Maternal eating disorders increase risk for ADHD, autism spectrum disorders in offspring

Children born to mothers with active eating disorders during pregnancy demonstrated an elevated risk for developing ADHD and autism spectrum disorders, according to a Swedish population-based cohort study published in JAMA Network Open.

“In addition to the direct effect on the fetal growth and development, the intrauterine environment presumably influences health during childhood and throughout life. Precise mechanisms and interactions are poorly defined, but it is assumed that intrauterine environmental exposures, including nutritional factors, affect neurodevelopment and immune maturation,” Ängla Mantel, MD, PhD, of the division of clinical epidemiology at Karolinska University Hospital in Stockholm, Sweden, and colleagues wrote. “Thus, hypothetically, children of mothers with eating disorders might be prone to develop specific conditions, including neurodevelopmental disorders.”

Mantel and colleagues sought to examine associations between preexisting or ongoing eating disorders in pregnant women, and the risk posed to their children for neuropsychiatric conditions.

The researchers culled information from the Swedish Medical Birth Registry and identified more than 2 million singleton births between Jan. 1, 1990, and Dec. 31, 2012. A total of 52,878 children were included in the final analysis. Researchers matched children of mothers with eating disorders with five children of mothers without eating disorders, based on maternal age at delivery, sex and birth year.

Participants were followed up from 1 year of age for ASD and from 3 years of age for ADHD, while relative risk for both disorders was broken down by subtype of eating disorder (anorexia nervosa, bulimia nervosa and unspecified eating disorder) and ongoing vs. prior diagnosis, then adjusted for possible external causes, such as parents’ socioeconomic status and comorbidities. Follow-up concluded on Dec. 31, 2017.

Results showed an association between maternal eating disorder exposure and increased risk for ADHD and ASD, along with high HRs for anorexia, bulimia and unspecified disorders.

Over a mean follow-up period of 9.7 years, data revealed a 40% increased risk for ADHD diagnosis among children born to mothers with anorexia. The risk fell to 27% with adjustments made for parental educational level and psychiatric comorbidities.

During a mean follow-up length of 10.8 years, ASD risk increased among children born to mothers with anorexia and remained so when adjusting for parental educational level and psychiatric comorbidities.

In addition, children born to mothers with ongoing anorexia had a four times greater risk for ASD compared with an 80% increased risk for those born to mothers with previous anorexia.

“We found an association between maternal eating disorders and neuropsychiatric diseases in children that could not entirely be explained by parental comorbidities or familial confounding,” Mantel and colleagues wrote. “The risk of neuropsychiatric diseases was highest among children of mothers with ongoing eating disorders during pregnancy.”