title: Biomarkers of nutrition and stress in pregnant women with a history of eating disorders in relation to head circumference and neurocognitive function of the offspring.
abstract: BACKGROUND
  Eating disorders during pregnancy can affect fetal growth and the child's early development, but the underlying mechanisms have not been elucidated. The aim of the present study was to investigate serum biomarkers of nutrition and stress in pregnant women with previous eating disorders compared to controls and in relation to head circumference and early neurocognitive development of the offspring.
  
  
  METHODS
  In a longitudinal cohort study, pregnant nulliparous non-smoking women with a history of anorexia nervosa (n = 20), bulimia nervosa (n = 17) and controls (n = 59) were followed during pregnancy and their children's growth and neurocognitive development were followed up to five years of age. We investigated maternal serum biomarkers of nutrition and stress (ferritin, cortisol, thyroid-stimulating hormone, free thyroxine, insulin, insulin-like growth factor I (IGF-I) and IGF binding protein 1) in blood samples collected during early pregnancy and compared between groups (ANOVA, LSD post-hoc test). The results were related to previous data on head circumference at birth and neurocognitive development at five years of age of the offspring (Spearman rank correlation or Pearson correlation test).
  
  
  RESULTS
  Serum levels of ferritin in the women with previous anorexia nervosa, but not in those with a history of bulimia nervosa, were significantly lower than in the controls (p < 0.01), and correlated strongly to impaired memory function in their children (rs = -0.70, p < 0.001). Maternal serum levels of free thyroxine were similar between groups but correlated positively to reduced head circumference at birth of the children in the bulimia nervosa group (r = 0.48, p < 0.05), and with the same tendency in the anorexia nervosa group (r = 0.42, p = 0.07), but not in the controls (r = 0.006). There were no significant differences in cortisol or the other biomarkers between groups.
  
  
  CONCLUSIONS
  Low maternal serum ferritin in women with previous anorexia nervosa may be of importance for impaired memory capacity in the offspring at five years of age. Our results also indicate that thyroxin levels in pregnant women with previous eating disorders are positively associated with fetal head growth.
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. saloua.koubaa@ki.se.
authors.forename: Saloua
authors.initials: S
authors.lastname: Koubaa
authors.affiliation: Department of Clinical Neuroscience, Division for Psychiatry, Huddinge, Karolinska Institutet, Stockholm, Sweden. tore.hallstrom@ki.se.|Department of Neuroscience and Physiology, Division for Psychiatry and Neurochemistry, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. tore.hallstrom@ki.se.
authors.forename: Tore
authors.initials: T
authors.lastname: Hällström
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. kerstin.brismar@ki.se.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Brismar
authors.affiliation: Department of Medical Sciences, Uppsala University, Uppsala, Sweden. per.hellstrom@medsci.uu.se.
authors.forename: Per M
authors.initials: PM
authors.lastname: Hellström
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. angelica.linden-hirschberg@karolinska.se.|Department of Obstetrics and Gynecology, Karolinska University Hospital, SE-171 76, Stockholm, Sweden. angelica.linden-hirschberg@karolinska.se.
authors.forename: Angelica Lindén
authors.initials: AL
authors.lastname: Hirschberg
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000150:complications; D015415:Biomarkers / Q000097:blood; D052018:Bulimia Nervosa / Q000150:complications; D002508:Cephalometry; D001068:Feeding and Eating Disorders / Q000097:blood / Q000150:complications*; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000503:physiopathology*; D008137:Longitudinal Studies; D019965:Neurocognitive Disorders / Q000503:physiopathology*; D009752:Nutritional Status; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood* / Q000523:psychology; D037841:Pregnant People / Q000523:psychology; D013315:Stress, Psychological / Q000097:blood* / Q000523:psychology; D013974:Thyroxine / Q000097:blood
chemical_list: D015415:Biomarkers; D005293:Ferritins; D013974:Thyroxine; D006854:Hydrocortisone