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Table 3 First and second order themes related to the experience of pregnancy for those with an eating disorder as reported in the primary paper

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 Theme 5 Theme 6
Journal Publications       
 Burton et al. 2015 [20] “The battle” between the eating disorder, your body and the baby. “Going around on the treadmill” – dealing with the eating disorder and the pregnancy and doing the same thing all the time; exhaustion. “Recreational show ride”- highs and lows and feeling of being out of control. “Walking the tightrope”- Staying in control and stopping from falling. “Teetering on the edge”- Feeling like about to fall off into the unknown. “Uninvited visitor from the past” – Known but unwanted visitor (ED) returning.
 Patel et al. 2005 [27] Loss of pre-pregnancy self  - Concerns about pregnancy weight gain  - Fear of not losing pregnancy weight Life transitions  - Using weight to control their lives  - Physical changes in pregnancy reawakened weight and body concerns Relationship with family members  - Lack of comfort with reliance on help from partners. Role within wider society  - Experiencing the world as hostile and critical in relation to their new maternal selves especially when their was distress about their changed bodies.   
 Shaffer et al. 2008 [28] A constant mental battle to prevent losing control  - Struggle to accept weight gain and size  - Struggle to accept the pregnancy  - Fear of control over their changing bodies. A distorted body image  - Difficulty looking in the mirror  - Use of restrictive eating, compulsive exercise, laxative use or binging and purging and controlling weight, a compensation for low self-esteem. Hiding their experience  - Lied about eating behaviours and exercise  - Used pregnancy symptoms e.g. nausea to explain/hide behaviours.  - Most didn’t tell their physicians or midwives. Scale-induced trauma at prenatal visits  - Routine weigh-ins at prenatal appointments traumatic.  - Fear and anxiety regarding weight gain and being weighted.   
 Stapleton et al. 2008 [54] Fighting to control the urge to restrict or binge-purge. Lack of disclosure of their eating disorder to maternity health professionals     
 Taborelli et al. 2015 [49] Approaching pregnancy: Not expecting to be pregnant Early pregnancy A difficult transition  a) Highly anxiety provoking  b) Loss of control over their body Making space for the baby The sacrifice of the eating disorder identity. Middle to late pregnancy Assuming the pregnancy identity. - a new body to love.    
 Stringer et al. 2010 [37] and Tierneyet al. 2011 [8] Transforming body and eating behaviours  - Concern about body shape  - First trimester difficult (“seen as fat” rather than pregnant)  - Less stress about body shape when obviously pregnant- not “fat” Concern about weight gain during pregnancy. Uncertainties about child’s shape  - Not wanting their children to be obese  - Not wanting them to obsess about food Emotional regulation  - Use of SIV in pregnancy to regulate emotion. Professional awareness  - Lack of empathy (from healthcare professionals) - Information deficits -Language used Type of care  - Early Support  - High risk surveillance  
 Willis & Rand 1988 [55] Decrease in binge/vomiting behaviours during pregnancy. SIV occurred during pregnancy. Mixed reporting of eating disorders to obstetric/maternal health care providers.    
Case Studies       
 Hollifield & Hobdy 1990 [18] Hiding the Eating disorder from obstetricians and other health care personal. Lied about specific behaviours to their spouse/therapists/family/friends. Experienced tremendous fears regarding health and wellbeing of their unborn child. Profound shame and guilt in relation to their inability to refrain from bulimic practices while pregnant. Rationalisation of behaviours.  
 Lewis & le Grange 1994 [53] Fear of losing control of their eating and weight during pregnancy. Fear of damaging their unborn child as a result of their unhealthy eating behaviours. Fear not enough to stop them from engaging in bulimic behavior. Anxiety about their ability to cope when their baby was born. Anxiety about the health of their unborn child.  
 Little & Lowkes 2000 [52] Hiding the Eating disorder. Difficulty giving up the eating disorder behavior.     
 Namer et al. 1986 [50] Positive benefits-  a) Being able to fall pregnant made them feel ‘normal’ and ‘better’  b) Pregnancy pleased their husbands Being ‘forced’ to take care of a baby made it easier to take care of themselves Change in body image-  a) Change in focus from stomach to weight and size of thighs as stomach considered to be the baby. Reliance on husband to provide perspective about their changing bodies and weight gain Change in eating habits-  a) Ability to eat 3–4 meals a day and not skip meals Increased variety in foods, eating foods not eaten in years Effects on marital relationship-  a) Husbands pleased with them but arguments about food intake and distress about their insecurity with their appearances. Mood states and cognitive concerns during pregnancy-  a) Concern about baby’s health  b) Irritability/Anxiety/Depression especially during first pounds of weight gain  c) Fear body wouldn’t return to pre-pregnancy weight  d) Later months of pregnancy diminution of anorexic thinking. Strong desire not to pass on food obsession to their child.