Risk of Psychiatric Disorders Increases for Children of Mothers With Eating Disorder History

During pregnancy, maternal nutrition is significant in fetal development. Particularly, neurodevelopment is a very regulated process that can be influenced by both internal and external factors. Because of this, irregular or disordered eating may also contribute to the offspring’s development. Authors of a study published in JAMA Network Open expanded on existing associations between different maternal eating disorders and pre-pregnancy body mass index (BMI) with neurodevelopmental and psychiatric diagnoses in offspring. Additionally, the authors assessed potential differences between exposure to maternal anorexia nervosa (AN) compared with maternal underweight with offspring mental health.

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For this population-based register cohort study, data from 3 different Finnish databases—Finnish Medical Birth Register, the Finnish Care Register for Health Care (HILMO), and the Finnish Register on Reimbursement Drugs (RRD)—were gathered. The study included all live births in Finland between January 1, 2004, and December 31, 2014, and were followed up until December 31, 2021. Data analyses were conducted from September 1, 2023, to September 30, 2024.

Data on the diagnoses of the offspring’s neurodevelopmental or psychiatric disorders were collected from HILMO. Additionally, diagnosis statuses were identified and grouped by the ICD-10 codes of any mental, behavioral, and neurodevelopmental disorder (F00-F99); mood disorders (F30-39, F92); anxiety disorders (F40-43, F93); sleep disorders (F51); intellectual disabilities (F70-79); specific developmental disorders (F80-83); autism spectrum disorder (ASD; F84); attention-deficit/hyperactivity disorder (ADHD) and conduct disorders (F90-91); social functioning and tic disorders (F94-95); and other feeding disorders of infancy and childhood (F98.2).

Additionally, maternal pre-pregnancy BMI was categorized according to the WHO’s guidelines (underweight: 18.5; normal: 18.5-24.9; overweight: 25.0-29.9; obesity: 30.0-34.9; and severe obesity: ≥35.0). Data on maternal eating disorder diagnoses were obtained from HILMO, and all were diagnosed prior to pregnancy.

A total of 392,098 mothers with a mean age of 30.15 years were included in the study. Among these mothers, approximately 1.60% (n = 6273) had a history of eating disorders, 5.89% (n = 23,114) were underweight prior to pregnancy, and 53.13% (n = 208,335) mothers had overweight or obesity (overweight: 34.32%, n = 134,584; obese: 12.73%, n = 49,909; and severe obesity: 6.08%; n = 23,842).

Additionally, a total of 649,956 offspring were included, and from birth until 7 to 17 years of age, approximately 16.43% (n = 106,777) were diagnosed with a neurodevelopmental or psychiatric disorder. Among these offspring, about 3.02% (n = 19,641) were diagnosed with a mood disorder, 5.18% (n = 33,687) with an anxiety disorder, 0.57% (n = 3700) with other feeding disturbances in infancy and childhood, 0.58% (n = 3753) with sleep disorders, 0.87% (n = 5684) with intellectual disabilities, 6.40% (n = 41,570) with specific developmental disorders, 1.49% (n = 9659) with ASD, 4.96% (n = 32,242) with ADHD or conduct disorders, and 1.31% (n = 8523) with social functioning and tic disorders.

According to the findings, there were only associations of maternal AN with offspring ASD in the adjusted models. The largest effect sizes in the most adjusted model were observed for sleep disorders (maternal eating disorders: HR, 2.36 [95% CI, 1.89-2.95]; AN: HR, 2.12 [95% CI, 1.53-2.92]; bulimia nervosa [BN]: HR, 2.35 [95% CI, 1.67-3.32]; and eating disorder not otherwise specified [EDNOS]: HR, 3.34 [95% CI, 2.39-4.67]) as well as social functioning and tic disorders (eating disorders: HR, 2.18 [95% CI, 1.87-2.53]; AN: HR, 2.16 [95% CI, 1.75-2.67]; BN: HR, 2.48 [95% CI, 1.99-3.09]; and EDNOS: HR, 2.79 [95% CI, 2.21-3.52]). There was over twice the risk for offspring of mothers with eating disorders.

Additionally, the sensitivity analysis excluding offspring with comorbid eating disorders showed that most associations remained, with no considerable changes in effect size; however, the association between maternal BN and offspring sleep disorders did not remain (BN in full cohort: HR, 2.35 [95% CI, 1.67-3.32]; and BN excluding offspring with eating disorders: HR, 1.84 [95% CI, 1.13-3.01]).

Further, the authors observed associations between maternal pre-pregnancy underweight for all analyzed offspring psychiatric diagnoses except for feeding disturbances of infancy and childhood as well as for sleep disorders. After adjusting for covariates, the associations were still present although there were small effect sizes for anxiety (HR, 1.10 [95% CI, 1.04-1.16]), intellectual disabilities (HR, 1.33 [95% CI, 1.16-1.51]), specific developmental disorders (HR, 1.18 [95% CI, 1.12-1.24]), and social functioning and tic disorders (HR, 1.18 [95% CI, 1.06-1.31]).

According to the authors, study limitations may include the relatively short follow-up time (7-17 years) and missing information in paternal data and genetic information. Additionally, they noted that a potential bias specific for associations between maternal history of eating disorders with other feeding disturbances in childhood and infancy is mothers with eating disorders may be more perceptive to their child’s eating behavior, resulting in higher access to care and diagnosis for these children. However, such an association was not observed with maternal AN, which speaks against this speculation.

REFERENCE

Nilsson IAK, Ozsvar J, Gissler M, Lavebratt C. Maternal Eating Disorders, Body Mass Index, and Offspring Psychiatric Diagnoses. JAMA Netw Open. 2024;7(10):e2440517. doi:10.1001/jamanetworkopen.2024.40517