Eating disorders during pregnancy are rarely discussed at OB appointments, but they’re not uncommon (a 2014 Norwegian review of studies surrounding women and eating disorders found that eating disorders in pregnancy are “relatively common” and may cause health risks for both mother and baby; some experts hypothesize one in twenty women suffer an eating disorder while pregnant). Bottom line: They should definitely be a topic of conversation between patients and health care providers, especially if a pregnant person has a history of disordered eating. “For women who have struggled with eating disorders in the past, a pregnancy is a time when special attention should be paid to their psychological wellbeing and physical health. Seeking support during this time may be wise,” says Ovidio Bermudez, MD, a psychiatrist and Chief Clinical Officer at Eating Recovery Center, an eating disorder treatment center in Denver, CO.

And the postpartum period is one where a new parent can be equally vulnerable: Stress, exhaustion, and pressure to bounce back to a pre-baby weight can all exacerbate disordered eating behavior, even if the person hasn’t exhibited symptoms in years. But what’s particularly worrisome, says Bermudez, is the fact that many moms may hide their eating disorder because they’re ashamed. “A woman may feel like she’s not a good mom because she’s struggling, when it’s an illness, it’s something bigger than her and has nothing to do with her self-control or her parenting skills,” says Bermudez. That’s why it’s crucial to get help from an expert.