Adverse Neonatal Outcomes Among Children Born to Mothers Eating Disorders: A Register-Based Cohort Study

OBJECTIVE: We examined the risk of adverse neonatal outcomes among children born to mothers with anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS).

DESIGN: Cohort study.

SETTING: Population-based using Danish national registers.

POPULATION: We included 1 517 839 singletons born between 1991 and 2015 in Denmark.

METHODS: For each ED subtype, we compared children born to mothers with a recent (≤ 2 years before conception and during pregnancy) or past (> 2 years before conception) diagnosis, with children born to mothers who had not been diagnosed with the ED of interest before the index delivery.

MAIN OUTCOME MEASURES: Using multinomial logistic regression, we estimated relative risk ratios (RRRs) and 95% confidence intervals (CIs) for gestational age, birthweight, weight-for-gestational age, low Apgar score, Caesarean section, congenital malformations and postpartum haemorrhage.

RESULTS: Both recent and past AN were associated with increased risk of low birthweight (recent: RRR = 2.36 [95% CI = 1.76-3.18]; past: 1.22 [1.04-1.43]), small-for-gestational age (recent: 1.52 [1.01-2.26]; past: 1.37 [1.16-1.62]), and preterm birth (recent: 1.83 [1.37-2.45]; past: 1.17 [1.00-1.36]), with more pronounced risks in recent AN. Recent (but not past) BN was associated with increased risk of low Apgar score (1.44 [1.03-2.00]). Recent (but not past) EDNOS was associated with increased risk of SGA (1.53 [1.04-2.27]).

CONCLUSIONS: Children born to mothers with EDs have an increased risk of some adverse neonatal outcomes, with more pronounced risks in recent than past EDs. These results underscore the need for improved prevention of maternal EDs and enhanced monitoring throughout pregnancy to mitigate adverse outcomes.