Association of Maternal Eating Disorders With Pregnancy and Neonatal Outcomes

Abstract

The prevalence of eating disorders is high among women of reproductive age, yet the association of eating disorders with pregnancy complications and neonatal health has not been investigated in detail, to our knowledge. OBJECTIVE To investigate the relative risk of adverse pregnancy and neonatal outcomes for women with eating disorders. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included all singleton births included in the Swedish Medical Birth Register from January 1, 2003, to December 31, 2014. A total of 7542 women with eating disorders were compared with 1 225 321 women without eating disorders. Statistical analysis was performed from January 1, 2018, to April 30, 2019. Via linkage with the national patient register, women with eating disorders were identified and compared with women free of any eating disorder. Eating disorders were further stratified into active or previous disease based on last time of diagnosis. MAIN OUTCOMES AND MEASURES The risk of adverse pregnancy outcomes (hyperemesis, anemia, preeclampsia, and antepartum hemorrhage), the mode of delivery (cesarean delivery, vaginal delivery, or instrumental vaginal delivery), and the neonatal outcomes (preterm birth, small and large sizes for gestational age, Apgar score <7 at 5 minutes, and microcephaly) were calculated using Poisson regression analysis to estimate risk ratios (RRs). Models were adjusted for age, parity, smoking status, and birth year. RESULTS There were 2769 women with anorexia nervosa (mean [SD] age, 29.4 [5.3] years), 1378 women with bulimia nervosa (mean [SD] age, 30.2 [4.9] years), and 3395 women with an eating disorder not otherwise specified (EDNOS; mean [SD] age, 28.9 [5.3] years), and they were analyzed and compared with 1 225 321 women without eating disorders (mean [SD] age, 30.3 [5.2] years). All subtypes of maternal eating disorders were associated with an approximately 2-fold increased risk of hyperemesis during pregnancy (anorexia nervosa: RR, 2.1 [95% CI, 1.8-2.5]; bulimia nervosa: RR, 2.1 [95% CI, 1.6-2.7]; EDNOS: RR, 2.6 [95% CI, 2.3-3.0]). The risk of anemia during pregnancy was doubled for women with active anorexia nervosa (RR, 2.1 [95% CI, 1.3-3.2]) or EDNOS (RR, 2.1 [95% CI, 1.5-2.8]). Maternal anorexia nervosa was associated with an increased risk of antepartum hemorrhage (RR, 1.6 [95% CI, 1.2-2.1]), which was more pronounced in active vs previous disease. Women with anorexia nervosa (RR, 0.7 [95% CI, 0.6-0.9]) and women with EDNOS (RR, 0.8 [95% CI, 0.7-1.0]) were at decreased risk of instrumental-assisted vaginal births; otherwise, there were no major differences in mode of delivery. Women with eating disorders, all subtypes, were at increased risk of a preterm birth (anorexia nervosa:

Social and economic cost of eating disorders in the United States: Evidence to inform policy action

“…Our study has several limitations, including: (1) reliance on several prevalence studies using varying estimation techniques, which may have led to uncertain estimates across age groups; (2) an inability to comprehensively control for all confounding factors, and in particular comorbidities, which are common among individuals with eating disorders—for example, some premature mortality costs may occur due to comorbid psychiatric illness among individuals with eating disorders (Cliffe et al, 2020); (3) the utilization of average group effects across all model inputs (there is inherent variability in costs across individuals and systems in the U.S. that no existing datasets could comprehensively address for the purposes of our study); (4) other limitations in the available epidemiological data precluded a comprehensive analysis of costs across all eating disorder diagnostic groups or major demographic groups (e.g., data on avoidant restrictive food intake disorder are lacking although it has been attracting increasing research attention; see Bourne, Bryant‐Waugh, Cook, & Mandy, 2020); and (5) our inability to estimate costs associated with the longer‐term physical and psychological health sequelae of eating disorders that persist or emerge over time (e.g., reproductive or obstetric complications, osteoporosis, gastrointestinal dysfunction or cancers, etc. ; Mantel, Hirschberg, & Stephansson, 2020; Thornton et al, 2017).…”

Eating disorders are associated with adverse obstetric and perinatal outcomes: a systematic review

“…Women with a lifetime history of BN had an OR = 1.7 (95%CI 1.1-2.5) of having a caesarian section, and women with EDNOS/sub-threshold EDs presented an OR = 3.1 (95%CI 1.1-8.8) of low Apgar score at 5 minutes. 34 Eight longitudinal studies 3,9,33,[36][37][38][39][40] assessed obstetric outcomes in patients with EDs. Two assessed clinical samples.…”

“…No differences were found in mean birth weight, prevalence of SGA, or premature birth. 36 Mantel et al 33 assessed the RR of adverse pregnancy and neonatal outcomes for women with EDs in the Swedish Medical Birth Register. The study compared data from 7,542 women with EDs and 1,225,321 women without EDs.…”

“…Women with EDs were at increased risk of preterm birth and of delivering neonates with microcephaly. 33 Koubaa et al 45 compared serum biomarkers related to nutrition and stress in pregnant women with previous EDs and healthy controls. The authors reported that women with AN presented a lower level of ferritin than controls.…”

Of Mice and Men: The Effect of Maternal Protein Restriction on Offspring’s Kidney Health. Are Studies on Rodents Applicable to Chronic Kidney Disease Patients? A Narrative Review

“…Anorexia represents a "rich" counterpart of restricted and unbalanced diets; intake of nutrients, and related deficits, vary widely: they can be multiple in the case of very restricted, rigid, repetitive diets, or there may not be any in the case of associated compulsory vitamin or micronutrient intake. The effect on offspring's health is mainly mediated by a higher incidence of preterm delivery [13].…”