THE IMPACT OF ACTIVE OR PAST MATERNAL ANOREXIA NERVOSA ON FETAL GROWTH AND DEVELOPMENT
Abstract
Introduction: Anorexia nervosa (AN) is a psychiatric eating disorder that disrupts the hypothalamic–pituitary–ovarian axis, often causing amenorrhea and delaying conception. Although remission can restore fertility, both active and past AN are linked to obstetric and neonatal complications.
Aim of the Study: We aimed to systematically review the current knowledge about the effect of maternal anorexia nervosa on fetal growth and development.
Methodology: PubMed was searched (2005–2025) for original English clinical studies on maternal AN and fetal outcomes; reviews, case reports, and non‐clinical articles were excluded, resulting in 17 eligible full‐text studies.
Results: The most consistently reported finding was a significantly lower birth weight in infants born to mothers with a history of past or active AN. The main cause of low birth weight was low maternal pre-pregnancy body mass index (BMI) and insufficient weight gain during pregnancy. Other common adverse neonatal outcomes included small-for-gestational-age, preterm birth, and reduced head circumference, the latter being associated with potential neurocognitive developmental delays. The risk of complications was markedly higher for women with active AN during pregnancy.
Conclusions: Maternal AN increases the risk of adverse obstetric and neonatal outcomes. Multidisciplinary care with careful monitoring of maternal weight, nutritional status, and mental health is essential to minimize risks and optimize perinatal outcomes.
References
Ante, Z., Luu, T. M., Healy-Profitós, J., He, S., Taddeo, D., Lo, E., & Auger, N. (2020). Pregnancy outcomes in women with anorexia nervosa. Int J Eat Disord, 53(5), 403-412. https://doi.org/10.1002/eat.23251
Baenas, I., Etxandi, M., & Fernandez-Aranda, F. (2024). Medical complications in anorexia and bulimia nervosa. Med Clin (Barc), 162(2), 67-72. https://doi.org/10.1016/j.medcli.2023.07.028 (Complicaciones medicas en anorexia y bulimia nerviosa.)
Baer, R. J., Bandoli, G., Jelliffe-Pawlowski, L. L., Rhee, K. E., & Chambers, C. D. (2024). Adverse live-born pregnancy outcomes among pregnant people with anorexia nervosa. Am J Obstet Gynecol, 231(2), 248.e241-248.e214. https://doi.org/10.1016/j.ajog.2023.11.1242
Bohnert, K. M., & Breslau, N. (2008). Stability of psychiatric outcomes of low birth weight: a longitudinal investigation. Arch Gen Psychiatry, 65(9), 1080-1086. https://doi.org/10.1001/archpsyc.65.9.1080
Brinch, M., Isager, T., & Tolstrup, K. (1988). Anorexia nervosa and motherhood: reproduction pattern and mothering behavior of 50 women. Acta Psychiatr Scand, 77(5), 611-617. https://doi.org/10.1111/j.1600-0447.1988.tb05175.x
Bulik, C. M., Hoffman, E. R., Von Holle, A., Torgersen, L., Stoltenberg, C., & Reichborn-Kjennerud, T. (2010). Unplanned pregnancy in women with anorexia nervosa. Obstet Gynecol, 116(5), 1136-1140. https://doi.org/10.1097/AOG.0b013e3181f7efdc
Bulik, C. M., Sullivan, P. F., Fear, J. L., Pickering, A., Dawn, A., & McCullin, M. (1999). Fertility and reproduction in women with anorexia nervosa: a controlled study. J Clin Psychiatry, 60(2), 130-135; quiz 135-137. https://doi.org/10.4088/jcp.v60n0212
Chaer, R., Nakouzi, N., Itani, L., Tannir, H., Kreidieh, D., El Masri, D., & El Ghoch, M. (2020). Fertility and Reproduction after Recovery from Anorexia Nervosa: A Systematic Review and Meta-Analysis of Long-Term Follow-Up Studies. Diseases, 8(4). https://doi.org/10.3390/diseases8040046
Chatwin, H., Holde, K., Momen, N. C., Yilmaz, Z., Liu, X., Munk-Olsen, T., Strandberg-Larsen, K., Micali, N., & Petersen, L. V. (2025). Adverse Neonatal Outcomes Among Children Born to Mothers Eating Disorders: A Register-Based Cohort Study. Bjog, 132(5), 577-587. https://doi.org/10.1111/1471-0528.18028
Corcos, M., Guilbaud, O., Speranza, M., Paterniti, S., Loas, G., Stephan, P., & Jeammet, P. (2000). Alexithymia and depression in eating disorders. Psychiatry Res, 93(3), 263-266. https://doi.org/10.1016/s0165-1781(00)00109-8
Dobrescu, S. R., Dinkler, L., Gillberg, C., Gillberg, C., Råstam, M., & Wentz, E. (2024). Mental and physical health in children of women with a history of anorexia nervosa. Eur Child Adolesc Psychiatry, 33(10), 3481-3493. https://doi.org/10.1007/s00787-024-02393-y
Eagles, J. M., Lee, A. J., Raja, E. A., Millar, H. R., & Bhattacharya, S. (2012). Pregnancy outcomes of women with and without a history of anorexia nervosa. Psychol Med, 42(12), 2651-2660. https://doi.org/10.1017/s0033291712000414
Easter, A., Treasure, J., & Micali, N. (2011). Fertility and prenatal attitudes towards pregnancy in women with eating disorders: results from the Avon Longitudinal Study of Parents and Children. Bjog, 118(12), 1491-1498. https://doi.org/10.1111/j.1471-0528.2011.03077.x
Ekéus, C., Lindberg, L., Lindblad, F., & Hjern, A. (2006). Birth outcomes and pregnancy complications in women with a history of anorexia nervosa. Bjog, 113(8), 925-929. https://doi.org/10.1111/j.1471-0528.2006.01012.x
Eriksson, J. G., Forsen, T., Tuomilehto, J., Osmond, C., & Barker, D. J. (2001). Early growth and coronary heart disease in later life: longitudinal study. BMJ, 322(7292), 949-953. https://doi.org/10.1136/bmj.322.7292.949
Feferkorn, I., Badeghiesh, A., Baghlaf, H., & Dahan, M. H. (2023). Pregnancy outcomes in women with anorexia nervosa: a population-based study and analysis of a matched cohort. Reprod Biomed Online, 46(3), 588-596. https://doi.org/10.1016/j.rbmo.2022.12.006
Fichter, M. M., & Quadflieg, N. (2016). Mortality in eating disorders - results of a large prospective clinical longitudinal study. Int J Eat Disord, 49(4), 391-401. https://doi.org/10.1002/eat.22501
Franko, D. L., Blais, M. A., Becker, A. E., Delinsky, S. S., Greenwood, D. N., Flores, A. T., Ekeblad, E. R., Eddy, K. T., & Herzog, D. B. (2001). Pregnancy complications and neonatal outcomes in women with eating disorders. Am J Psychiatry, 158(9), 1461-1466. https://doi.org/10.1176/appi.ajp.158.9.1461
Frisch, R. E., & Revelle, R. (1970). Height and weight at menarche and a hypothesis of critical body weights and adolescent events. Science, 169(3943), 397-399. https://doi.org/10.1126/science.169.3943.397
Gluckman, P. D., Hanson, M. A., Cooper, C., & Thornburg, K. L. (2008). Effect of in utero and early-life conditions on adult health and disease. N Engl J Med, 359(1), 61-73. https://doi.org/10.1056/NEJMra0708473
Himmerich, H., & Treasure, J. (2024). Anorexia nervosa: diagnostic, therapeutic, and risk biomarkers in clinical practice. Trends Mol Med, 30(4), 350-360. https://doi.org/10.1016/j.molmed.2024.01.002
Koubaa, S., Hällström, T., Brismar, K., Hellström, P. M., & Hirschberg, A. L. (2015). 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. BMC Pregnancy Childbirth, 15, 318. https://doi.org/10.1186/s12884-015-0741-7
Koubaa, S., Hällström, T., Hagenäs, L., & Hirschberg, A. L. (2013). Retarded head growth and neurocognitive development in infants of mothers with a history of eating disorders: longitudinal cohort study. Bjog, 120(11), 1413-1422. https://doi.org/10.1111/1471-0528.12370
Koubaa, S., Hällström, T., Lindholm, C., & Hirschberg, A. L. (2005). Pregnancy and neonatal outcomes in women with eating disorders. Obstet Gynecol, 105(2), 255-260. https://doi.org/10.1097/01.AOG.0000148265.90984.c3
Letranchant, A., Corcos, M., Nicolas, I., & Robin, M. (2022). Anorexia nervosa, fertility and medically assisted reproduction. Ann Endocrinol (Paris), 83(3), 191-195. https://doi.org/10.1016/j.ando.2022.04.012
Linna, M. S., Raevuori, A., Haukka, J., Suvisaari, J. M., Suokas, J. T., & Gissler, M. (2014). Pregnancy, obstetric, and perinatal health outcomes in eating disorders. Am J Obstet Gynecol, 211(4), 392.e391-398. https://doi.org/10.1016/j.ajog.2014.03.067
Mantel, Ä., Hirschberg, A. L., & Stephansson, O. (2020). Association of Maternal Eating Disorders With Pregnancy and Neonatal Outcomes. JAMA Psychiatry, 77(3), 285-293. https://doi.org/10.1001/jamapsychiatry.2019.3664
Micali, N., De Stavola, B., dos-Santos-Silva, I., Steenweg-de Graaff, J., Jansen, P. W., Jaddoe, V. W., Hofman, A., Verhulst, F. C., Steegers, E. A., & Tiemeier, H. (2012). Perinatal outcomes and gestational weight gain in women with eating disorders: a population-based cohort study. Bjog, 119(12), 1493-1502. https://doi.org/10.1111/j.1471-0528.2012.03467.x
Micali, N., dos-Santos-Silva, I., De Stavola, B., Steenweg-de Graaff, J., Jaddoe, V., Hofman, A., Verhulst, F. C., Steegers, E., & Tiemeier, H. (2014). Fertility treatment, twin births, and unplanned pregnancies in women with eating disorders: findings from a population-based birth cohort. Bjog, 121(4), 408-416. https://doi.org/10.1111/1471-0528.12503
Micali, N., Simonoff, E., & Treasure, J. (2007). Risk of major adverse perinatal outcomes in women with eating disorders. Br J Psychiatry, 190, 255-259. https://doi.org/10.1192/bjp.bp.106.020768
Micali, N., Stemann Larsen, P., Strandberg-Larsen, K., & Nybo Andersen, A. M. (2016). Size at birth and preterm birth in women with lifetime eating disorders: a prospective population-based study. Bjog, 123(8), 1301-1310. https://doi.org/10.1111/1471-0528.13825
Rodino, I. S., Byrne, S. M., & Sanders, K. A. (2017). Eating disorders in the context of preconception care: fertility specialists' knowledge, attitudes, and clinical practices. Fertil Steril, 107(2), 494-501. https://doi.org/10.1016/j.fertnstert.2016.10.036
Rome, E. S., & Ammerman, S. (2003). Medical complications of eating disorders: an update. J Adolesc Health, 33(6), 418-426. https://doi.org/10.1016/j.jadohealth.2003.07.002
Schorr, M., & Miller, K. K. (2017). The endocrine manifestations of anorexia nervosa: mechanisms and management. Nat Rev Endocrinol, 13(3), 174-186. https://doi.org/10.1038/nrendo.2016.175
Smink, F. R., van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep, 14(4), 406-414. https://doi.org/10.1007/s11920-012-0282-y
Smythe, J., Colebourn, C., Prisco, L., Petrinic, T., & Leeson, P. (2021). Cardiac abnormalities identified with echocardiography in anorexia nervosa: systematic review and meta-analysis. Br J Psychiatry, 219(3), 477-486. https://doi.org/10.1192/bjp.2020.1
Sollid, C. P., Wisborg, K., Hjort, J., & Secher, N. J. (2004). Eating disorder that was diagnosed before pregnancy and pregnancy outcome. Am J Obstet Gynecol, 190(1), 206-210. https://doi.org/10.1016/s0002-9378(03)00900-1
Steinhausen, H. C., & Jensen, C. M. (2015). Time trends in lifetime incidence rates of first-time diagnosed anorexia nervosa and bulimia nervosa across 16 years in a Danish nationwide psychiatric registry study. Int J Eat Disord, 48(7), 845-850. https://doi.org/10.1002/eat.22402
Stewart, D. E., Robinson, E., Goldbloom, D. S., & Wright, C. (1990). Infertility and eating disorders. Am J Obstet Gynecol, 163(4 Pt 1), 1196-1199. https://doi.org/10.1016/0002-9378(90)90688-4
Tabler, J., Utz, R. L., Smith, K. R., Hanson, H. A., & Geist, C. (2018). Variation in reproductive outcomes of women with histories of bulimia nervosa, anorexia nervosa, or eating disorder not otherwise specified relative to the general population and closest-aged sisters. Int J Eat Disord, 51(2), 102-111. https://doi.org/10.1002/eat.22827
Watson, H. J., Zerwas, S., Torgersen, L., Gustavson, K., Diemer, E. W., Knudsen, G. P., Reichborn-Kjennerud, T., & Bulik, C. M. (2017). Maternal eating disorders and perinatal outcomes: A three-generation study in the Norwegian Mother and Child Cohort Study. J Abnorm Psychol, 126(5), 552-564. https://doi.org/10.1037/abn0000241
Wentz, E., Gillberg, I. C., Anckarsäter, H., Gillberg, C., & Råstam, M. (2009). Reproduction and offspring status 18 years after teenage-onset anorexia nervosa--a controlled community-based study. Int J Eat Disord, 42(6), 483-491. https://doi.org/10.1002/eat.20664
Wentz, E., Gillberg, I. C., Gillberg, C., & Rastam, M. (2005). Fertility and history of sexual abuse at 10-year follow-up of adolescent-onset anorexia nervosa. Int J Eat Disord, 37(4), 294-298. https://doi.org/10.1002/eat.20093
Zipfel, S., Giel, K. E., Bulik, C. M., Hay, P., & Schmidt, U. (2015). Anorexia nervosa: aetiology, assessment, and treatment. Lancet Psychiatry, 2(12), 1099-1111. https://doi.org/10.1016/S2215-0366(15)00356-9
Views:
40
Downloads:
19
Copyright (c) 2025 Julia Procyk, Marta Danuta Cendrowska, Aleksandra Klukowska, Beata Choromańska, Karolina Stępień, Justyna Berent, Paulina Rzepa, Barbara Ponitka, Julia Maszewska, Szymon Milnerowicz, Łukasz Brzost, Wiktoria Szumlińska
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
