Prepregnancy Obesity, Eating Disorders Linked to Mental Health Diagnoses in Kids

Among mothers, a history of eating disorders or body mass index (BMI) outside the normal range was associated with a higher risk of neurodevelopmental and psychiatric disorders in their offspring, according to a Finnish population-based cohort study.

In an analysis of nearly 400,000 mothers and nearly 650,000 offspring, the largest effect sizes were for non-specified maternal eating disorders in association with childhood sleep disorders (HR 3.34, 95% CI 2.39-4.67, P<0.001) and social functioning and tic disorders (HR 2.79, 95% CI 2.21-3.52, P<0.001), reported Ida Nilsson, PhD, of Karolinska Hospital in Stockholm, and co-authors.

For maternal severe prepregnancy obesity, the largest effect size was for intellectual disabilities (HR 2.04, 95% CI 1.83-2.28, P<0.001), they noted in JAMA Network Open.

Adverse birth outcomes further increased the risk of disturbances with feeding in childhood and infancy (HR 4.53, 95% CI 2.97-6.89 for maternal eating disorders) and attention deficit-hyperactivity disorder (ADHD) and conduct disorder (HR 2.27, 95% CI 1.74-2.96 for maternal anorexia nervosa).

“The study confirms previously published associations between maternal eating disorders and BMI and offspring psychiatric disorder, but also reports new associations,” Nilsson told MedPage Today.

She explained that these associations remained even after they controlled for the potential influence of maternal genetics of psychiatric disorders. She noted that they observed further increased risk for psychiatric diagnoses in children born to mothers who experienced birth complications, such as premature birth.

“The findings underline the importance of considering maternal eating disorders and BMI in maternity care, aiming to reduce the number of offspring with neurodevelopmental and psychiatric disorders,” Nilsson said. “The findings also strengthen the importance of the nutrition of pregnant women.”

She added that these outcomes could guide future research in identifying and understanding the biological mechanisms behind these neurodevelopmental and psychiatric disorders.

Laura Cooney, MD, of the University of Wisconsin-Madison, who wasn’t involved in the study, told MedPage Today that it is always necessary and important to raise societal awareness about mental health disorders, especially in children.

These results “could help you have a higher index of suspicion when you’re treating children,” she said. “At the same time, a lot of these factors are out of the mom’s control, and so we definitely don’t want to stigmatize her.”

Cooney noted that it would be helpful to know whether these associations remain when the mother is treated for an eating disorder or when a mother successfully loses weight. “Are these fixed risks, or can these risks be modified with successful prepregnancy counseling and treatment of the moms?”

For this study, Nilsson and colleagues used Finnish national registries to assess all live births from January 2004 through December 2014. They followed children from birth until ages 7 to 17.

Primary outcomes were nine neurodevelopmental and psychiatric diagnoses, including mood disorders, anxiety disorders, sleep disorders, intellectual disabilities, specific developmental disorders, autism spectrum disorder, ADHD and conduct disorders, social functioning and tic disorders, and other feeding disorders of infancy and childhood.

In total, they included 649,956 children from 392,098 mothers. The mean age of mothers was 30.15 years. Overall, 53.13% had prepregnancy overweight or obesity, 5.89% had underweight, and 1.6% had a history of an eating disorder. Among the children, 51.14% were male, and 16.43% had received a neurodevelopmental or psychiatric diagnosis.

Looking at specific maternal eating disorders, there was an association between sleep disorders and maternal anorexia nervosa (HR 2.12, 95% CI 1.53-2.92, P<0.001) and maternal bulimia nervosa (HR 2.35, 95% CI 1.67-3.32, P<0.001), and an association between social functioning and tic disorders and maternal anorexia nervosa (HR 2.16, 95% CI 1.75-2.67, P<0.001).

The study had several limitations. First, the authors did not have access to any paternal information. Second, the follow-up time for children in the study was relatively short, ending at 17 years at the oldest. They noted that this likely limited analysis for psychiatric diagnoses with late onset, such as schizophrenia.

In addition, additive genetic factors could account for approximately 40% to 60% of the liability associated with eating disorders, they said.

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