title: Maternal eating disorders and infant feeding difficulties: maternal and child mediators in a longitudinal general population study.
abstract: BACKGROUND
  Maternal eating disorders (ED) have been shown to increase the risk of feeding difficulties in the offspring. Very few studies, however, have investigated whether the effect of a maternal ED on childhood feeding is a direct effect or whether it can be ascribed to other child or maternal factors. We aimed to determine the role of maternal anxiety and depression in mediating the risk for feeding difficulties in infants of women with ED.
  
  
  METHODS
  A prospective study comparing women with lifetime ED (441) and without any lifetime psychiatric disorder (10,461) and their infants from the Avon Longitudinal Study of Parents and Children (ALSPAC). We investigated the effect of: maternal anxiety and depression in late pregnancy (32 weeks) and the post-partum (8 weeks), child temperament and developmental status on infant feeding difficulties at 1 and 6 months. We also investigated the effect of active pregnancy ED symptoms. We tested 3 models and their fit to the data using structured equation modelling: a direct effect model, a fully mediational model and an integrated (partial meditational) model.
  
  
  RESULTS
  The integrated model including a direct effect of maternal lifetime ED on infant feeding and a mediational path via maternal distress (a latent variable combining anxiety and depression) fitted the data best. This also applied to maternal pregnancy ED symptoms. Feeding difficulties in turn increased maternal distress over time.
  
  
  CONCLUSIONS
  Lifetime ED and active pregnancy ED increase the risk for infant feeding difficulties and do so via maternal distress (i.e., depression and anxiety). This has important implications for prevention and early intervention in relation to infant feeding difficulties, as well as for future research in the field.
authors.affiliation: King's College London, Child and Adolescent Psychiatry Department, Institute of Psychiatry, London, UK. nadia.micali@kcl.ac.uk
authors.forename: Nadia
authors.initials: N
authors.lastname: Micali
authors.forename: Emily
authors.initials: E
authors.lastname: Simonoff
authors.forename: Daniel
authors.initials: D
authors.lastname: Stahl
authors.forename: Janet
authors.initials: J
authors.lastname: Treasure
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000453:epidemiology* / Q000523:psychology*; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology; D001499:Bayes Theorem; D052018:Bulimia Nervosa / Q000453:epidemiology* / Q000523:psychology*; D016022:Case-Control Studies; D015897:Comorbidity; D019052:Depression, Postpartum / Q000453:epidemiology / Q000523:psychology; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D004739:England; D019959:Feeding and Eating Disorders of Childhood / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D008960:Models, Psychological; D009034:Mother-Child Relations; D009035:Mothers / Q000523:psychology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000523:psychology; D011446:Prospective Studies; D012307:Risk Factors; D013223:Statistics as Topic; D013694:Temperament