Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden.
JAMA Netw Open. 2024 Oct 1;7(10):e2440517. doi: 10.1001/jamanetworkopen.2024.40517.
Maternal nutrition is essential in fetal development; thus, disordered eating may influence this process and contribute to the development of offspring psychiatric disorders.
To investigate the association of maternal eating disorders and prepregnancy body mass index (BMI) with offspring psychiatric diagnoses.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used Finnish national registers to assess all live births from January 1, 2004, through December 31, 2014, with follow-up until December 31, 2021. The data analyses were conducted from September 1, 2023, to September 30, 2024.
Maternal eating disorder and prepregnancy BMI.
Primary outcomes were 9 neurodevelopmental and psychiatric offspring diagnoses. Cox proportional hazards modeling adjusted for potential risk factors in the development of the outcome disorders was applied in 2 models. Secondary analyses were stratified for adverse birth outcomes (prematurity, small size for gestational age, and low Apgar score) or comorbid offspring eating disorders. Categories of BMI (calculated as weight in kilograms divided by height in meters squared) included underweight (BMI <18.5), normal weight (18.5-24.9), overweight (25.0-29.9), obesity (30.0-34.9), and severe obesity (≥35.0).
The mean (SD) age of 392 098 included mothers was 30.15 (5.38) years, 42 590 mothers (10.86%) were born outside of Finland, 6273 mothers (1.60%) had a history of an eating disorder, 23 114 mothers (5.89%) had prepregnancy underweight, and 208 335 (53.13%) mothers had overweight or obesity. Among 649 956 included offspring, 332 359 (51.14%) were male, and 106 777 (16.43%) had received a neurodevelopmental or psychiatric diagnosis. Maternal eating disorders, prepregnancy underweight, and overweight or obesity were associated with most of the studied mental diagnoses in offspring, even after adjusting for potential covariates. The largest effect sizes were observed for maternal eating disorders not otherwise specified in association with offspring sleep disorders (hazard ratio [HR], 3.34 [95% CI, 2.39-4.67]) and social functioning and tic disorders (HR, 2.79 [95% CI, 2.21-3.52]), while for maternal severe prepregnancy obesity, offspring intellectual disabilities (HR, 2.04 [95% CI, 1.83-2.28]) had the largest effect size. Adverse birth outcomes further increased the risk of offspring having other feeding disturbances of childhood and infancy (eg, HR, 4.53 [95% CI, 2.97-6.89] for maternal eating disorders) and attention-deficit/hyperactivity disorder and conduct disorder (eg, HR, 2.27 [95% CI, 1.74-2.96] for maternal anorexia nervosa).
In this population-based cohort study including 392 098 mothers and 649 956 offspring, offspring from mothers with an eating disorder history or prepregnancy BMI outside normal weight were at higher risk of psychiatric disorders. The results differed somewhat between the 2 exposures with regard to which offspring diagnoses had associations, and effect sizes were typically larger for maternal eating disorders vs BMI. These findings suggest a need to consider these 2 exposures clinically to help prevent offspring mental illness.
母体营养对胎儿发育至关重要；因此，饮食失调可能会影响这一过程，并导致后代出现精神障碍。
调查母亲的饮食障碍和孕前体重指数（BMI）与后代精神科诊断之间的关联。
设计、地点和参与者：本基于人群的队列研究使用芬兰国家登记处评估了 2004 年 1 月 1 日至 2014 年 12 月 31 日期间的所有活产儿，并随访至 2021 年 12 月 31 日。数据分析于 2023 年 9 月 1 日至 9 月 30 日进行。
母亲的饮食障碍和孕前 BMI。
主要结局是 9 种神经发育和精神科后代诊断。应用 Cox 比例风险模型调整了潜在的风险因素，对两种模型中的结果障碍进行了调整。二级分析按不良出生结局（早产、胎儿大小小于胎龄和低 Apgar 评分）或共患后代饮食障碍进行分层。BMI 类别（计算为体重公斤数除以身高米数的平方）包括体重不足（BMI<18.5）、正常体重（18.5-24.9）、超重（25.0-29.9）、肥胖（30.0-34.9）和严重肥胖（≥35.0）。
纳入的 392098 名母亲的平均（SD）年龄为 30.15（5.38）岁，42590 名母亲（10.86%）出生在芬兰以外，6273 名母亲（1.60%）有饮食障碍史，23114 名母亲（5.89%）有孕前体重不足，208335 名母亲（53.13%）超重或肥胖。在 649956 名纳入的后代中，332359 名（51.14%）为男性，106777 名（16.43%）接受了神经发育或精神科诊断。母亲的饮食障碍、孕前体重不足和超重或肥胖与后代大多数精神科诊断有关，即使在调整了潜在的混杂因素后也是如此。最大的效应大小见于特定的母亲饮食障碍与后代睡眠障碍（危险比[HR]，3.34[95%CI，2.39-4.67]）和社会功能和抽搐障碍（HR，2.79[95%CI，2.21-3.52]）相关，而对于严重的母亲孕前肥胖，后代智力障碍（HR，2.04[95%CI，1.83-2.28]）的效应最大。不良出生结局进一步增加了后代出现其他儿童和婴儿期喂养障碍的风险（例如，母亲饮食障碍时 HR 为 4.53[95%CI，2.97-6.89]）和注意缺陷/多动障碍和品行障碍（例如，母亲神经性厌食症时 HR 为 2.27[95%CI，1.74-2.96]）。
在这项包括 392098 名母亲和 649956 名后代的基于人群的队列研究中，有饮食障碍史或孕前 BMI 超出正常范围的母亲所生的后代患精神障碍的风险更高。这两种暴露因素在与哪些后代诊断相关方面存在一些差异，而且母亲饮食障碍的影响通常大于 BMI。这些发现表明，临床上需要考虑这两种暴露因素，以帮助预防后代的精神疾病。
