Skip to main content Accessibility help

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

  • Please note a correction has been issued for this article.



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.


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.


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.


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.


Corresponding author

*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:


Hide All
Abrams, B. & Laros, R. J. (1986). Prepregnancy weight, weight gain, and birth weight. American Journal of Obstetrics and Gynecology 154, 503509.
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, 785790.
APA (1994). Diagnostic and Statistical Manual for Psychiatric Disorders (4th edn). American Psychiatric Press: Washington, DC.
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, 289300.
Brinch, M., Isager, T. & Tolstrup, K. (1988). Anorexia nervosa and motherhood: reproduction pattern and mothering behavior of 50 women. Acta Psychiatrica Scandinavica 77, 611617.
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, 267273.
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, 130135.
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, 15171524.
Carter, F., McIntosh, V., Joyce, P. & Bulik, C. (2003). Bulimia nervosa, childbirth, and subsequent psychopathology. Journal of Psychosomatic Research 55, 357361.
Carter, R., Lipsitz, S. & Tilley, B. (2005). Quasi-likelihood estimation for relative risk regression models. Biostatistics 6, 3944.
Conti, J., Abraham, S. & Taylor, A. (1998). Eating behavior and pregnancy outcome. Journal of Psychosomatic Research 44, 465477.
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, 10481050.
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, 220223.
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, 14611466.
Götestam, K. & Agras, W. (1995). General population-based epidemiology study of eating disorders in Norway. International Journal of Eating Disorders 18, 119126.
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, 415423.
Hartge, P. (2006). Participation in population studies. Epidemiology 17, 252254.
Hoek, H. W. (2006). Incidence, prevalence and mortality of anorexia nervosa and other eating disorders. Current Opinions in Psychiatry 19, 389394.
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, 435439.
Keel, P., Haedt, A. & Edler, C. (2005). Purging disorder: an ominous variant of bulimia nervosa? International Journal of Eating Disorders 38, 191199.
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, 293296.
Kouba, S., Hallstrom, T., Lindholm, C. & Hirschberg, A. (2005). Pregnancy and neonatal outcomes in women with eating disorders. Obstetrics and Gynecology 105, 255260.
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, 627632.
Lacey, J. & Smith, G. (1987). Bulimia nervosa: the impact of pregnancy on mother and baby. British Journal of Psychiatry 50, 777781.
Lemberg, R. & Phillips, J. (1989). The impact of pregnancy on anorexia nervosa and bulimia. International Journal of Eating Disorders 8, 285295.
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, 755760.
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, 11461150.
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, 209214.
Morgan, J., Lacey, J. & Sedgwick, P. (1999). Impact of pregnancy on bulimia nervosa. British Journal of Psychiatry 174, 135140.
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, 721732.
Namir, S., Melman, K. & Yager, J. (1986). Pregnancy in restrictor-type anorexia nervosa: a study of six women. International Journal of Eating Disorders 5, 837845.
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, 150159.
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, 196202.
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, 123132.
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, 307314.
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, 138.
SAS Institute Inc. (2004). SAS/STAT® Software: Version 9. SAS Institute, Inc.: Cary, NC.
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, 146153.
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.
Skjaerven, R., Wilcox, A. & Lie, R. (2002). The interval between pregnancies and the risk of preeclampsia. New England Journal of Medicine 346, 3338.
Solomon, L. & Quinn, V. (2004). Spontaneous quitting: self-initiated smoking cessation in early pregnancy. Nicotine and Tobacco Research 6 (Suppl. 2), S203S216.
Stewart, D., Raskin, J., Garfinkel, P., MacDonald, O. & Robinson, G. (1987). Anorexia nervosa, bulimia, and pregnancy. American Journal of Obstetrics and Gynecology 157, 11941198.
Stewart, D., Robinson, G., Goldbloom, D. & Wright, C. (1990). Infertility and eating disorders. American Journal of Obstetrics and Gynecology 163, 11961199.
Stokes, M., Davis, C. & Koch, G. (2000). Categorical Data Analysis Using the SAS System. SAS Institute Inc.: Cary, NC.
Strimling, B. (1984). Infant of a pregnancy complicated by anorexia nervosa. American Journal of Diseases of Children 138, 6869.
Sullivan, P. F., Bulik, C. M. & Kendler, K. S. (1998). The epidemiology and classification of bulimia nervosa. Psychological Medicine 28, 599610.
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.
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, 962965.
Wade, T. (2007). A retrospective comparison of purging type disorders: eating disorder not otherwise specified and bulimia nervosa. International Journal of Eating Disorders 40, 16.
Weinfeld, R., Dubay, M., Burchell, R., Mellerick, J. & Kennedy, A. (1977). Pregnancy associated with anorexia and starvation. American Journal of Obstetrics and Gynecology 15, 698699.
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.
Willis, D. & Rand, C. (1988). Pregnancy in bulimic women. Obstetrics and Gynecology 71, 708710.
Zou, G. (2004). A modified Poisson regression approach to prospective studies with binary data. American Journal of Epidemiology 159, 702706.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

A correction has been issued for this article: