Psychological Medicine

Original Article

Patterns of remission, continuation and incidence of broadly defined eating disorders during early pregnancy in the Norwegian Mother and Child Cohort Study (MoBa)

CYNTHIA M. BULIKa1a2 c1, ANN VON HOLLEa1, ROBERT HAMERa1, CECILIE KNOPH BERGa4, LEILA TORGERSENa4, PER MAGNUSa5, CAMILLA STOLTENBERGa5, ANNA MARIA SIEGA-RIZa2, PATRICK SULLIVANa1a3 and TED REICHBORN-KJENNERUDa4a6

a1 Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

a2 Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

a3 Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

a4 Division of Mental Health, Norwegian Institute of Public Health, Norway

a5 Epidemiology, Norwegian Institute of Public Health, Norway

a6 Department of Psychiatry, University of Oslo, Norway

ABSTRACT

Background We explored the course of broadly defined eating disorders during pregnancy in the Norwegian Mother and Child Cohort Study (MoBa) at the Norwegian Institute of Public Health.

Method A total of 41 157 pregnant women, enrolled at approximately 18 weeks' gestation, had valid data from the Norwegian Medical Birth Registry. We collected questionnaire-based diagnostic information on broadly defined anorexia nervosa (AN), and bulimia nervosa (BN), and eating disorders not otherwise specified (EDNOS). EDNOS subtypes included binge eating disorder (BED) and recurrent self-induced purging in the absence of binge eating (EDNOS-P). We explored rates of remission, continuation and incidence of BN, BED and EDNOS-P during pregnancy.

Results Prepregnancy prevalence estimates were 0·1% for AN, 0·7% for BN, 3·5% for BED and 0·1% for EDNOS-P. During early pregnancy, estimates were 0·2% (BN), 4·8% (BED) and 0·1% (EDNOS-P). Proportions of individuals remitting during pregnancy were 78% (EDNOS-P), 40% (BN purging), 39% (BED), 34% (BN any type) and 29% (BN non-purging type). Additional individuals with BN achieved partial remission. Incident BN and EDNOS-P during pregnancy were rare. For BED, the incidence rate was 1·1 per 1000 person-weeks, equating to 711 new cases of BED during pregnancy. Incident BED was associated with indices of lower socio-economic status.

Conclusions Pregnancy appears to be a catalyst for remission of some eating disorders but also a vulnerability window for the new onset of broadly defined BED, especially in economically disadvantaged individuals. Vigilance by health-care professionals for continuation and emergence of eating disorders in pregnancy is warranted.

(Online publication May 10 2007)

Correspondence

c1 *Address for correspondence: Dr C. M. Bulik, Department of Psychiatry, University of North Carolina at Chapel Hill, 101 Manning Drive, CB #7160, Chapel Hill, NC 27599-7160, USA. (Email: cbulik@med.unc.edu)

Footnotes

Portions of this paper were presented at the Eating Disorders Research Society Annual Meeting, Port Douglas, Australia, in August 2006.

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