Maternal Eating Disorders Associated With Adverse Pregnancy, Neonatal Outcomes

Girl with anorexia in hospital with tray of food in front of her. Refusing to eat.
Compared with control individuals, the risk for hyperemesis was approximately doubled for women with anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified.

Women with active or previous eating disorders may be at increased risk for adverse pregnancy and neonatal outcomes, according to study data published in JAMA Psychiatry.

Ängla Mantel, MD, PhD, from Karolinska Hospital in Stockholm, Sweden, designed this population-based cohort study of all singleton births in the Swedish Medical Birth Register between January 2003 and December 2014. Birth register data were linked with the National Patient Register, which contains information on adverse pregnancy outcomes, mode of delivery, neonatal outcomes, and maternal eating disorder status. Poisson regression analyses were performed to estimate risk ratios for adverse outcomes across eating disorder strata. Models were adjusted for age, parity, smoking status, and birth year.

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The eating disorder cohort comprised 2769 women with anorexia nervosa (mean age, 29.4±5.3 years), 1378 with bulimia nervosa (mean age, 30.2±4.9 years), and 3395 with an eating disorder not otherwise specified (EDNOS; mean age, 28.9±5.3 years). The control group included 1,225,321 women without eating disorders (mean age, 30.3±5.2 years).

Compared with control individuals, the risk for hyperemesis was approximately doubled for women with anorexia nervosa (risk ratio [RR], 2.1; 95% CI, 1.8-2.5), bulimia nervosa (RR, 2.1; 95% CI, 1.6-2.7), and EDNOS (RR, 2.6; 95% CI, 2.3-3.0). Women with bulimia nervosa (RR, 1.3; 95% CI, 1.1-1.6) or EDNOS (RR, 1.1; 95% CI, 1.0-1.3) were also twice as likely to receive a diagnosis of anemia compared with control individuals. A slightly decreased risk for instrumental-assisted vaginal birth was observed among women with anorexia nervosa (RR, 0.7; 95% CI, 0.6-0.9) and EDNOS (RR, 0.8; 95% CI, 0.7-1.0), although no other significant differences in delivery mode were observed between cases and controls.

Women with eating disorders of any subtype were at increased risk for preterm birth (anorexia nervosa: RR, 1.6 [95% CI, 1.4-1.8]; bulimia nervosa: RR, 1.3 [95% CI, 1.0-1.6]; EDNOS: RR, 1.4 [95% CI, 1.2-1.6]) and of delivering neonates with microcephaly (anorexia nervosa: RR, 1.9 [95% CI, 1.5-2.4]; bulimia nervosa: RR, 1.6 [95% CI, 1.1-2.4]; EDNOS: RR, 1.4 [95% CI, 1.2-1.9]).

RRs were typically increased for women with active vs passive eating disorders, and the risk for antepartum hemorrhage was greater in women with active (RR, 2.0; 95% CI, 0.9-4.3) vs passive (RR, 1.5; 95% CI, 1.1-2.1) anorexia nervosa. Risk ratios remained similar after adjustments for covariates.

As study limitations, investigators noted that more granular information on nutritional status and maternal weight gain during pregnancy could not be obtained. In addition, results may not be generalizable to populations in other countries, particularly given Sweden’s universal healthcare system. Nonetheless, these results “emphasize the importance of developing a reliable antenatal routine enabling identification of women with ongoing or previous eating disorders and considering extended pregnancy screening,” as the investigators wrote.


Mantel Ä, Lindén Hirschberg A, Stephansson O. Association of maternal eating disorders with pregnancy and neonatal outcomes [published online November 20, 2019]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2019.3664