title: A systematic review of obstetric complications as risk factors for eating disorder and a meta-analysis of delivery method and prematurity.
abstract: OBJECTIVE
  The aim of this study was to systematically review the literature on obstetric factors at birth and their role as risk factors for a subsequent eating disorder (ED) and where possible to perform a meta-analysis of case-control studies of EDs and obstetric complications (OCs).
  
  
  METHODS
  Studies were ascertained by computer searches of electronic databases (Medline, PsycINFO, Web of Science and CINAHL), searches of reference lists and from raw data obtained upon request from the authors. A total of 14 studies were identified for the systematic review, of which 6 were eligible for the subsequent meta-analysis. Of the selected 6 studies, 5 reported on the same OCs, namely vaginal instrumental delivery and prematurity. Accordingly, meta-analyses were run on these two variables. Both analyses were conducted on anorexia nervosa (AN) patients.
  
  
  RESULTS
  Findings from the systematic review were conflicting, with some studies reporting a significant relationship between OCs and ED diagnoses and/or ED symptomatology and others refuting it. A non-significant association of instrumental delivery [pooled odds ratio (OR) 1.06, 95%CI: 0.69, 1.65] and prematurity [pooled OR 1.17, 95%CI: 0.91, 1.52] with AN was revealed in our meta-analysis.
  
  
  CONCLUSIONS
  The current literature on OCs as risk factors for a later ED is contradictory. The range of different occurrences considered as OCs and methodological limitations hinder ultimate conclusions. Upcoming studies should pool datasets together to obtain sufficient power to assess OCs and EDs in combination.
authors.affiliation: Eating Disorders Unit of Psychological Medicine, Institute of Psychiatry, King's College London, De Crespigny Park, UK. Isabel.1.krug@kcl.ac.uk
authors.forename: Isabel
authors.initials: I
authors.lastname: Krug
authors.forename: Emma
authors.initials: E
authors.lastname: Taborelli
authors.forename: Hannah
authors.initials: H
authors.lastname: Sallis
authors.forename: Janet
authors.initials: J
authors.lastname: Treasure
authors.forename: Nadia
authors.initials: N
authors.lastname: Micali
mesh_terms: D000818:Animals; D036861:Delivery, Obstetric / Q000009:adverse effects*; D001068:Feeding and Eating Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications / Q000503:physiopathology*; D011247:Pregnancy; D047928:Premature Birth / Q000503:physiopathology*; D012307:Risk Factors