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Exposures during pregnancy and at birth are associated with the risk of offspring eating disorders
Judit Ozsvar1,2, Mika Gissler1,2,3,4, Catharina Lavebratt1,2
1Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Insights
Prenatal and birth exposures significantly impact offspring eating disorder (ED) risk, with specific factors influencing anorexia nervosa (AN), bulimia nervosa (BN), and ED not otherwise specified (EDNOS) differently. These findings highlight the need for subtype- and sex-specific analyses in ED research.
Area of Science:
- Reproductive Health
- Psychiatry
- Perinatal Medicine
Background:
- Eating disorders (ED) are severe psychiatric conditions with early onset.
- Intrauterine and perinatal environmental factors are implicated in ED risk.
- This study investigates the association between various prenatal and birth exposures and offspring ED, including anorexia nervosa (AN), bulimia nervosa (BN), and ED not otherwise specified (EDNOS).
Purpose of the Study:
- To determine the effect size of prenatal and birth exposures on the risk of developing specific eating disorders in offspring.
- To identify specific risk factors associated with AN, BN, and EDNOS.
- To explore sex-specific associations between exposures and ED subtypes.
Main Methods:
- A population-based cohort study utilizing Finnish national registries from 1996-2014.
- Involved over 1 million live births.
- Cox proportional hazards modeling was employed for risk analysis, with adjustments for confounders and sex-stratified analyses.
Main Results:
- 6,614 offspring were diagnosed with an ED.
- AN risk was lower with young mothers, continued smoking, and instrumental delivery; higher with older mothers, inflammatory disorders, prematurity, small for gestational age, and low Apgar.
- BN risk was higher with continued smoking and prematurity; lower with postmature birth.
- EDNOS risk was higher for older mothers, polycystic ovary syndrome, insulin-treated pregestational diabetes, antibacterial treatment, prematurity, and small for gestational age; lower with instrumental delivery.
- Sex-specific associations were observed.
Conclusions:
- Multiple prenatal and birth exposures are linked to offspring ED risk.
- Confounding by maternal BMI cannot be excluded.
- Specific exposures are selectively associated with AN, BN, or EDNOS, and some associations are sex-specific, underscoring the importance of stratified analyses.
Background:
Eating disorders (ED) are severe psychiatric disorders, commonly debuting early. Aberrances in the intrauterine environment and at birth have been associated with risk of ED. Here, we explore if, and at what effect size, a variety of such exposures associate with offspring ED, that is, anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS).
Methods:
This population-based cohort study, conducted from September 2021 to August 2023, used Finnish national registries of all live births in 1996-2014 (N = 1,097,753). Cox proportional hazards modeling was used to compare ED risk in exposed versus unexposed offspring, adjusting for potential confounders and performing sex-stratified analyses.
Results:
A total of 6614 offspring were diagnosed with an ED; 3668 AN, 666 BN, and 4248 EDNOS. Lower risk of offspring AN was seen with young mothers, continued smoking, and instrumental delivery, while higher risk was seen with older mothers, inflammatory disorders, prematurity, small for gestational age, and low Apgar. Offspring risk of BN was higher with continued smoking and prematurity, while lower with postmature birth. Offspring risk of EDNOS was lower with instrumental delivery, higher for older mothers, polycystic ovary syndrome, insulin-treated pregestational diabetes, antibacterial treatment, prematurity, and small for gestational age. Sex-specific associations were found.
Conclusions:
Several prenatal and at birth exposures are associated with offspring ED; however, we cannot exclude confounding by maternal BMI. Nevertheless, several exposures selectively associate with risk of either AN, BN, or EDNOS, and some are sex-specific, emphasizing the importance of subtype- and sex-stratified analyses of ED.
Public Significance:
We define environmental factors involved in the development of different ED, of importance as preventive measure, but also in order to aid in defining the molecular pathways involved and thus in the longer perspective contribute to the development of pharmacological treatment of ED.
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