Eating disorders are relatively common among women of reproductive age, yet literature exploring the effects of maternal eating disorders (ED) on pregnancy and child outcomes is sparse. Using data from the Swedish Medical Birth Registry, a recent report looks at the prevalence of neurodevelopmental disorders, attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), among children born to mothers with a diagnosis of eating disorder.
The researchers identified singleton births registered between January 1990 and December 2012. The analysis included 52,878 children. Children born to mothers with a diagnosis of an eating disorder were matched with children born to mothers with no eating disorder diagnoses. Children with ADHD and ASD were identified using ICD-9 and ICD-10 codes in the medical record, requiring at least two documentations of an ADHD or ASD diagnosis in the record or the dispensation of an ADHD medication (for children with ADHD) to confirm the diagnosis.
A total of 8813 mothers had an eating disorder diagnosis. Among 4047 mothers with anorexia nervosa, 417 (10.3%) had ongoing illness during pregnancy; 803 of 3581 (22.4%) of mothers with unspecified eating disorder and 339 of 1185 (28.6%) of mothers with bulimia nervosa. Being underweight (body mass index <18.5) was more frequent among mothers with anorexia nervosa (341 of 4047 [8.4%]) and unspecified eating disorder (201 of 3581 [5.6%]).
Risk of ADHD and ASD in the Children
The researchers observed an increased risk of ADHD and ASD among the children of mothers with eating disorders, regardless of subtype, compared to children of mothers without eating disorder diagnoses. After adjusting for parental education and psychiatric comorbidity, the investigators observed that the risk of ADHD was still significantly increased in the children of women with eating disorders, with the following adjusted hazard ratios (HRs): anorexia nervosa 1.27 (95% CI1.06-1.50), bulimia nervosa 1.45 (95% CI 1.04-2.17)and unspecified eating disorder 1.51 (95% CI 1.23-1.85). In contrast, after adjustment, only the association between anorexia nervosa and increased risk of ASD remained significant (aHR 1.96, 95% CI 1.46-2.64).
Risk of ADHD and ASD: Previous Versus Ongoing Illness
In the next analysis, the investigators focused on the children born to women with ongoing illness during pregnancy. Highest risk was observed in the children born to mothers with a current diagnosis of anorexia nervosa: HR of 2.52 for ADHD (95% CI 1.86-3.42) and HR of 3.98 for ASD (95% CI 2.49-6.27). Lower risk was observed in the children of mothers with a history of anorexia nervosa (HR for ADHD, 1.26 [95% CI, 1.06-1.48] and HR for ASD, 1.81 [95% CI, 1.38-2.38]).
The Bottom Line
This analysis demonstrates that the children of mothers with eating disorders, and in particular the children of mothers with a current diagnosis of anorexia nervosa during pregnancy, are at an increased risk of either ADHD or ASD. From this sort of study, it is difficult to pinpoint exactly how eating disorders may contribute to vulnerability to neurodevelopmental disorders. In addition to the direct effects of an eating disorder on fetal growth and development, the intrauterine environment influences vulnerability to physical illness and mental health issues later on in life. Psychiatric comorbidity seems to play an important role. In addition, because a history of anorexia nervosa is also associated with an increased risk of ADHD and ASD, there may be some genetic factors which increase risk for eating disorders, as well as vulnerability to ASD and ADHD.
Ruta Nonacs, MD PhD
Mantel Ä, Örtqvist AK, Hirschberg AL, Stephansson O. Analysis of Neurodevelopmental Disorders in Offspring of Mothers With Eating Disorders in Sweden. JAMA Netw Open. 2022 Jan 4;5(1):e2143947. Free article.