Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 65
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Gold, Katherine J and Marcus, Sheila M 2008. Effect of maternal mental illness on pregnancy outcomes. Expert Review of Obstetrics & Gynecology, Vol. 3, Issue. 3, p. 391.

    Hoffman, Elizabeth R Zerwas, Stephanie C and Bulik, Cynthia M 2011. Reproductive issues in anorexia nervosa. Expert Review of Obstetrics & Gynecology, Vol. 6, Issue. 4, p. 403.

    Kimmel, M.C. Ferguson, E.H. Zerwas, S. Bulik, C.M. and Meltzer-Brody, S. 2016. Obstetric and gynecologic problems associated with eating disorders. International Journal of Eating Disorders, Vol. 49, Issue. 3, p. 260.

    Golding, Jean 2009. Measuring outcomes in a longitudinal birth cohort. Paediatric and Perinatal Epidemiology, Vol. 23, p. 185.

    Broussard, Brenda 2012. Psychological and Behavioral Traits Associated with Eating Disorders and Pregnancy: A Pilot Study. Journal of Midwifery & Women's Health, Vol. 57, Issue. 1, p. 61.

    Luca, Antonina Luca, Maria and Calandra, Carmela 2015. Eating Disorders in Late-life. Aging and Disease, Vol. 6, Issue. 1, p. 48.

    Pearlstein, Teri and Star, Jami 2010. de Swiet's Medical Disorders in Obstetric Practice.

    Rushing, Stephanie 2011. Eating Disorders in Women and Children.

    Lai, Beatrice Pui-yee and Tang, Catherine So-kum 2008. The negative impact of maternal bulimic symptoms on parenting behavior. Journal of Psychosomatic Research, Vol. 65, Issue. 2, p. 181.

    Babbs, R.K. Unger, E.L. and Corwin, R.L.W. 2013. 2-Hydroxyestradiol enhances binge onset in female rats and reduces prefrontal cortical dopamine in male rats. Hormones and Behavior, Vol. 63, Issue. 1, p. 88.

    Coker, Elise L. Mitchell-Wong, Lisa A. and Abraham, Suzanne F. 2013. Is pregnancy a trigger for recovery from an eating disorder?. Acta Obstetricia et Gynecologica Scandinavica, Vol. 92, Issue. 12, p. 1407.

    Maine, Margo D. Samuels, Karen L. and Tantillo, Mary 2015. Eating disorders in adult women: biopsychosocial, developmental, and clinical considerations. Advances in Eating Disorders, Vol. 3, Issue. 2, p. 133.

    Micali, Nadia and Treasure, Janet 2009. Biological effects of a maternal ED on pregnancy and foetal development: a review. European Eating Disorders Review, Vol. 17, Issue. 6, p. 448.

    Bansil, Pooja and Kuklina, Elena V 2009. Striving for ‘perfection’: influences, prevalence and dangers of eating disorders in expectant mothers. Expert Review of Obstetrics & Gynecology, Vol. 4, Issue. 3, p. 231.

    Tierney, Stephanie McGlone, Carole and Furber, Christine 2013. What can qualitative studies tell us about the experiences of women who are pregnant that have an eating disorder?. Midwifery, Vol. 29, Issue. 5, p. 542.

    Campbell, Iain C. Mill, Jonathan Uher, Rudolf and Schmidt, Ulrike 2011. Eating disorders, gene–environment interactions and epigenetics. Neuroscience & Biobehavioral Reviews, Vol. 35, Issue. 3, p. 784.

    Andersen, Arnold E. and Ryan, Ginny L. 2009. Eating Disorders in the Obstetric and Gynecologic Patient Population. Obstetrics & Gynecology, Vol. 114, Issue. 6, p. 1353.

    Pettersson, Cecilia Brundin Zandian, Modjtaba and Clinton, David 2016. Eating disorder symptoms pre- and postpartum. Archives of Women's Mental Health, Vol. 19, Issue. 4, p. 675.

    Maine, Margo 2010. Treatment of Eating Disorders.

    Chassevent-Pajot, A. Guillou-Landréat, M. Grall-Bronnec, M. Wainstein, L. Philippe, H.-J. Lombrail, P. and Vénisse, J.-L. 2011. Étude de prévalence des conduites addictives chez les femmes enceintes dans une maternité universitaire. Journal de Gynécologie Obstétrique et Biologie de la Reproduction, Vol. 40, Issue. 3, p. 237.


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

  • DOI:
  • Published online: 10 May 2007

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:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

B. Abrams & R. J. Laros (1986). Prepregnancy weight, weight gain, and birth weight. American Journal of Obstetrics and Gynecology 154, 503509.

B. Abrams & V. Newman (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.

M. Brinch , T. Isager & K. Tolstrup (1988). Anorexia nervosa and motherhood: reproduction pattern and mothering behavior of 50 women. Acta Psychiatrica Scandinavica 77, 611617.

C. Bulik , P. Sullivan , J. Fear , A. Pickering , A. Dawn & M. McCullin (1999). Fertility and reproduction in women with a history of anorexia nervosa: a controlled study. Journal of Clinical Psychiatry 60, 130135.

C. M. Bulik , T. D. Wade , A. C. Heath , N. G. Martin , A. J. Stunkard & L. J. Eaves (2001). Relating body mass index to figural stimuli: population-based normative data for Caucasians. International Journal of Obesity and Related Metabolic Disorders 25, 15171524.

F. Carter , V. McIntosh , P. Joyce & C. Bulik (2003). Bulimia nervosa, childbirth, and subsequent psychopathology. Journal of Psychosomatic Research 55, 357361.

R. Carter , S. Lipsitz & B. Tilley (2005). Quasi-likelihood estimation for relative risk regression models. Biostatistics 6, 3944.

J. Conti , S. Abraham & A. Taylor (1998). Eating behavior and pregnancy outcome. Journal of Psychosomatic Research 44, 465477.

S. Crow , P. Thuras , P. K. Keel & J. E. Mitchell (2002). Long-term menstrual and reproductive function in patients with bulimia nervosa. American Journal of Psychiatry 159, 10481050.

S. J. Crow , P. K. Keel , P. Thuras & J. E. Mitchell (2004). Bulimia symptoms and other risk behaviors during pregnancy in women with bulimia nervosa. International Journal of Eating Disorders 36, 220223.

D. Franko , M. Blais , A. Becker , S. Delinsky , D. Greenwood , A. Flores , E. Ekeblad , K. Eddy & D. Herzog (2001). Pregnancy complications and neonatal outcomes in women with eating disorders. American Journal of Psychiatry 158, 14611466.

K. Götestam & W. Agras (1995). General population-based epidemiology study of eating disorders in Norway. International Journal of Eating Disorders 18, 119126.

J. Harris , P. Magnus & K. Tambs (2002). The Norwegian Institute of Public Health Twin Panel: a description of the sample and program of research. Twin Research 5, 415423.

P. Hartge (2006). Participation in population studies. Epidemiology 17, 252254.

H. W. Hoek (2006). Incidence, prevalence and mortality of anorexia nervosa and other eating disorders. Current Opinions in Psychiatry 19, 389394.

L. Irgens , P. Bergsjø & R. Lie (2000). The Medical Birth Registry of Norway. Epidemiological research and surveillance throughout 30 years. Acta Obstetricia et Gynecologica Scandinavica 79, 435439.

P. Keel , A. Haedt & C. Edler (2005). Purging disorder: an ominous variant of bulimia nervosa? International Journal of Eating Disorders 38, 191199.

H. Kohmura , A. Miyake , T. Aono & O. Tanizawa (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.

S. Kouba , T. Hallstrom , C. Lindholm & A. Hirschberg (2005). Pregnancy and neonatal outcomes in women with eating disorders. Obstetrics and Gynecology 105, 255260.

J. Kruse , M. Le Fevre & S. Zweig (1986). Changes in smoking and alcohol consumption during pregnancy: a population-based study in a rural area. Obstetrics and Gynecology 67, 627632.

R. Lemberg & J. Phillips (1989). The impact of pregnancy on anorexia nervosa and bulimia. International Journal of Eating Disorders 8, 285295.

R. Lie , A. Wilcox & R. Skjaerven (2001). Survival and reproduction among males with birth defects and risk of recurrence in their children. Journal of the American Medical Association 285, 755760.

P. Magnus , L. Irgens , K. Haug , W. Nystad , R. Skjaerven , C. Stoltenberg & the MoBa Study Group (2006). Cohort profile: the Norwegian Mother and Child Cohort Study (MoBa). International Journal of Epidemiology 35, 11461150.

J. E. Mitchell , H. C. Seim , D. Glotter , E. A. Soll & R. L. Pyle (1991). A retrospective study of pregnancy in bulimia nervosa. International Journal of Eating Disorders 10, 209214.

J. Morgan , J. Lacey & P. Sedgwick (1999). Impact of pregnancy on bulimia nervosa. British Journal of Psychiatry 174, 135140.

P. E. Mullen , J. L. Martin , J. C. Anderson , S. E. Romans & G. P. Herbison (1993). Childhood sexual abuse and mental health in adult life. British Journal of Psychiatry 163, 721732.

S. Namir , K. Melman & J. Yager (1986). Pregnancy in restrictor-type anorexia nervosa: a study of six women. International Journal of Eating Disorders 5, 837845.

J. Ockene , Y. Ma , J. Zapka , L. Pbert , K. Valentine Goins & A. Stoddard (2002). Spontaneous cessation of smoking and alcohol use among low-income pregnant women. American Journal of Preventive Medicine 23, 150159.

T. Reichborn-Kjennerud , C. Bulik , K. Kendler , H. Maes , E. Roysamb , K. Tambs & J. Harris (2003). Gender differences in binge-eating: a population-based twin study. Acta Psychiatrica Scandinavica 108, 196202.

T. Reichborn-Kjennerud , C. Bulik , K. Kendler , E. Roysamb , K. Tambs , J. Harris & S. Torgeson (2004 a). Influence of weight on self-evaluation: a population-based study of gender differences. International Journal of Eating Disorders 35, 123132.

T. Reichborn-Kjennerud , C. Bulik , K. Tambs & J. Harris (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.

J. A. Russell , A. J. Douglas & C. D. Ingram (2001). Brain preparations for maternity – adaptive changes in behavioral and neuroendocrine systems during pregnancy and lactation. An overview. Progress in Brain Research 133, 138.

R. Skjaerven , L. Vatten , A. Wilcox , T. Ronning , L. Irgens & R. Lie (2005). Recurrence of pre-eclampsia across generations: exploring fetal and maternal genetic components in a population based cohort. British Medical Journal 331, 877.

R. Skjaerven , A. Wilcox & R. Lie (2002). The interval between pregnancies and the risk of preeclampsia. New England Journal of Medicine 346, 3338.

L. Solomon & V. Quinn (2004). Spontaneous quitting: self-initiated smoking cessation in early pregnancy. Nicotine and Tobacco Research 6 (Suppl. 2), S203S216.

D. Stewart , J. Raskin , P. Garfinkel , O. MacDonald & G. Robinson (1987). Anorexia nervosa, bulimia, and pregnancy. American Journal of Obstetrics and Gynecology 157, 11941198.

D. Stewart , G. Robinson , D. Goldbloom & C. Wright (1990). Infertility and eating disorders. American Journal of Obstetrics and Gynecology 163, 11961199.

P. F. Sullivan , C. M. Bulik & K. S. Kendler (1998). The epidemiology and classification of bulimia nervosa. Psychological Medicine 28, 599610.

J. L. Treasure & G. F. M. Russell (1988). Intrauterine growth and neonatal weight gain in babies of women with anorexia nervosa. British Medical Journal 296, 1038.

Z. M. van der Spuy , P. J. Steer , M. McCusker , S. J. Steele & H. S. Jacobs (1988). Outcome of pregnancy in underweight women after spontaneous and induced ovulation. British Medical Journal 296, 962965.

T. Wade (2007). A retrospective comparison of purging type disorders: eating disorder not otherwise specified and bulimia nervosa. International Journal of Eating Disorders 40, 16.

G. Zou (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? *