Hostname: page-component-5f56664f6-2gss9 Total loading time: 0 Render date: 2025-05-07T08:23:11.623Z Has data issue: false hasContentIssue false
  • English
  • Français

Patterns of remission, continuation and incidence of broadly defined eating disorders during early pregnancy in the Norwegian Mother and Child Cohort Study (MoBa)

Published online by Cambridge University Press:  10 May 2007

CYNTHIA M. BULIK ,
ANN VON HOLLE ,
ROBERT HAMER ,
CECILIE KNOPH BERG ,
LEILA TORGERSEN ,
PER MAGNUS ,
CAMILLA STOLTENBERG ,
ANNA MARIA SIEGA-RIZ ,
PATRICK SULLIVAN  and
TED REICHBORN-KJENNERUD
CYNTHIA M. BULIK*
Affiliation:
Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
ANN VON HOLLE
Affiliation:
Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
ROBERT HAMER
Affiliation:
Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
CECILIE KNOPH BERG
Affiliation:
Division of Mental Health, Norwegian Institute of Public Health, Norway
LEILA TORGERSEN
Affiliation:
Division of Mental Health, Norwegian Institute of Public Health, Norway
PER MAGNUS
Affiliation:
Epidemiology, Norwegian Institute of Public Health, Norway
CAMILLA STOLTENBERG
Affiliation:
Epidemiology, Norwegian Institute of Public Health, Norway
ANNA MARIA SIEGA-RIZ
Affiliation:
Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
PATRICK SULLIVAN
Affiliation:
Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
TED REICHBORN-KJENNERUD
Affiliation:
Division of Mental Health, Norwegian Institute of Public Health, Norway Department of Psychiatry, University of Oslo, Norway
*
*Address for correspondence: Dr C. M. Bulik, Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive, CB #7160, Chapel Hill, NC 27599-7160, USA. (Email: cbulik@med.unc.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

We explored the course of broadly defined eating disorders during pregnancy in the Norwegian Mother and Child Cohort Study (MoBa) at the Norwegian Institute of Public Health.

Method

A total of 41 157 pregnant women, enrolled at approximately 18 weeks' gestation, had valid data from the Norwegian Medical Birth Registry. We collected questionnaire-based diagnostic information on broadly defined anorexia nervosa (AN), and bulimia nervosa (BN), and eating disorders not otherwise specified (EDNOS). EDNOS subtypes included binge eating disorder (BED) and recurrent self-induced purging in the absence of binge eating (EDNOS-P). We explored rates of remission, continuation and incidence of BN, BED and EDNOS-P during pregnancy.

Results

Prepregnancy prevalence estimates were 0·1% for AN, 0·7% for BN, 3·5% for BED and 0·1% for EDNOS-P. During early pregnancy, estimates were 0·2% (BN), 4·8% (BED) and 0·1% (EDNOS-P). Proportions of individuals remitting during pregnancy were 78% (EDNOS-P), 40% (BN purging), 39% (BED), 34% (BN any type) and 29% (BN non-purging type). Additional individuals with BN achieved partial remission. Incident BN and EDNOS-P during pregnancy were rare. For BED, the incidence rate was 1·1 per 1000 person-weeks, equating to 711 new cases of BED during pregnancy. Incident BED was associated with indices of lower socio-economic status.

Conclusions

Pregnancy appears to be a catalyst for remission of some eating disorders but also a vulnerability window for the new onset of broadly defined BED, especially in economically disadvantaged individuals. Vigilance by health-care professionals for continuation and emergence of eating disorders in pregnancy is warranted.

Type
Original Article
Information
Psychological Medicine , Volume 37 , Issue 8 , August 2007 , pp. 1109 - 1118
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

REFERENCES

Abrams, B. & Laros, R. J. (1986). Prepregnancy weight, weight gain, and birth weight. American Journal of Obstetrics and Gynecology 154, 503–509.CrossRefGoogle ScholarPubMed
Abrams, B. & Newman, V. (1991). Small-for-gestational-age birth: maternal predictors and comparison with risk factors of spontaneous preterm delivery in the same cohort. American Journal of Obstetrics and Gynecology 164, 785–790.CrossRefGoogle ScholarPubMed
APA (1994). Diagnostic and Statistical Manual for Psychiatric Disorders (4th edn). American Psychiatric Press: Washington, DC.Google Scholar
Benjamini, Y. & Hochberg, Y. (1995). Controlling the false discovery rate: a practical and powerful approach to multiple testing. Journal of the Royal Statistical Society Series B 57, 289–300.Google Scholar
Brinch, M., Isager, T. & Tolstrup, K. (1988). Anorexia nervosa and motherhood: reproduction pattern and mothering behavior of 50 women. Acta Psychiatrica Scandinavica 77, 611–617.CrossRefGoogle ScholarPubMed
Bruce, F. C., Adams, M. M., Shulman, H. B. & Martin, M. L. (1993). Alcohol use before and during pregnancy. PRAMS Working Group. American Journal of Preventive Medicine 9, 267–273.CrossRefGoogle ScholarPubMed
Bulik, C., Sullivan, P., Fear, J., Pickering, A., Dawn, A. & McCullin, M. (1999). Fertility and reproduction in women with a history of anorexia nervosa: a controlled study. Journal of Clinical Psychiatry 60, 130–135.CrossRefGoogle ScholarPubMed
Bulik, C. M., Wade, T. D., Heath, A. C., Martin, N. G., Stunkard, A. J. & Eaves, L. J. (2001). Relating body mass index to figural stimuli: population-based normative data for Caucasians. International Journal of Obesity and Related Metabolic Disorders 25, 1517–1524.CrossRefGoogle ScholarPubMed
Carter, F., McIntosh, V., Joyce, P. & Bulik, C. (2003). Bulimia nervosa, childbirth, and subsequent psychopathology. Journal of Psychosomatic Research 55, 357–361.CrossRefGoogle Scholar
Carter, R., Lipsitz, S. & Tilley, B. (2005). Quasi-likelihood estimation for relative risk regression models. Biostatistics 6, 39–44.CrossRefGoogle ScholarPubMed
Conti, J., Abraham, S. & Taylor, A. (1998). Eating behavior and pregnancy outcome. Journal of Psychosomatic Research 44, 465–477.CrossRefGoogle ScholarPubMed
Crow, S., Thuras, P., Keel, P. K. & Mitchell, J. E. (2002). Long-term menstrual and reproductive function in patients with bulimia nervosa. American Journal of Psychiatry 159, 1048–1050.CrossRefGoogle ScholarPubMed
Crow, S. J., Keel, P. K., Thuras, P. & Mitchell, J. E. (2004). Bulimia symptoms and other risk behaviors during pregnancy in women with bulimia nervosa. International Journal of Eating Disorders 36, 220–223.CrossRefGoogle ScholarPubMed
Franko, D., Blais, M., Becker, A., Delinsky, S., Greenwood, D., Flores, A., Ekeblad, E., Eddy, K. & Herzog, D. (2001). Pregnancy complications and neonatal outcomes in women with eating disorders. American Journal of Psychiatry 158, 1461–1466.CrossRefGoogle ScholarPubMed
Götestam, K. & Agras, W. (1995). General population-based epidemiology study of eating disorders in Norway. International Journal of Eating Disorders 18, 119–126.3.0.CO;2-U>CrossRefGoogle ScholarPubMed
Harris, J., Magnus, P. & Tambs, K. (2002). The Norwegian Institute of Public Health Twin Panel: a description of the sample and program of research. Twin Research 5, 415–423.CrossRefGoogle Scholar
Hartge, P. (2006). Participation in population studies. Epidemiology 17, 252–254.CrossRefGoogle ScholarPubMed
Hoek, H. W. (2006). Incidence, prevalence and mortality of anorexia nervosa and other eating disorders. Current Opinions in Psychiatry 19, 389–394.CrossRefGoogle ScholarPubMed
Irgens, L., Bergsjø, P. & Lie, R. (2000). The Medical Birth Registry of Norway. Epidemiological research and surveillance throughout 30 years. Acta Obstetricia et Gynecologica Scandinavica 79, 435–439.CrossRefGoogle Scholar
Keel, P., Haedt, A. & Edler, C. (2005). Purging disorder: an ominous variant of bulimia nervosa? International Journal of Eating Disorders 38, 191–199.CrossRefGoogle ScholarPubMed
Kohmura, H., Miyake, A., Aono, T. & Tanizawa, O. (1986). Recovery of reproductive function in patients with anorexia nervosa: a 10-year follow-up study. European Journal of Obstetrics, Gynecology and Reproductive Biology 22, 293–296.CrossRefGoogle ScholarPubMed
Kouba, S., Hallstrom, T., Lindholm, C. & Hirschberg, A. (2005). Pregnancy and neonatal outcomes in women with eating disorders. Obstetrics and Gynecology 105, 255–260.CrossRefGoogle Scholar
Kruse, J., Le Fevre, M. & Zweig, S. (1986). Changes in smoking and alcohol consumption during pregnancy: a population-based study in a rural area. Obstetrics and Gynecology 67, 627–632.CrossRefGoogle ScholarPubMed
Lacey, J. & Smith, G. (1987). Bulimia nervosa: the impact of pregnancy on mother and baby. British Journal of Psychiatry 50, 777–781.CrossRefGoogle Scholar
Lemberg, R. & Phillips, J. (1989). The impact of pregnancy on anorexia nervosa and bulimia. International Journal of Eating Disorders 8, 285–295.3.0.CO;2-P>CrossRefGoogle Scholar
Lie, R., Wilcox, A. & Skjaerven, R. (2001). Survival and reproduction among males with birth defects and risk of recurrence in their children. Journal of the American Medical Association 285, 755–760.CrossRefGoogle ScholarPubMed
Magnus, P., Irgens, L., Haug, K., Nystad, W., Skjaerven, R., Stoltenberg, C. & the MoBa Study Group (2006). Cohort profile: the Norwegian Mother and Child Cohort Study (MoBa). International Journal of Epidemiology 35, 1146–1150.CrossRefGoogle ScholarPubMed
Mitchell, J. E., Seim, H. C., Glotter, D., Soll, E. A. & Pyle, R. L. (1991). A retrospective study of pregnancy in bulimia nervosa. International Journal of Eating Disorders 10, 209–214.3.0.CO;2-S>CrossRefGoogle Scholar
Morgan, J., Lacey, J. & Sedgwick, P. (1999). Impact of pregnancy on bulimia nervosa. British Journal of Psychiatry 174, 135–140.CrossRefGoogle ScholarPubMed
Mullen, P. E., Martin, J. L., Anderson, J. C., Romans, S. E. & Herbison, G. P. (1993). Childhood sexual abuse and mental health in adult life. British Journal of Psychiatry 163, 721–732.CrossRefGoogle ScholarPubMed
Namir, S., Melman, K. & Yager, J. (1986). Pregnancy in restrictor-type anorexia nervosa: a study of six women. International Journal of Eating Disorders 5, 837–845.3.0.CO;2-Y>CrossRefGoogle Scholar
Ockene, J., Ma, Y., Zapka, J., Pbert, L., Valentine Goins, K. & Stoddard, A. (2002). Spontaneous cessation of smoking and alcohol use among low-income pregnant women. American Journal of Preventive Medicine 23, 150–159.CrossRefGoogle ScholarPubMed
Reichborn-Kjennerud, T., Bulik, C., Kendler, K., Maes, H., Roysamb, E., Tambs, K. & Harris, J. (2003). Gender differences in binge-eating: a population-based twin study. Acta Psychiatrica Scandinavica 108, 196–202.CrossRefGoogle ScholarPubMed
Reichborn-Kjennerud, T., Bulik, C., Kendler, K., Roysamb, E., Tambs, K., Harris, J. & Torgeson, S. (2004 a). Influence of weight on self-evaluation: a population-based study of gender differences. International Journal of Eating Disorders 35, 123–132.CrossRefGoogle ScholarPubMed
Reichborn-Kjennerud, T., Bulik, C., Tambs, K. & Harris, J. (2004 b). Genetic and environmental influences on binge eating in the absence of compensatory behaviours: a population-based twin study. International Journal of Eating Disorders 36, 307–314.CrossRefGoogle ScholarPubMed
Russell, J. A., Douglas, A. J. & Ingram, C. D. (2001). Brain preparations for maternity – adaptive changes in behavioral and neuroendocrine systems during pregnancy and lactation. An overview. Progress in Brain Research 133, 1–38.CrossRefGoogle ScholarPubMed
SAS Institute Inc. (2004). SAS/STAT® Software: Version 9. SAS Institute, Inc.: Cary, NC.Google Scholar
Siega-Riz, A., Adair, L. & Hobel, C. (1996). Maternal underweight status and inadequate rate of weight gain in the third trimester of pregnancy increases the risk of preterm delivery. Journal of Nutrition 126, 146–153.CrossRefGoogle ScholarPubMed
Skjaerven, R., Vatten, L., Wilcox, A., Ronning, T., Irgens, L. & Lie, R. (2005). Recurrence of pre-eclampsia across generations: exploring fetal and maternal genetic components in a population based cohort. British Medical Journal 331, 877.CrossRefGoogle Scholar
Skjaerven, R., Wilcox, A. & Lie, R. (2002). The interval between pregnancies and the risk of preeclampsia. New England Journal of Medicine 346, 33–38.CrossRefGoogle ScholarPubMed
Solomon, L. & Quinn, V. (2004). Spontaneous quitting: self-initiated smoking cessation in early pregnancy. Nicotine and Tobacco Research 6 (Suppl. 2), S203–S216.CrossRefGoogle ScholarPubMed
Stewart, D., Raskin, J., Garfinkel, P., MacDonald, O. & Robinson, G. (1987). Anorexia nervosa, bulimia, and pregnancy. American Journal of Obstetrics and Gynecology 157, 1194–1198.CrossRefGoogle ScholarPubMed
Stewart, D., Robinson, G., Goldbloom, D. & Wright, C. (1990). Infertility and eating disorders. American Journal of Obstetrics and Gynecology 163, 1196–1199.CrossRefGoogle ScholarPubMed
Stokes, M., Davis, C. & Koch, G. (2000). Categorical Data Analysis Using the SAS System. SAS Institute Inc.: Cary, NC.Google Scholar
Strimling, B. (1984). Infant of a pregnancy complicated by anorexia nervosa. American Journal of Diseases of Children 138, 68–69.Google ScholarPubMed
Sullivan, P. F., Bulik, C. M. & Kendler, K. S. (1998). The epidemiology and classification of bulimia nervosa. Psychological Medicine 28, 599–610.CrossRefGoogle ScholarPubMed
Treasure, J. L. & Russell, G. F. M. (1988). Intrauterine growth and neonatal weight gain in babies of women with anorexia nervosa. British Medical Journal 296, 1038.CrossRefGoogle ScholarPubMed
van der Spuy, Z. M., Steer, P. J., McCusker, M., Steele, S. J. & Jacobs, H. S. (1988). Outcome of pregnancy in underweight women after spontaneous and induced ovulation. British Medical Journal 296, 962–965.CrossRefGoogle ScholarPubMed
Wade, T. (2007). A retrospective comparison of purging type disorders: eating disorder not otherwise specified and bulimia nervosa. International Journal of Eating Disorders 40, 1–6.CrossRefGoogle Scholar
Weinfeld, R., Dubay, M., Burchell, R., Mellerick, J. & Kennedy, A. (1977). Pregnancy associated with anorexia and starvation. American Journal of Obstetrics and Gynecology 15, 698–699.CrossRefGoogle Scholar
Westfall, P., Tobias, R., Rom, D., Wolfinger, R. & Hochberg, Y. (1999). Multiple Comparisons and Multiple Tests Using the SAS System. SAS Institute Inc.: Cary, NC.Google Scholar
Willis, D. & Rand, C. (1988). Pregnancy in bulimic women. Obstetrics and Gynecology 71, 708–710.Google ScholarPubMed
Zou, G. (2004). A modified Poisson regression approach to prospective studies with binary data. American Journal of Epidemiology 159, 702–706.CrossRefGoogle ScholarPubMed