Maternal eating disorders may worsen pregnancy and neonatal outcomes

Women with active or previous eating disorders are at increased risk of adverse pregnancy and neonatal outcomes, according to findings in a population-based cohort study.

In terms of pregnancy complications, all subtypes of eating disorders were associated with an approximately 2-fold increase in risk of hyperemesis during pregnancy (anorexia nervosa: relative risk [RR], 2.1; 95 percent confidence interval [CI], 1.8 to 2.5; bulimia nervosa: RR, 2.1; 95 percent CI, 1.6 to 2.7;  eating disorder otherwise not specified [EDNOS]: RR, 2.6; 95 percent CI, 2.3 to 3.0). A diagnosis of anaemia was significantly increased in women with bulimia nervosa or EDNOS compared with unexposed women (bulimia nervosa: RR, 1.3; 95 percent CI, 1.1 to 1.6; EDNOS: RR, 1.1; 95 percent CI, 1.0 to 1.3). On the other hand, maternal anorexia nervosa was associated with a 60 percent increase in risk of antepartum haemorrahge (RR, 1.6; 95 percent CI, 1.2 to 2.1). The significance differences remained similar with adjustment for age, parity, smoking status and birth year. [JAMA Psychiatry 2019; doi: 10.1001/jamapsychiatry.2019.3664]

As to the mode of delivery, both women with anorexia nervosa and EDNOS had a slight decrease in risk of instrumental-assisted vaginal birth (anorexia nervosa: RR, 0.7; 95 percent CI, 0.6 to 0.9; EDNOS: RR, 0.8; 95 percent CI, 0.7 to 1.0).

With regard to neonatal complications, those with eating disorders, of all subtypes, were at a significantly increased risk of a preterm birth (anorexia nervosa: RR, 1.6; 95 percent CI, 1.4 to 1.8; bulimia nervosa, RR 1.3; 95 percent CI, 1.0 to 1.6: EDNOS: RR, 1.4; 95 percent CI, 1.2 to 1.6) as well as delivering neonates with microcephaly (anorexia nervosa: RR, 1.9; 95 percent CI, 1.5 to 2.4; bulimia nervosa: RR, 1.6; 95 percent CI, 1.1 to 2.4; EDNOS: RR, 1.4; 95 percent CI, 1.2 to 1.9).

In this population-based cohort study based on the Swedish Medical Birth Registry, a total of 7542 women with eating disorders (women with anorexia nervosa, n=2769, mean age, 29.4 years; women with bulimia nervosa, n=1378, mean age, 30.2 years; women with EDNOS, n=3395, mean age, 28.9 years) were compared with 1225,321 women without eating disorders.

Eating disorders are serious diseases affecting people of all genders, ages, races and ethnicities. The conditions are associated with increased risk of psychiatric and medical complications. [Eur Eat Disord Rev 2017;25:432-450]

“These findings emphasize the importance of developing a reliable antenatal routine enabling identification of women with ongoing or previous eating disorders and considering extended pregnancy screening,” concluded the authors.