studies     
 Little & Lowkes 2000 [52] Increase of eating disorder behaviours postpartum.