Body image and eating habits during pregnancy and postpartum: Themes and suggestions for maternal healthcare

Abstract

Background.

Pregnancy to postpartum is a critical transition period for changes in mental health, including disordered eating habits and body image concerns. In order to understand why some people experience new or worsening eating disorder symptoms during this period, it is important to gather insights from individuals with recent lived experience of pregnancy. Lived experience is also valuable for informing how to best address eating disorder concerns in obstetric healthcare settings.

Methods.

Women around eight weeks postpartum (N = 175) completed surveys that included open-ended questions about eating habits, body-related self-perception, and healthcare experiences during the peripartum period. These responses were coded using structured tabular thematic analysis to identify common themes.

Results.

45% and 25% of participants in our sample endorsed self-critical responses to changes in body shape/weight and eating habits respectively. Smaller proportions of the sample endorsed acceptance of or empowerment from physical changes. Factors that impacted how individuals responded to physical changes included expectations, social factors, physiological factors, and stage of pregnancy. Commonly endorsed suggestions for healthcare providers included reduced weight-focused judgment and increased nutritional guidance.

Conclusion.

Identified themes provide insight into what factors may contribute to risk for unhelpful changes in eating habits and body image concerns during pregnancy and postpartum. Future research should quantitatively explore these themes and their relation to postpartum mental and physical health outcomes. This research highlights the importance of incorporating lived experience into discussions of peripartum mental health and obstetric healthcare.

The pregnancy-to-postpartum transition is marked by considerable physical and behavioural changes, including significant changes to eating behaviours and body shape and weight (Mayo Clinic, 2009). These changes to one’s body and food intake, and the sociocultural context in which they occur, engender risk for changes in eating disorder (ED) symptoms. Peripartum ED risk is critical to study, as EDs during pregnancy have been found to be associated with poor mental and physical health outcomes, including depression, anxiety, low birthweight, gestational diabetes, and hypertension (Janas-Kozik et al., 2021; Kimmel et al., 2016). Prior research suggests that among individuals without an ED history, ED symptoms often worsen during pregnancy and remain higher during the postpartum period (Coker & Abraham, 2015; Easter et al., 2015). However, other studies have found no change or decreasing ED symptoms during this period (Micali et al., 2011; Rocco et al., 2005). Understanding how individuals respond and adapt to pregnancy-related body and eating changes may aid in explaining this discrepancy in the literature. Qualitative research specifically can help understand the pathways through which peripartum ED risk changes through leveraging insights about eating, body image, and healthcare experiences from individuals with recent lived experience.

Nutritional and Eating-Related Factors

Research on eating and nutrition during pregnancy has been a critical topic given the direct implications for short- and long-term foetal growth and development. Prior research has identified guidelines for eating during pregnancy, including increased caloric intake based on stage of pregnancy, recommended supplements (e.g., folic acid), and recommendations regarding macronutrient consumption (Ho et al., 2016; Tsakiridis et al., 2020). However, formal guidelines for nutritional intake during pregnancy vary considerably, and pregnant people may receive widely differing recommendations from medical professionals, family members, and online sources (De Vito et al., 2022; Tsakiridis et al., 2020). Additionally, this nutritional guidance largely focuses on infant health markers, and often ignores important considerations, barriers, and implications for the pregnant person. For example, well-established changes in appetite during pregnancy, such as increased or decreased appetite, cravings, and aversions, may lead to changes in eating and difficulty adhering to nutritional guidelines (Forbes et al., 2018).

Further, in a recent qualitative study assessing how pregnancy changed food perceptions, participants endorsed both positive changes to their eating-related attitudes and behaviours, such as reducing restrictive eating, and negative changes, such as increased guilt or worry regarding food intake (Vanderkruik et al., 2022). These changes in eating habits may increase risk for engaging in unhealthy eating behaviours (e.g., overeating, restrictive eating), even among individuals with no history of these behaviours. Indeed, binge eating, loss of control eating, and restrictive eating behaviours are common in pregnancy, and were endorsed by one third and one half of peripartum people respectively in a community sample (Christian, 2022; Donofry et al., 2021). Among individuals without a diagnosable ED, disordered eating during pregnancy has been shown to be associated with postpartum disordered eating, anxiety, and depression, suggesting that even subclinical disordered eating behaviours can have a marked impact on maternal mental health (Chan et al., 2019). It is important to explore lived experiences of eating changes during pregnancy, as well as how and why people respond to these changes, to better understand risk for developing disordered eating habits across this vulnerable period.

Body Dissatisfaction and Mood

Body changes, such as gaining weight, abdomen increasing in size, and fat redistribution, are another important adaptation that occurs in pregnancy to support healthy foetal development. Parallel with these physical changes, many peripartum individuals experience shifts in how they view or evaluate their body, which can confer risk for worsening ED symptoms (Hodgkinson et al., 2014). For example, prior research suggests that many individuals experience heightened body dissatisfaction in response to weight gain during pregnancy (Coker & Abraham, 2015).

Body dissatisfaction not only increases during pregnancy for many individuals, often peaking in the third trimester, but also frequently endures into the postpartum period (Chan et al., 2020; Coker & Abraham, 2015; Lee, Bolton, et al., 2025). One study found individuals experienced heightened body dissatisfaction at six-month and 1-year postpartum check-ins compared to dissatisfaction experienced prior to pregnancy (Coker & Abraham, 2015). For many pregnant people, body dissatisfaction may increase during the postpartum period, given the reduced social acceptance of body changes and the internalization of pressure to “bounce back” to one’s pre-pregnancy body (Hicks & Brown, 2016; Lee, Bolton, et al., 2025). However, not all individuals experience worsening body image during pregnancy. For example, in a prior study, 20% of pregnant participants endorsed bodily appreciation and 15% endorsed increased bodily comfort (Vanderkruik et al., 2022). Thus, it is important to understand how and why peripartum individuals respond to pregnancy-related physical changes to better understand risk for increasing body dissatisfaction and ED symptoms.

Sociocultural Context and Health Care Implications

In discussing ED risk during the peripartum period, it is important to consider how sociocultural norms and expectations impact the psychological well-being of pregnant people. For example, research in western culture using a social anthropological framework showed that magazines often portray an idealized postpartum body, rather than heterogeneous, realistic body representations (Roth et al., 2012), demonstrating how the media may impact expectations of one’s peripartum body. Additionally, qualitative studies have found that body-related comments from others during pregnancy were commonly reported to impact body image either positively (e.g., supportive comments) or negatively (e.g., perceived negative comments about size; Vanderkruik et al., 2022). These studies exemplify how sociocultural factors around food and body changes during pregnancy may perpetuate weight-related biases and increase ED risk.

Medical providers also play a critical role regarding how people view their bodies and eating during pregnancy and postpartum, which may mitigate or exacerbate ED risk. For example, providers may perpetuate weight stigma, or negative beliefs or stereotypes based on weight, during perinatal health visits through making weight-based judgments, providing unsolicited weight loss advice, and differential treatment of patients in larger bodies (Incollingo Rodriguez et al., 2020; Mulherin et al., 2013). Weight stigma experienced from obstetric providers has been shown to be associated with postpartum weight gain, disordered eating, and depressive symptoms (Hill & Incollingo Rodriguez, 2020; Incollingo Rodriguez et al., 2019). Even among well-intentioned providers, routine medical practices in obstetrics, such as weighing during appointments and the use of body mass index, could exacerbate risk for body dissatisfaction and ED symptoms (Holton et al., 2017). However, little is known about how maternal healthcare experiences impact ED risk. Despite the ideal positioning of obstetric professionals to identify and support women with ED symptoms, lack of training, provider attitudes about EDs, and stigma are among identified barriers limiting discussions about ED symptoms (Bye et al., 2018). It is important to incorporate lived experiences of healthcare among pregnant people to inform obstetric healthcare and improve communication and intervention around weight and eating during the peripartum period.

Current study

The current study (N = 175 individuals assessed at eight weeks postpartum) aims to fill gaps in the literature by elucidating personal experiences of eating, body image, and healthcare experiences among a community-based sample of pregnant people. In this study, we asked participants to provide short responses (i.e., a few sentences) to questions about changes in eating habits and body image during pregnancy and postpartum, as well as perceived gaps in mental health, body image, and eating support from healthcare providers. We identified themes from these data, which may help identify concrete directions for obstetric and maternal healthcare to better address ED risk among pregnant individuals.

First, we hypothesized that many participants would endorse changes in body image and eating habits across the peripartum period, and that participants on average would report worsening body-related self-image during this period. Second, we predicted some individuals would endorse self-compassion and acceptance of pregnancy-related challenges, while other women may be self-critical or use dieting behaviours to retain “control” of physical changes. Third, we hypothesized that participants would identify lack of mental health support and weight-focused care as areas for improvement within obstetric healthcare.

Methods

Participants

Participants in the current study were 175 postpartum women recruited as part of a larger study on eating, body image, and mental health during the peripartum period (Christian et al., 2024). At baseline, participants were ≥18 years of age and currently experiencing pregnancy. Qualitative data utilized in the current study was collected within surveys administered at the second timepoint, emailed to participants eight weeks after participants’ self-reported due date. There were no specific exclusion criteria. See Table 1 for sample demographic and descriptive information.

Table 1.

Sample Demographics and Descriptives

		n (%)	M (SD)	Range
Age			31.07 (5.16)	19-45
Number of children			0.72 (1.06)	0-7
Body mass index			28.52 (6.94)	17.8-60.2
Trimester
	First	38 (21.8)
	Second	69 (39.7)
	Third	67 (38.5)
Gender
	Cisgender women	175 (100)
Sexual Orientation
	Heterosexual	155 (89.1)
	Bisexual	15 (8.6)
	Lesbian/Gay	1 (0.6)
	Not disclose	3 (1.7)
Marital status
	Single, never married	18 (10.3)
	Married/remarried	149 (85.6)
	Divorced/Separated	7 (4.1)
Income
	Less than $25,000/year	4 (2.3)
	$25,000-50,000/year	22 (12.6)
	$50,000-100,000/year	72 (41.3)
	$100,000-200,000/year	62 (35.6)
	Over $200,000/year	12 (6.9)
	Missing	2 (1.1)
Ethnicity
	Non-Hispanic White	155 (89.1)
	Asian or Asian American	3 (1.7)
	Non-Hispanic Black	3 (1.7)
	Multiracial or Biracial	6 (3.4)
	American/Alaskan Native	1 (0.6)
	Hispanic	5 (2.9)
	Other/Not listed	1 (0.6)
Self-reported lifetime ED diagnoses:
	Anorexia nervosa	8 (4.6)
	Bulimia nervosa	4 (2.3)
	Binge eating disorder	1 (0.6)
	Other ED	12 (6.8)
	No ED diagnostic history	150 (86.2)
Lifetime mood disorder		43 (24.7)
Lifetime GAD		62 (35.6)
No lifetime mental health diagnosis		84 (48.3)

Note. ED = eating disorder; GAD = generalized anxiety

Procedures

All study procedures were approved by the University of Louisville Institutional Review Board. Participants were recruited during pregnancy using social media posts and advertisements. Given this recruitment strategy, several methods were used to remove possible bots and careless responders and ensure reliable data (See Christian et al., 2024 for additional information about data exclusion procedures). Participants provided informed consent before completing a battery of surveys on REDCap asking about demographics, mood, and ED symptoms online (Harris et al., 2019). Participants were contacted again eight weeks after their self-reported due date (an average of 5.9 months after baseline) to complete a second battery of surveys online, which included short-form, open-response questions about their experiences during pregnancy and postpartum. Participants were entered into a drawing for a $100 gift card for completing the surveys at each timepoint; participants completing all timepoints were entered into a drawing for an additional $100 gift card.

Measures

The open-response questions utilized in this project were designed for the purpose of this study. These questions were drafted by the first author, and revised based on feedback from a team comprising mentors, collaborators, peers, and research assistants who study EDs and/or peripartum mental health. The goal of these questions was to elicit open feedback from participants about body image, eating, and healthcare experiences during pregnancy and postpartum that could be used to inform future quantitative research, obstetric care, and peripartum health interventions.

Participants were provided the following instructions prior to reading the open-response questions, “We want to hear more about your unique experiences during pregnancy. Please answer the following questions in your own words to best reflect your experience.” Participants were then asked three sets of questions: “What changes did you notice about your body during and after this pregnancy? How did these changes to your body impact how you think or feel about yourself?”, “What changes did you notice about your eating habits during and after this pregnancy? How did these changes with your eating habits impact how you think or feel about yourself?”, and “How could health care providers, medical professionals, or your community better support your mental health, body image, or eating habits during pregnancy?”

Thematic Analysis

This study used Structured Tabular Thematic Analysis (ST-TS) in Microsoft Excel to analyse brief qualitative responses, following recommendations from Robinson (2021). This study used hybrid inductive and deductive approaches to developing coding schemes and themes, as there is considerable research on eating and body changes during pregnancy and postpartum, but little research on individuals’ responses to physical and behavioural changes. Steps were taken to minimize bias in the identification of themes, including deidentifying data for coding so that it did not include any participant characteristics, using active collaborative coding with multiple coders, and reflection on and documentation of positionality.

For each question, a-priori themes were developed based on a review of the literature. Second, both qualitative analysts read responses and notated possible codes and themes. Third, codes and themes were revised and integrated with a-priori theory and themes. At this stage, the independent analysts discussed identified codes and themes and reached agreement on the final thematic framework. Fourth, each analyst coded the responses with the agreed upon themes and subthemes. Fifth, inter-analyst agreement was calculated on 25% of responses by adding total number of agreements + disagreements. Consistent with past research, 80% agreement between analysts was considered good agreement (Robinson, 2021). If 80% agreement was not attained, the two analysts would discuss themes and revise until coding revealed at least 80% agreement. All themes reached this threshold, with inter-coder agreement ranging from 80-99% across themes. Sixth, theme frequencies were tabulated to estimate the prevalence of themes and subthemes across participants in the sample.

Results

Body and Body Image Changes during Pregnancy

Table 2 reports identified themes, subthemes, and additional examples regarding body changes and how these changes impacted self-image and mental health during pregnancy and postpartum. Overall, participants endorsed a variety of body changes during this transitional period, including changes to body shape (62%), body weight (52%), pain (25%), and fitness (15%). Participants responded differently to bodily changes, with the most common response being self-criticism or distress regarding self-image (45%). For example, one participant noted “Now that it's been ten weeks [postpartum] and my body remains different, I see it as sort of shameful and unattractive.” Other responses included a desire to change one’s body or return to pre-pregnancy body (25%) and feeling empowered by the function of one’s body (19%), with one participant stating “I love looking at my belly and thinking about how my beautiful baby grew in there”. Participants reported several factors that impacted how they responded to body changes, such as stage of pregnancy/postpartum (24%), social pressures (23%), comparison making (21%), and birthing experience (6.5%). One participant noted, “Everyone said the weight would just "melt off" and so far that hasn't happened.” In terms of peripartum stages, many participants endorsed feeling a shift in body image during the early postpartum period; for example, one participant expressed, “I loved my pregnant body. My postpartum body feels ruined.”

Table 2.

Themes and Theme Endorsement for Body Changes and Body Image during Peripartum Period

Theme	Subtheme	Example Quotation (s)	Count (%)
Types of body changes	Changes in weight	1. “I gained weight quickly at the beginning of pregnancy.” 2. “I lost a lot of weight during my pregnancy, which was unexpected.”	91 (52.0%)
	Changes in shape and surface changes (e.g., skin)	1. “I noticed the weight gain in my face and thighs” 2. “Loose tummy skin, bigger tummy and stretch marks.”	109 (62.3%)
	Changes in strength or fitness	1. “I… lost more muscle, which makes me feel less good and less fit.” 2. “During pregnancy my body felt stronger.”	25.5 (14.6%)
	Changes in health or physical pain	1. “During the pregnancy I had shortness of breath which resolved immediately at delivery.” 2. “I experienced pelvic organ prolapse.”	44 (25.1%)
Response to body changes	Feeling empowered about function of body	“During pregnancy I really loved my body and how it was changing with my growing baby”	34.5 (19.7%)
	Self-critical or uncomfortable emotions	“I hate how I look. I hate my weight. I'm disgusted with how I look, how clothes fit, how fat I am.”	79 (45.1%)
	Desire to change body or return to pre-pregnancy	“I gained a lot of weight and am unhappy about that. I hope I am able to lose it in the next few months.”	45 (25.7%)
	Accepting or neutral about changes	“These changes have not negatively impacted the way I feel about myself and I accept these changes.”	31.5 (18.0%)
Factors that impacted body image change	Making comparisons based on past or others’ experiences	“I gained a lot more weight with this pregnancy than with my others.”	37.5 (21.4%)
	Social perception or acceptability of body changes	“The weight gain and stretch marks have hit my ego. I don't feel as pretty or sexy…My husband has even joked about it.”	40 (22.8%)
	Birthing experience (e.g., traumatic birth)	“I …went in to preterm labor shortly after with cervical insufficiency. Since birth I haven't fully trusted or appreciated my body.”	11.5 (6.6%)
	Stage of pregnancy or postpartum	“I loved the way my body looked during pregnancy, but after pregnancy my insecure area (stomach) makes me feel bad.”	42.5 (24.3%)

Note. Values provided in the frequency tabulation of themes reflect the average tabulation of codes across the two analysts. Because inter-analyst agreement was not 100% for some themes, half values are possible. Agreement for body image themes ranged from 80-94%

Eating Habits and Changes during Pregnancy

Table 3 reports identified themes, subthemes, and additional examples regarding dietary changes and how these changes impacted self-image and mental health during pregnancy and postpartum. Overall, many participants endorsed changes in the amount (55%) and type/subjective quality (50%) of food consumed during pregnancy. However, a smaller proportion of participants endorsed that their eating habits did not change much during this period (8%). Similarly to body-related changes, the most common response to dietary changes was self-criticism (25%) and desire to change dietary behaviours (17%). For example, one participant noted, “I'm slightly obsessed with getting to my pre pregnancy weight, I count calories and restrict at a certain points.” Conversely, some participants endorsed feeling accepting (16%) or self-compassionate (15%) regarding eating-related changes, including one participant who expressed, “Now that I am breastfeeding, I eat way more. It doesn't bother me; I am listening to my body to see what it needs.” Factors impacting eating changes included stage of pregnancy/ postpartum (48%), physiological changes (27%), expectations (17%), and ¹wanting to prioritize body and baby’s needs (13%). Several participants noted the early postpartum period, as compared to pregnancy, as a time marked by shifts in eating habits, including one participant who shared, “Postpartum, I have had a harder time eating as healthy because I feel like I have much less time to myself.” Physiological changes noted by participants were heterogeneous, including cravings, “I craved carbs, so I ate more carbs, which made me gain weight.” and aversions, “I avoided meat and chocolate because they made me sick.”

Table 3.

Themes and Theme Endorsement for Eating Habits and Changes during Peripartum Period

Theme	Subtheme	Example Quotation(s)	Count (%)
Type of eating changes	Amount of food consumed	1. “I'm hungry more often and eating more.” 2. “I lost my appetite for most of my pregnancy, and I really lost my appetite afterwards… I have to try to remember to eat”	95.5 (54.6%)
	Type and perceived health quality of food consumed	1. “I reduced my sugar intake and intake of sodas, and it made me feel good about myself that I was able to make a positive change.” 2. “My quality of food went down and I ate a lot more junk food and sugar.”	88 (50.3%)
	No/minimal changes in food consumption	“My eating habits did not change”	14.5 (8.3%)
Response to eating changes	Self-critical thoughts and emotions	“I started eating more while pregnant without guilt but I feel more guilty now and try to eat less. I feel badly about myself every time I eat food.”	44 (25.1%)
	Dieting or trying to control food intake	“I was very strict on what I ate in pregnancy so I won't get too big. Breastfeeding hunger makes me nervous I'm going to be larger than I was.”	30 (17.1%)
	Felt good or self-compassionate	1. “I … try to give myself grace.” 2. “It made me feel good to provide positive nutrition to my baby.”	27 (15.4%)
	Neutral/accepting of eating-related changes	“I feel fine about it. I … have a fairly neutral relationship with how much I eat.”	29 (16.6%)
Factors that impacted eating changes	Physiological factors	“I had severe nausea and vomiting with the pregnancy so after birth I've been able to eat more normally and my appetite has increased.	48 (27.4%)
	Stage of pregnancy and postpartum	1. “First trimester I was feeling sick often… Second trimester I was ravenous all the time. That is when I gained the most weight in my pregnancy… Third trimester I felt full all the time.” 2. “I ate as healthy as I could during the pregnancy… It is harder postpartum because I am too drained and busy to cook.	84.5 (48.3%)
	Expectations (e.g., expectation of return to “normal”)	“I didn't worry as much because I wasn't gaining that much weight and weight gain was expected.”	29.5 (16.9%)
	Prioritizing baby's needs and/or body's needs	“I eat whenever I'm hungry. I feel I restrict myself less than before I was pregnant, because my baby needed me to in the womb and now that I'm breastfeeding.	22.5 (12.9%)

Note. Values provided in the frequency tabulation of themes reflect the average tabulation of codes across the two analysts. Because inter-analyst agreement was not 100% for some themes, half values are possible. Agreement for eating themes ranged from 80-95%

Obstetric Health Care Experiences and Suggestions for Care

Table 4 reports identified themes, subthemes, and additional subtheme examples regarding healthcare experiences and requests. Many participants reported specific comments regarding both the style and content of healthcare experiences. With regards to the style of healthcare experiences, the most common subtheme was less focus and judgment related to weight and body changes (20%), with one participant saying, “It would also help to put less emphasis on getting your pre baby body back, or going on a diet etc.” Other suggestions for maternal healthcare providers included honesty about expectations (11%), increased personalization (9%), and increased accessibility of providers (8%). In terms of content of healthcare experiences, commonly endorsed subthemes were more nutritional guidance (17%), asking about mental health beyond surveys (11%), and providing more resources and referrals (10%). One participant shared her positive experience as a suggestion for other providers, “My midwife provided me with a binder of resources and information that was extremely helpful. It covered all those topics: mental health, body image, and eating habits.” A significant proportion of the sample endorsed having no specific suggestions for obstetric care providers (35%).

Table 4.

Themes and Theme Endorsement for Healthcare Experiences and Requests

Theme	Subtheme	Example Quotation	Count (%)
Style of care	More personalized care and attention	1. “They could be more personally involved, not being so protocolly” 2. “My OB wasn't that concerned about me as an individual, but she had a large practice.”	16 (9.1%)
	More accessibility to provider and more check ins	1. “I think making maternal postpartum care more of a focus - having more regular check ins … would make it easier.” 2. “Midwife follow up at 1 week and 3 weeks instead of just 6 weeks would be helpful.”	13.5 (7.7%)
	Less judgment and focus on weight	1. “I sought out healthcare providers who would honor my request to not discuss my weight during pregnancy. It was difficult to find someone who met that criteria.” 2. “Not shame me for gaining more than the ‘recommended amount’ of weight or gaining weight quicker than expected.”	35.5 (20.3%)
	Honesty about expectations and hard topics	“Providers would do well to better inform patients during pregnancy about the myriad of physical changes that occur postpartum.”	20 (11.4%)
Content of care	Provide (free/ evidence based) resources and referrals	1. “More free resources for moms.” 2. “Offering referrals routinely even without cause for concern”	17 (9.7%)
	Provide more nutritional guidance	1. “There could also be more support for food aversions and easily accessible information on pregnancy nutrition. It was difficult to find useful and reliable information online.” 2. “Perhaps bringing in the advice of a dietitian.”	30.5 (17.4%)
	Meal support from community	“It has been helpful the times my support group/community have offered meals.”	4 (2.3%)
	Ask about mental health (beyond surveys)	“I think they need more awareness of mental health and not just base it off of checklists… They should spend more time actually asking other questions about how the mother is doing.”	19.5 (11.1%)
No suggestions	Because providers were supportive	“I felt adequately supported throughout my pregnancy.”	24.4 (14.0%)
	Because change feels futile	“I'm not sure, this feels like a 'me' problem”	5 (2.9%)
	Reason unclear	“I don't have any suggestions”	32.5 (18.6%)

Note. Values provided in the frequency tabulation of themes reflect the average tabulation of codes across the two analysts. Because inter-analyst agreement was not 100% for some themes, half values are possible. Agreement for healthcare themes ranged from 89-99%

Discussion

This study utilized short-response qualitative data to identify common themes regarding body and food-related changes and healthcare experiences during the peripartum period. In line with our first and second hypotheses, participants endorsed divergent responses to body and eating changes during pregnancy. Specifically, the highest proportion of participants endorsed struggling with self-criticism or negative affect in response to pregnancy-related physical changes, whereas a smaller proportion of the sample endorsed acceptance or empowerment from these changes. Our third hypothesis was partially supported, as reduced weight-related judgment and increased need for mental health support were both identified as areas for improved obstetric support. Another commonly endorsed suggestion for healthcare providers was increased nutritional guidance. These findings identify possible factors that may impact ED symptom change during pregnancy and highlight the importance of listening to individuals with lived experience of pregnancy to identify domains of risk and areas for improved intervention within existing healthcare systems.

Eating and Body Changes

Identified themes for eating and body changes are largely consistent with normative physical changes during pregnancy. For example, common pregnancy symptoms, such as morning sickness, food aversions, and food cravings, were cited as reasons for changes in type or quantity of food consumed. Commonly reported body-related changes, such as gaining weight and changes to the shape and size of the midsection, were also unsurprising in the context of pregnancy. However, what is more important for ED risk than the types of changes experienced during peripartum, is the way individuals respond to these changes.

Given that this is a community sample with average rates of endorsement of lifetime mental health diagnoses (see Table 1), it is notable that almost half of the sample endorsed self-criticism, guilt, and negative affect in response to changes in eating and body image. Indeed, past research has found that peripartum self-criticism is common and associated with increased risk for developing postpartum depression (Gerhardt et al., 2024; Pedro et al., 2019). This finding emphasizes that negative emotional responses, including those driven by normative body-related changes during pregnancy, are common. However, these experiences are often not evaluated by providers, especially in relation to problematic eating habits and weight-related distress. Pending future research, self-criticism or attempts to retain control over physical changes to the body may impact why some individuals experience worsening ED symptoms during this transition period.

Although the largest proportion of the sample reported self-criticism, some participants reported feeling accepting of these changes as “part of the process” or empowered, as these body changes reflected the ability to grow a human life. These findings are consistent with prior research that has explored empowerment and body acceptance during pregnancy, with one study demonstrating that about a third of pregnant women had high self-acceptance and about a fourth had low self-acceptance during this transition period (Meireles et al., 2023). Additionally, body-acceptance and positive attitudes towards maternity may mitigate the association between body dissatisfaction and postpartum mental health outcomes (Przybyła-Basista et al., 2020). Indeed, these themes may reflect resiliency factors that can protect against negative outcomes resulting from physical transitions during pregnancy (Borghei et al., 2017; Golmakani et al., 2020). Exploring who develops, and how people develop, resilient responses to pregnancy-related stressors, and if this group has improved mental and physical health outcomes, are important future research questions.

Finally, it is important to contextualize these findings within the sociocultural context of pregnancy. Although weight gain and increased dietary intake are a normative, and often recommended, part of pregnancy, Western cultural factors may impact why some individuals feel shameful about these changes. Specifically, the “pregnancy ideal” in American culture involves gaining only a small amount of weight, changing size only in the midsection, staying active through all stages of pregnancy, and returning to one’s pre-pregnancy body shortly after delivery (Kapoor, 2018). Individuals who internalize this messaging may hold themselves to unrealistic standards, and express guilt if their pregnancy does not follow this ideal (Lee, Bolton, et al., 2025; Lee, Muldoon, et al., 2025; Rodgers et al., 2024). Indeed, in our study, comparison making, social pressures, and expectations were all cited by participants as relevant factors for changing body image. Several participants noted that these factors were more challenging during the postpartum period, as physical changes were seen as more acceptable during pregnancy, compared to after birth. Pressures to conform to the thin-ideal, or to lose weight after delivery have also been identified in past qualitative research focused on the postpartum period (Lee, Muldoon, et al., 2025; Nippert et al., 2021). Thus, these sociocultural trends around pregnancy may represent a larger, public health concern that should be addressed to mitigate the damaging impact on mental health during pregnancy, especially in the context of disordered eating and body image.

Support from Healthcare Providers

The identified themes for maternal healthcare systems may provide avenues for improving peripartum mental health and ED risk. In contrast to the identified themes related to body image and eating, there was less consistent endorsement of themes related to health care. Specifically, no themes for healthcare needs were endorsed by more than a third of the sample. This aspect of our results may imply that patients’ wants and needs for healthcare providers are heterogeneous, and no one-size-fits-all model will work for every patient. Instead, eliciting and incorporating feedback from individual patients to create personalized healthcare goals may be an important facet of obstetric care.

Further, self-criticism was highly endorsed in this community sample, and may reflect an important, and under-assessed risk factor during pregnancy and postpartum. Notably, healthcare providers may unintentionally amplify self-criticism, as patients may feel pressure to conform perfectly to weight- and eating-related recommendations from healthcare professionals (Gibbins et al., 2023). On the other hand, routine visits with prenatal healthcare providers could provide an opportunity to intervene on self-criticism. Such interventions could include asking patients about guilt and self-criticism, modelling compassion and understanding towards difficulties that may arise, and providing resources for learning about and practicing self-compassion towards dietary and body changes (Golmakani et al., 2020; Papini et al., 2022).

Additionally, the two most highly endorsed suggestions for peripartum healthcare were reduced weight-focused judgment and increased nutritional guidance and resources. Weight-related judgment during obstetric visits is an important concern raised by participants, supported by prior research that has found that weight loss recommendations, routine weighing, and the use of BMI during pregnancy may contribute to adverse outcomes, such as perpetuating weight stigma and weight cycling (Gibbins et al., 2023). Thus, maternal healthcare providers may benefit from increased training on how to provide weight-neutral, behaviour-focused care and the development and dissemination of evidence-based nutritional resources to support patients (Gibbins et al., 2023; Papini et al., 2025).

We recognise that these recommendations require time and effort from healthcare providers, which may not be feasible given the overburdened systems in place to support peripartum people. Indeed, it is important to note that fault or responsibility for these concerns falls not just on healthcare providers, but also on larger, profit-focused healthcare systems. By implementing changes that incorporate provider feedback and minimize the burden on providers, we can enact feasible and sustainable processes that benefit both patients and medical teams. For example, creating easy-to-access resource and referral lists would allow providers to quickly and easily share evidence-based information with patients with minimal-to-no increases in time or costs for healthcare systems.

Strengths and Limitations

This study has notable strengths. Foremost, this study centres the voices of people who have recently experienced pregnancy to inform future research and interventions. As researchers and healthcare providers, listening to patients and incorporating feedback are crucial for improving care. We also view the community sample as a strength, given that most research on ED symptoms during peripartum has been in clinical or high-risk samples. Thus, this study provides needed context about ED symptom risk among pregnant individuals in the general population. Additionally, the relatively large sample for qualitative research enhances the generalizability of the identified themes.

There are also important limitations to consider when interpreting results. First, this sample comprised primarily white, straight, cisgender individuals with high incomes living in the United States, which captures only a small proportion of people experiencing pregnancy. Future qualitative research should explore these questions among black and indigenous people of colour, members of the LGBTQ+ community, and low income pregnant people to better understand the unique experiences and needs among individuals who are disproportionately overlooked by healthcare systems. Second, although we view the community sample as a strength, these findings should not be generalized to individuals with clinical EDs or other high-risk groups. It is important to examine differences in maternal healthcare experiences and responses to physical changes during pregnancy among high-risk populations. Third, this study uses short, open-response data collection, rather than interviews or focus groups, limiting the depth of information gathered from participants. Finally, although the research team comprises individuals with varied life experiences, expertise, and training, the identification and interpretation of themes is inherently biased by the perspectives of the research team. Throughout this study, we took steps to amplify the voices of participants, rather than editing or reframing their responses.

Future Directions

Several future directions stem from this project. As with all qualitative research, this study raises questions that could be explored quantitatively. For example, do individuals who respond to eating and body changes with acceptance have different physical or mental health outcomes compared to individuals who respond with self-criticism or distress? Additionally, to inform optimal intervention on ED risk factors during the peripartum period, it is important to gather feedback from healthcare providers. For example, a future qualitative study could explore healthcare providers’ thoughts on how to increase personalization, accessibility, nutritional guidance, and resources in the context of perinatal health appointments. Relatedly, this project raises the importance of developing evidence-based resources for nutritional support, body image, and self-criticism that can be freely and easily implemented within and beyond healthcare systems. Examples include developing and optimizing web- or app-based interventions designed to be utilized during pregnancy, creating better screening or assessment tools, and improving in-office educational materials (e.g., Chae & Kim, 2021).

Conclusions

This study centres the voices of postpartum people to enhance discussions of ED risk and healthcare experiences during the critical pregnancy-postpartum transition period. Identified themes highlight divergent responses to eating- and body-related changes during pregnancy, which may reflect risk (e.g., self-criticism) and resilience (e.g., acceptance) factors. Future research should explore these factors as they relate to peripartum body image, disordered eating, and comorbid mental health concerns. Suggestions for healthcare providers emphasize a desire for weight-neutral care, increased mental health resources, and enhanced nutritional guidance. Incorporating provider training, assessment, and evidence-based resources to optimize routine perinatal healthcare visits may improve ED-related outcomes for this vulnerable population.