MUNICH — Louisa Bartel* still remembers the first thought that ran through her head when she found out she was pregnant: “Now I’ll have to eat more. I won’t be able to go running every day. I’ll get fat.”

Louisa suffered from anorexia as a teenager, reacting to a difficult home situation with a depressed mother and absent father. She spent years in therapy, including six months in a specialist clinic, before she was able to articulate this. When she was released, the doctors thought she was cured, but she says she had simply found a way to live with her disease. Then when she fell pregnant in her thirties, the panic set in again.

Louisa’s pregnancy was full of ups and downs. Some days she managed to eat everything on her plate without feeling guilty about it. Other days the thought of food made her feel sick, and she would go to bed with an empty stomach. She can cope with that, though. It’s how she lived for years.

You wouldn’t know it to look at her. Louisa is a management consultant, a career that relies on convincing others to trust your judgment. She can’t afford to let clients see any shred of self doubt. Friends and colleagues know an open, friendly woman who enjoys life and has everything under control.

But that is precisely the problem. Eating disorders are an attempt to regain control, often when physical or emotional changes threaten to overwhelm. That is why they often appear during puberty, a time of significant biological changes. After puberty, pregnancy is the next most significant period of upheaval in a woman’s life, with considerable changes to both body and lifestyle, all under the influence of intense hormonal shifts.

Despite the similarities between the two stages, psychologists and experts on eating disorders have traditionally overlooked pregnancy as a vulnerable time, probably because the idea of a pregnant woman intentionally endangering her unborn child by not eating was simply unthinkable.

A quantifiably real problem

It wasn’t until last year that a group of British scientists began to study the problem. The results, carried out by researchers at the Institute of Child Health and the psychiatric department at the University of London, were clear. Of the 739 women who participated, 25% admitted being afraid of weight gain and the changes to their body during pregnancy. One in 10 women was already exhibiting signs of an eating disorder and one in 15 fulfilled all the criteria.

“We found that many of the women’s concerns had to do with the public perception of pregnant women,” explains lead researcher Nadia Micali. In the past, pregnancy was treated with discretion, but that has changed and the media play a role in shaping our idea of how pregnant women should look. “Celebrities show off their baby bumps, and a few days after giving birth they’re very slim,” Micali says. “We see that on TV, in magazines, on the Internet. These images give women unrealistic expectations of their bodies.”

Heidi Klum modeled in her underwear only five weeks after the birth of her son Henry. One week after giving birth to daughter Harper, designer Victoria Beckham was wearing a U.S. size 4. New mothers are bombarded with diet and exercise tips, as if their most pressing concern should be losing their baby weight. Some magazines even calculate how much weight is lost through sweat during labor.

And it’s not just traditional media promoting these ideas. The pressure is only intensified by the many selfies posted on social media sites by proud new mothers showing off their flat stomachs. There is also a troubling number of pregnant women participating in online “pro-ana” forums, where anorexia sufferers post extreme weight-loss tips and “thinspiration” photos. Pictures of skeletal women with tiny baby bumps have begun appearing on the sites. Like many of the thinspiration images, some have been photoshopped: It’s impossible to maintain a pregnancy at certain very unhealthy weights. But anorexia sufferers have distorted perceptions of their bodies and see these images as aspirational.

A disease only recently acknowledged

The growing prevalence of anorexia cases during pregnancy cannot be blamed entirely on the media. It may be partly explained by the fact that the medical profession officially recognized the disease only a few decades ago. Now the first generations of diagnosed teenage anorexia sufferers have grown up and are having children.

The problem is so great that some clinics, such as Inntal in South Germany, have reacted by creating therapy rooms for mothers with nursing babies. Andreas Schnebel, director of the Anad clinic in Munich, believes that the cause of anorexia during pregnancy goes beyond desire to conform to an ideal of beauty and is more about people’s changing relationship with their bodies. “All people, not only women, are afraid of losing control over their bodies,” he says. “Sport, nutrition and sex are all seen as a means of self-improvement or fulfilment. It’s very rare to find someone who just enjoys their body.”

During pregnancy, women have less control over their bodies than ever, and they are no longer the reliable machines they once were. Women are also subject to intense and contradictory pressures during this period. They are expected to regularly visit the doctor and attend birth classes, read the right books, paint the nursery, tell their boss when they plan to return to work, research kindergartens, etc. But most importantly, they should find the time to celebrate the miracle of their femininity.

“For women who need to be in control, this pressure can be very harmful,” says Schnebel. It may sound counter-intuitive, but an eating disorder gives sufferers the impression of being able to control at least one thing in their lives.

Louisa Bartel ultimately gave birth to a daughter. Although she was sometimes overcome by panic as she watched her belly grow, she returned to her therapist and got through her pregnancy with the support of her husband. Her healthy baby daughter was born in the fall, but Louisa is still regularly attending support groups to try and overcome her eating disorder. She needs to get better, if not for herself, then for her child. Because, as she says, “What kind of role model would such a mother be?”

*The woman’s name was changed to protect her identity.