Pregnant women with eating disorders have an increased risk of complications, both for the mother and the baby, according to new research.

Eating disorders affect millions of people around the world, most often women in childbearing age. However, to date only a few smaller, limited studies have examined potential complications for children born to mothers with eating disorders.

That led researchers at the Karolinska Institutet in Sweden to take a comprehensive view by studying all the 1.2 million mothers who gave birth in Sweden between 2003 and 2014. Of those mothers, nearly 2,800 had anorexia, 1,400 had bulimia, and 3,400 had an unspecified eating disorder. They also compared whether the risk varied between these different types of eating disorders and whether the mother had an active or previous eating disorder.

The study showed that all types of eating disorders increased the risk of premature birth, microcephaly (small head circumference for gestational age), and hyperemesis during pregnancy, a severe form of nausea and vomiting affecting the mother.

The risk of anemia was twice as high for women with active anorexia or unspecified eating disorder as for mothers without eating disorders. Active anorexia was also associated with an increased risk of antepartum hemorrhage.

The increases in risk were more pronounced if the disease was active, but women who hadnt been treated for an eating disorder in more than a year before conception were also at higher risk of complications compared to mothers who had never been diagnosed with an eating disorder, according to the studys findings.

Women with an eating disorder should be recognized as a high-risk group among pregnant women. From a clinical point of view, this means that care providers need to develop better routines to identify women with active or previous eating disorders and consider extended pregnancy screenings to meet their needs, said ngla Mantel, a researcher at the Department of Medicine in Solna at the Karolinska Institutet and resident physician in obstetrics and gynecology at Karolinska Universitetssjukhuset and corresponding author of the study.

According to the researchers, there are several possible explanations for the associations. An inadequate diet with subsequent nutritional deficiencies may limit fetal growth. The stress hormone cortisol tends to be high in women with anorexia and bulimia and has previously been associated with microcephaly. Both stress and some nutritional deficiencies in the mother have previously been connected to premature birth. Vitamin and mineral deficiencies have also been associated with placental abruption, which could explain the increased risk of bleeding during pregnancy.

When it comes to hyperemesis, the researchers noticed that part of the association to eating disorders disappeared when they adjusted for psychiatric conditions such as anxiety and depression. Other outcomes remained largely the same after adjusting for variables such as age, smoking, and birth year.

The study was published in the journal JAMA Psychiatry.

Source: Karolinska Institutet

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