Kasahara2828. Kasahara K, Ono T, Higuchi A, Katsura D, Hayashi K, Tokoro S, et al. Smoking during pregnancy is a predictor of poor perinatal outcomes in maternal anorexia nervosa: a case series and single-center cross-sectional study in Japan. Tohoku J Exp Med. 2020;250:191-200. |
Cross-sectional |
To compare pregnancy outcomes between women with and without a lifetime history of AN in medical records of a Japanese tertiary hospital |
13 single pregnancies of 11 women with lifetime AN |
Pregnant women with AN were at higher risk of premature birth and symmetric growth restriction. |
Only severe cases of AN were included |
Ante2929. Ante Z, Luu TM, Healy-Profitos J, He S, Taddeo D, Lo E, et al. Pregnancy outcomes in women with anorexia nervosa. Int J Eat Disord. 2020;53:673-82. |
Retrospective cohort study |
To assess if hospitalization for AN before or during pregnancy is associated with increased risk of adverse maternal and infant birth outcomes |
2,134,945 pregnancies |
Women with previous AN admission had increased risk of stillbirth (OR = 1.99; 95%CI 1.20-3.30), preterm birth (OR = 1.32; 95%CI 1.13-1.55), LBW (OR = 1.69; 95%CI 1.44-1.99), and SGA (OR = 1.52; 95%CI 1.35-1.72). LBW and SGA birth were more severe in women hospitalized for AN during pregnancy or within 2 years of delivery. |
Data collection was restricted to administrative hospital data and only severe cases of AN were assessed |
Eagles3030. Eagles JM, Lee AJ, Raja EA, Millar HR, Bhattacharya S. Pregnancy outcomes of women with and without a history of anorexia nervosa. Psychol Med. 2012;42:2651-60. |
Retrospective study |
To compare the pregnancy outcomes of women with and without a history of AN |
134 women with a lifetime history of AN and 670 healthy women from a local Aberdeen maternal and neonatal database |
Women with AN delivered lower weight babies although this difference was not significant after adjusting for maternal BMI in early pregnancy. Standardized birth weight scores suggested that AN mothers were more prone to deliver babies with intrauterine growth restriction (RR = 1.54; 95%CI 1.11-2.13). AN mothers were more prone to experience antepartum hemorrhage (RR = 1.70; 95%CI 1.09-2.65). |
Study did not evaluate comorbid disorders or medication use |
Wentz3131. Wentz E, Gillberg IC, Anckarsater H, Gillberg C, Råstam M. Reproduction and offspring status 18 years after teenage-onset anorexia nervosa--a controlled community-based study. Int J Eat Disord. 2009;42:483-91. |
Cross-sectional study |
To compare complications during pregnancy and delivery in a community-based sample of teenage-onset AN vs. a well-matched control group in adult years |
51 adolescent-onset AN cases initially recruited after community screening and 51 age-matched comparison cases; 6 women with current ED, 27 with previous AN, and 31 in the comparison group had children, 3 women developed an ED during pregnancy |
27 AN woman and 31 matched comparison cases. |
Small sample size and only mild cases |
Ekeus3232. Ekeus C, Lindberg L, Lindblad F, Hjern A. Birth outcomes and pregnancy complications in women with a history of anorexia nervosa. BJOG. 2006;113:925-9. |
Prospective cohort study |
To assess maternal or fetal complications in women with AN in a nationwide study in Sweden |
1,000 AN women and 827,582 healthy women |
The birth outcome measures in women with a history of AN were similar to those of the healthy population. |
Used self-report to identify women with AN; the database used did not allow ascertainment of diagnosis quality and excluded women treated as outpatients or not diagnosed with AN |
Mantel3333. Mantel A, Hirschberg AL, Stephansson O. Association of maternal eating disorders with pregnancy and neonatal outcomes. JAMA Psychiatry. 2020;77:285-93. |
Longitudinal study |
To investigate the RR of adverse pregnancy and neonatal outcomes for women with EDs (cohort study included all singleton births in the Swedish Medical Birth Register from January 1, 2003 to December 31, 2014) |
1,236,777 births were evaluated; 1,378 (0.1%) occurred in women with BN, 2,769 (0.2%) in women with AN, and 3,395 (0.3%) in women with EDNOS |
AN, BN, and EDNOS: increased risk of hyperemesis gravidarum, preterm birth, and SGA. |
The study used data from public register sources, with the risk of introducing selection and/or recall biases |
Eik-Nes3434. Eik-Nes TT, Horn J, Strohmaier S, Holmen TL, Micali N, Bjørnelv S. Impact of eating disorders on obstetric outcomes in a large clinical sample: a comparison with the HUNT study. Int J Eat Disord. 2018;51:1134-43. |
Retrospective study |
To compare the prevalence of obstetric and postnatal complications in a population-based study (The HUNT Study) linked to the Medical Birth Registry in Norway |
Database including 19,049 women with 43,651 births and 272 women with lifetime ED and 532 births |
Lifetime AN increased the odds of SGA; lifetime BN increased the odds of caesarian delivery; EDNOS/sub-threshold ED had higher likelihood of low Apgar score at 5 minutes. |
Study lacked detailed information on length of illness and was unable to examine obstetric outcomes among women in remission compared to women with active ED |
O’Brien3535. O'Brien KM, Whelan DR, Sandler DP, Hall JE, Weinberg CR. Predictors and long-term health outcomes of eating disorders. PLoS One 2017;12:e0181104. |
Cross-sectional study |
To assess predictors of self-reported ED and associations with later health events in the Sister Study cohort with a computer-assisted telephone interview |
The study included sisters of women who had breast cancer from a database of 50,884 Americans or Puerto Rican women aged 35-74 years; 2% (967) of women had a history of ED, and for the study researchers included 462 self-reports of ED (202 AN cases, 207 BN, and 41 AN + BN) |
Women reporting an ED presented higher chance of bleeding (OR = 1.37; 95%CI 1.11-1.69) and nausea or vomiting (OR = 1.25, 95%CI 1.08-145) during pregnancy. |
The initial study was not designed for the assessed ED endpoint. The study used self-reported ED diagnosis, with a sample including more well-educated and non-minority women |
Watson33. Watson HJ, Zerwas S, Torgersen L, Gustavson K, Diemer EW, Knudsen GP, et al. Maternal eating disorders and perinatal outcomes: a three-generation study in the Norwegian Mother and Child Cohort Study. J Abnorm Psychol. 2017;126:552-64. |
Longitudinal study |
To assess if maternal ED increases risk of perinatal negative outcomes after evaluating the contribution of familial transmission of perinatal events in the MoBa |
Cohort including 114,500 children and 95,200 mothers; samples included 70,881 grandmother-mother-child triads in dataset 1 (ED status during pregnancy), and 52,348 grandmother-mother-child triads in dataset 2 (lifetime ED status) |
ED was associated with higher incidence of perinatal complications, even after adjusting for grandmaternal perinatal events; AN immediately prior to pregnancy was associated with shorter birth length (RR = 1.62; 95%CI 1.20-2.14); BN was associated with induced labor (RR = 1.21; 95%CI 1.07-1.36); and BED was associated with several delivery complications, higher birth length (RR = 1.25; 95%CI 1.17-1.34), and large-for-gestational-age (RR = 1.04; 95%CI 1.01-1.06). Maternal pregravid BMI and gestational weight mediated most associations. |
Recall bias due to self-report measures. Low response rate and possible selection bias. |
dos Santos22. Dos Santos AM, Benute GR, Dos Santos NO, Nomura RM, de Lucia MC, Francisco RP. Presence of eating disorders and its relationship to anxiety and depression in pregnant women. Midwifery. 2017;51:12-5. |
Cross-sectional |
To evaluate the association of ED and anxiety and depressive disorders in high-risk pregnancies |
913 pregnant women from an outpatient clinic |
The prevalence of ED was 7.6%, of AN 0.1%, of BN 0.7%, of BED 1.1%, and of pica 5.7%. EDs were significantly associated with depression and anxiety during pregnancy. |
The study did not evaluate the effect of lifetime ED on pregnancy |
Micali3636. Micali N, Stemann Larsen P, Strandberg-Larsen K, Nybo Andersen AM. Size at birth and preterm birth in women with lifetime eating disorders: a prospective population-based study. BJOG. 2016;123:1301-10. |
Longitudinal population-based cohort |
To assess whether EDs are associated with smaller size at birth, symmetric growth restriction, and preterm birth, and whether pregnancy smoking explains the association between AN and fetal growth |
Data from women of the DNBC (n=83,826) |
Women with lifetime AN and lifetime AN + BN were more prone to restricted fetal growth and had higher odds of SGA (respectively, OR = 1.6; 95%CI 1.3-1.8 and OR = 1.5; 95%CI 1.2-1.9), compared with unexposed women. Active AN was associated with lower birth weight, length, head and abdominal circumference, ponderal index, higher odds of SGA (OR = 2.90; 95CI% 1.98-4.26) and preterm birth (OR = 1.77; 95%CI 1.00-3.12) compared with unexposed women. Pregnancy smoking only partially explained the association between NA and adverse fetal outcomes. |
Ascertainment of exposure obtained by self-report |
Linna11. Linna MS, Raevuori A, Haukka J, Suvisaari JM, Suokas JT, Gissler M. Pregnancy, obstetric, and perinatal health outcomes in eating disorders. Am J Obstet Gynecol. 2014;211:392 e1-8. |
Retrospective study |
To evaluate pregnancy, obstetric, and perinatal health outcomes and complications in women with lifetime EDs |
The study assessed women treated at the Eating Disorder Clinic of Helsinki University Central Hospital (2,257, 302 births of mothers with AN, 724 with BN and 52 with BED) compared to 9,028 unexposed women from the population |
The prevalence of anemia was higher in women with AN vs. unexposed women (3.97 vs. 1.54%). BED women had higher risk of maternal hypertension than unexposed women (22.22 vs. 2.2%) Furthermore, slow fetal growth was observed more frequently in AN vs. unexposed women (4.64 vs. 1.93%). Women with AN and BN had increased odds of premature contractions vs. unexposed women (2.18 and 2.18 vs. 1%). Women with AN and BN gave birth to babies with lower birth weight vs. unexposed women (mean 3,302 g [SD 562], adjusted p < 0.001 in AN, mean 3,464 g [SD 563], adjusted p = 0.037 in BN, mean 3,520 g [SD 539] in unexposed women), whereas birth weight was higher among babies of women with BED (mean 3,812 g [SD 519]), adjusted p < 0.001). Babies of women with AN had a fourfold higher risk of perinatal death (adjusted OR = 4.06; 95%CI 1.15-14.35) |
A sample representative of patients treated at a specialized clinic, representing more severe cases; used intake diagnosis to classify the cases, not considering evolution or diagnosis modification; used data from medical files |
Micali3737. Micali N, De Stavola B, dos-Santos-Silva I, Steenweg-de Graaff J, Jansen PW, Jaddoe VW, et al. Perinatal outcomes and gestational weight gain in women with eating disorders: a population-based cohort study. BJOG. 2012;119:1493-502. |
Longitudinal study |
To assess adverse perinatal outcomes and gestational weight gain trajectories in women with lifetime EDs from a prospective general population cohort |
Women with lifetime ED giving birth to a live singleton (5,256), including women with lifetime AN (129), lifetime BN (209), lifetime AN + BN (100), other lifetime psychiatric disorder (1,002), compared with unexposed women (3,816) |
The prevalence of pregnancy complications was similar in women with ED and controls. Women with lifetime AN + BN had increased odds of being hospitalized during pregnancy (OR = 2.7; 95%CI 0.9-7.6). The study found no differences in mean birth weight, prevalence of a SGA, or premature birth. |
Recall bias due to self-report measures. The lack of power to detect differences in rare outcomes between the various exposure groups. |
Bulik99. Bulik CM, Von Holle A, Siega-Riz AM, Torgersen L, Lie KK, Hamer RM, et al. Birth outcomes in women with eating disorders in the Norwegian Mother and Child cohort study (MoBa). Int J Eat Disord. 2009;42:9-18. |
Longitudinal study |
|
All 35,929 pregnant women included in the MoBa cohort study: 35 women with AN, 304 with BN, 1,812 with BED, and 36 with EDNOS diagnosed 6 months before or during pregnancy |
Pre-pregnancy BMI was significantly lower in mothers with AN and higher in mothers with BED vs. women without ED (i.e., referent). Mothers with AN, BN, and BED presented more significant weight gain during pregnancy and mothers with ED had a higher prevalence of smoking during pregnancy than the referent. Women with BED had higher birth weight babies, lower risk of SGA babies, and higher risk of large for gestational age babies and caesarean section than the referent. |
Recall bias due to self-report measures; BED and purging criteria differed from DSM criteria; low response rate and possible selection bias |
Torgersen3838. Torgersen L, Von Holle A, Reichborn-Kjennerud T, Berg CK, Hamer R, Sullivan P, et al. Nausea and vomiting of pregnancy in women with bulimia nervosa and eating disorders not otherwise specified. Int J Eat Disord. 2008;41:722-7. |
Longitudinal study |
To assess the prevalence of pregnancy-related nausea and vomiting and hyperemesis gravidarum in women with BN and EDNOS purging subtype in the MoBa |
All 38,038 pregnant women included in the MoBa cohort study; 118 (0.8%) women with BN before pregnancy and 43 (0.1%) of women with EDNOS purging subtype |
BN purging subtype was associated with higher odd of pregnancy-related nausea and vomiting. Women with EDNOS had higher odds of vomiting. |
Memory bias due to the use of self-report measure; refusal rate of 42% |
Kouba3939. Koubaa S, Hallstrom T, Lindholm C, Hirschberg AL. Pregnancy and neonatal outcomes in women with eating disorders. Obstet Gynecol. 2005;105:255-60. |
Longitudinal study |
To compare the prevalence of pregnancy and neonatal outcomes in women with past or current EDs vs. a control group |
49 nulliparous nonsmoking women previously diagnosed with EDs (24 AN, 20 BN, 5 EDNOS) and 68 controls recruited in early pregnancy |
22% of women with a previously diagnosed ED relapsed during pregnancy; hyperemesis was more frequent in women with ED. Delivered infants of women with ED had LBW and smaller head circumference vs. controls. Infants of women with active ED had higher chance of microcephaly or SGA. |
Small sample size |
Franko4040. Franko DL, Blais MA, Becker AE, Delinsky SS, Greenwood DN, Flores AT, et al. Pregnancy complications and neonatal outcomes in women with eating disorders. Am J Psychiatry. 2001;158:1461-6. |
Longitudinal study |
To report pregnancy complications and neonatal outcomes in 49 live births in a group of women with ED |
246 women with AN and BN issued from a longitudinal study |
The mean length of pregnancy was 38.7 weeks, mean birth weight was 7.6 lb, and mean Apgar scores at 1 and 5 minutes 8.2 and 9.0 respectively. Three babies (6.1%) had congenital disabilities, and 17 women (34.7%) experienced postpartum depression. The mean number of adverse obstetric outcomes in the ED group was 1.3; 13 women (26.5%) delivered by caesarean section. Women with active AN or BN during pregnancy had a higher frequency of birth by caesarean and postpartum depression than non-symptomatic women. |
Small sample size, absence of comparison group, use of medical records as data source, lack of previous planning for longitudinal study |
Conti4141. Conti J, Abraham S, Taylor A. Eating behavior and pregnancy outcome. J Psychosom Res. 1998;44:465-77. |
Retrospective study |
To investigate the factors associated with clinical ED and “normative” weight and shape concerns and disturbances in eating behavior that predict delivery of LBW infants as a result of growth retardation or prematurity |
88 women delivering LBW infants (34 term infants SGA, 54 premature, and 86 women delivering infants above 2.5 kg [controls]) |
The prevalence of ED was higher in women delivering term, LBW infants. There was a decline in clinical ED during pregnancy. |
Retrospective design precluding inference of causality; possible recall bias; small sample without statistically significant power; women evaluated only after delivery |