The effect of eating disorders in pregnancy on neurodevelopmental risk in infants

Eating disorders are a difficult behavioral condition to treat and relapse is not rare. Some experiences can make relapse more likely, such as pregnancy when weight gain or loss become a part of the discussion at every doctor’s visit. Understanding the impact of a history of an eating disorder or even an active one on risk of suboptimal outcomes in the offspring is important and a new report looked into whether eating disorders during pregnancy lead to an increased risk of developing neuropsychiatric diseases.¹

The investigators used the Swedish Medical Birth Registry for a population-based prospective cohort study. They identified singleton births that had been registered between January 1990 and December 2012. Children who were delivered to mothers with a diagnosis of an eating disorder were matched with children who had mothers with no eating disorder diagnoses. Every child was followed up from his or her first birthday for autism spectrum disorder and from his or her third birthday for attention-deficit/hyperactivity disorder.

A total of 52,878 children were included in the study. The investigators found that maternal eating disorder exposure (n = 8813) was linked to an increased risk of attention-deficit/hyperactivity disorder ADHD (hazard ratio [HR] for anorexia nervosa, 1.42 [95% CI, 1.23-1.63]; HR for bulimia nervosa, 1.91 [95% CI, 1.43-2.54]; and HR for unspecified eating disorder, 2.00 [95% CI, 1.72-2.32]) as well as autism spectrum disorder (HR for anorexia nervosa, 2.04 [95% CI, 1.58-2.63]; HR for bulimia nervosa, 2.70 [95% CI, 1.68-4.32]; and HR for unspecified eating disorder, 1.95 [95% CI, 1.49-2.54]). Following adjustment for parental confounders, they found that the risk of attention-deficit/hyperactivity disorder was still significantly increased, but the risk of autism spectrum disorder in children born to mothers with bulimia nervosa was found to be no longer significant. They also found that ongoing cases of anorexia nervosa was tied to higher risks for attention-deficit/hyperactivity disorder (HR, 2.52 [95% CI, 1.86-3.42]) and autism spectrum disorder (HR, 3.98 [95% CI, 2.49-6.27]) when compared to a history of disease (HRs, 1.26 [95% CI, 1.06-1.48] and 1.81 [95% CI, 1.38-2.38], respectively).

The investigators concluded that the children of mothers with eating disorders and in particular those that experienced an eating disorder during pregnancy are at an increased risk of either attention-deficit/hyperactivity disorder and autism spectrum disorder.

Reference

1. Mantel A, Örtqvist A, Hirschberg A, Stephansson. Analysis of neurodevelopmental disorders in offspring of mothers with eating disorders in Sweden. JAMA Netw Open. 2022;5(1):e2143947. doi:10.1001/jamanetworkopen.2021.43947

This article was originally published on Contemporary Pediatrics®.