title: Size at birth and preterm birth in women with lifetime eating disorders: a prospective population-based study.
abstract: OBJECTIVE
  To investigate whether eating disorders are associated with lower size at birth, symmetric growth restriction, and preterm birth; and whether pregnancy smoking explains the association between anorexia nervosa and fetal growth.
  
  
  METHODS
  Longitudinal population-based cohort study.
  
  
  METHODS
  Denmark.
  
  
  METHODS
  Women from the Danish National Birth Cohort (n = 83 826).
  
  
  METHODS
  Women with anorexia nervosa (n = 1609), bulimia nervosa (n = 1693) and both (anorexia + bulimia nervosa, n = 634) were compared with unexposed women (n = 76 724) (women with exposure data and singletons n = 80 660) using crude and adjusted linear and logistic regression models.
  
  
  METHODS
  Size at birth (birthweight, length, head and abdominal circumference and placental weight); gestational age; small- and large-for-gestational-age (SGA, LGA); ponderal index, abdominal/head circumference.
  
  
  RESULTS
  Lifetime anorexia nervosa and lifetime anorexia + bulimia nervosa were prospectively associated with restricted fetal growth and higher odds of SGA [respectively, OR = 1.6 [95% CI 1.3-1.8] and OR = 1.5 [95% CI 1.2-1.9)] compared with unexposed women. Active anorexia nervosa was associated with lower birthweight, length, head and abdominal circumference, ponderal index, higher odds of SGA [OR = 2.90 (95% 1.98-4.26)] and preterm birth [OR = 1.77 (95% CI 1.00-3.12)] compared with unexposed women. Pregnancy smoking only partly explained the association between anorexia nervosa and adverse fetal outcomes.
  
  
  CONCLUSIONS
  Maternal anorexia nervosa (both active and past) is associated with lower size at birth and symmetric growth restriction, with evidence of worse outcomes in women with active disorder. Women with anorexia nervosa should be advised about achieving full recovery before conceiving. Similarly, targeting smoking in pregnancy might improve fetal outcomes.
  
  
  CONCLUSIONS
  Anorexia nervosa predicts small size at birth, small-for-gestational-age and symmetric growth restriction.
authors.affiliation: Behavioural and Brain Sciences Unit, Institute of Child Health, UCL, London, UK.|Department of Psychiatry and Mindich Child Health and Development Institute, Icahn Medical School at Mount Sinai, New York, NY, USA.
authors.forename: N
authors.initials: N
authors.lastname: Micali
authors.affiliation: Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Stemann Larsen
authors.affiliation: Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Strandberg-Larsen
authors.affiliation: Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: A-M
authors.initials: AM
authors.lastname: Nybo Andersen
mesh_terms: D000005:Abdomen / Q000033:anatomy & histology; D000328:Adult; D000856:Anorexia Nervosa / Q000453:epidemiology; D001724:Birth Weight; D001827:Body Height; D049628:Body Size; D052018:Bulimia Nervosa / Q000453:epidemiology; D016022:Case-Control Studies; D003718:Denmark / Q000453:epidemiology; D001068:Feeding and Eating Disorders / Q000453:epidemiology*; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology*; D005320:Fetal Macrosomia / Q000453:epidemiology*; D005865:Gestational Age; D006257:Head / Q000033:anatomy & histology; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D016014:Linear Models; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D009929:Organ Size; D010920:Placenta / Q000033:anatomy & histology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology*; D011446:Prospective Studies; D055815:Young Adult
keywords: Anorexia nervosa; bulimia nervosa; eating disorders; growth; obstetric; restriction