Psychological Medicine

Original Articles

Remission, continuation and incidence of eating disorders during early pregnancy: a validation study in a population-based birth cohort

H. J. Watsona1a2a3, A. Von Hollea4, R. M. Hamera4a5, C. Knoph Berga6, L. Torgersena6, P. Magnusa7, C. Stoltenberga7a8, P. Sullivana4a9, T. Reichborn-Kjenneruda6a10 and C. M. Bulika4a11 c1

a1 Centre for Clinical Interventions, Department of Health in Western Australia, Northbridge, WA, Australia

a2 Eating Disorders Program, Princess Margaret Hospital for Children, Department of Health in Western Australia, Subiaco, WA, Australia

a3 School of Paediatrics and Child Health, The University of Western Australia, Nedlands, WA, Australia

a4 Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

a5 Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

a6 Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway

a7 Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway

a8 Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway

a9 Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

a10 Department of Psychiatry, University of Oslo, Oslo, Norway

a11 Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

Abstract

Background We internally validated previously published rates of remission, continuation and incidence of broadly defined eating disorders during pregnancy in the Norwegian Mother and Child Cohort (MoBa) at the Norwegian Institute of Public Health.

Method A total of 77 267 pregnant women enrolled at 17 weeks gestation between 2001 and 2009 were split into a training sample (n = 41 243) from the version 2 dataset and a validation sample (n = 36 024) from the version 5 dataset who were not in the original study. Internal validation of original rate models involved fitting a calibration model to compare model parameters between the two samples and bootstrap estimates of bias in the entire version 5 dataset.

Results Remission, continuation and incidence estimates remained stable. Pre-pregnancy prevalence estimates in the validation sample were: anorexia nervosa (AN; 0.1%), bulimia nervosa (BN; 1.0%), binge eating disorder (BED; 3.3%) and eating disorder not otherwise specified-purging disorder (EDNOS-P; 0.1%). In early pregnancy, estimates were: BN (0.2%), BED (4.8%) and EDNOS-P (<0.01%). Incident BN and EDNOS-P during pregnancy were rare. The highest rates were for full or partial remission for BN and EDNOS-P and continuation for BED.

Conclusions We validated previously estimated rates of remission, continuation and incidence of eating disorders during pregnancy. Eating disorders, especially BED, during pregnancy were relatively common, occurring in nearly one in every 20 women. Pregnancy was a window of remission from BN but a window of vulnerability for BED. Training to detect eating disorders by obstetricians/gynecologists and interventions to enhance pregnancy and neonatal outcomes warrant attention.

(Received July 05 2012)

(Revised September 28 2012)

(Accepted October 01 2012)

(Online publication November 20 2012)

Key words

  • Eating disorders;
  • epidemiology;
  • incidence;
  • Norwegian Mother and Child Cohort Study;
  • pregnancy;
  • prospective studies;
  • remission

Correspondence

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

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