Leila Torgersen

Birth outcomes in women with eating disorders in the Norwegian Mother and Child cohort study (MoBa).

OBJECTIVE We explored the impact of eating disorders on birth outcomes in the Norwegian Mother and Child Cohort Study. METHOD Of 35,929 pregnant women, 35 reported broad anorexia nervosa (AN), 304 bulimia nervosa (BN), 1,812 binge eating disorder (BED), and 36 EDNOS-purging type (EDNOS-P) in the six months before or during pregnancy. The referent comprised 33,742 women with no eating disorder. RESULTS Pre-pregnancy body mass index (BMI) was lower in AN and higher in BED than the referent. AN, BN, and BED mothers reported greater gestational weight gain, and smoking was elevated in all eating disorder groups. BED mothers had higher birth weight babies, lower risk of small for gestational age, and higher risk of large for gestational age and cesarean section than the referent. Pre-pregnancy BMI and gestational weight gain attenuated the effects. CONCLUSION BED influences birth outcomes either directly or via higher maternal weight and gestational weight gain. The absence of differences in AN and EDNOS-P may reflect small numbers and lesser severity in population samples. Adequate gestational weight gain in AN may mitigate against adverse birth outcomes. Detecting eating disorders in pregnancy could identify modifiable factors (e.g., high gestational weight gain, binge eating, and smoking) that influence birth outcomes.

Patterns of maternal feeding and child eating associated with eating disorders in the Norwegian Mother and Child Cohort Study (MoBa).

The impact of eating disorders on maternal feeding practices and childrens eating behaviors is not well understood. In the prospective Norwegian Mother and Child Cohort Study (MoBa), we compared self-reported feeding behavior in mothers with anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and no eating disorders (No ED) as well as child eating behaviors and psychological symptoms. The sample comprised 13,006 women and their children from a prospective population-based study of 100,000 births throughout Norway. Eating disorder status was measured 6 months prior to pregnancy and during pregnancy. Maternal feeding, child eating, and psychological variables were reported by mothers when their child was 36 months old. Mothers with BN and BED were more likely to report restrictive feeding styles and child eating problems than mothers without eating disorders. Regarding the pressure to eat feeding style, no significant differences emerged across groups. Differences in self-reported feeding styles and childrens eating behavior exist between mothers with and without eating disorders. Longitudinal follow-up will assist in determining the implications of feeding style on later growth trajectories and development.

Unplanned Pregnancy in Women With Anorexia Nervosa

OBJECTIVE: To compare the frequency with which unplanned pregnancies occur in individuals with anorexia nervosa relative to women without eating disorders in the Norwegian Mother and Child Cohort Study. METHOD: In a sample of 62,060 women, 62 reported anorexia nervosa. Using data from a questionnaire completed by all participating mothers, we compared mothers age at birth and the frequency with which mothers reported their index pregnancy as being unplanned. RESULTS: Women with anorexia nervosa were younger (26.2 years, standard deviation 4.76) than women with no eating disorder (29.9 years, standard deviation 4.60) at the time of birth. Significantly more women with anorexia nervosa (50.0%) reported unplanned pregnancy than women in the referent group (18.9%). After adjustment for maternal age and infertility treatment, the relative risk of unplanned pregnancy in individuals with anorexia nervosa was 2.11 (95% confidence interval 1.64–2.72). Induced abortion was also significantly more common in women with anorexia nervosa than referent women (24.2% compared with 14.6%). CONCLUSION: The higher rate of unplanned pregnancy and abortion in women with anorexia nervosa is of clinical concern because absent or irregular menstruation may be misinterpreted as decreasing risk of pregnancy. LEVEL OF EVIDENCE: II

Later Emotional and Behavioral Problems Associated With Sleep Problems in Toddlers: A Longitudinal Study

IMPORTANCE Childhood sleep problems have been linked to a range of adverse health outcomes, but there is limited knowledge as to the temporal association between sleep problems and subsequent emotional and behavioral problems in young children. OBJECTIVE To examine whether sleep problems in toddlers aged 18 months are related to both concurrent and subsequent emotional and behavioral problems in preschool children aged 5 years. DESIGN, SETTING, AND PARTICIPANTS A large population-based longitudinal study was conducted in September 2014 using data from the Norwegian Mother and Child Cohort Study conducted at the Norwegian Institute of Public Health from June 1, 1999, to December 31, 2008. A total of 32 662 children or pregnancies were included. EXPOSURES Sleep was assessed by mother-reported child sleep duration and nocturnal awakenings. MAIN OUTCOMES AND MEASURES Emotional and behavioral problems were measured with items from the Child Behavior Checklist and operationalized according to recommended clinical cutoffs, corresponding to T scores of greater than 65 (93rd percentile). Risk ratios (RRs) were calculated using negative binomial regression, controlling for emotional and behavioral problems at 18 months and other relevant covariates. RESULTS Short sleep duration (≤10 hours) in 556 children (1.7%) and frequent nocturnal awakenings (≥3 times) in 1033 children (3.2%) at 18 months significantly predicted both concurrent and later incidence of emotional and behavioral problems at 5 years. The longitudinal RRs were generally larger for internalizing problems, with adjusted RRs of 1.59 (95% CI, 1.23-2.08) for both short sleep duration and 1.57 (95% CI, 1.28-1.93) for nocturnal awakenings; RRs for externalizing problems were 1.77 (95% CI, 1.37-2.30) and 1.25 (95% CI, 1.00-1.58), respectively. Additional adjustment for emotional and behavioral problems at 18 months slightly reduced the strength of these associations, and all RRs remained significant in the fully adjusted models. CONCLUSIONS AND RELEVANCE Early sleep problems predict later development of emotional and behavioral problems. Intervention studies are needed to examine whether sleep programs targeting early childhood may avert the onset of later adverse outcomes.

Picky eating in preschool children: The predictive role of the child's temperament and mother's negative affectivity

OBJECTIVE The objective of this study is to describe the development and examine predictors of picky eating from 1.5 to 4.5 years of age in a community sample of children. METHODS Mothers completed a questionnaire, assessing picky eating and a range of child and maternal factors, when their children were aged 1.5 (n = 913), 2.5 (n = 777), and 4.5 (n = 727) years. RESULTS Picky eating increased significantly from 1.5 to 4.5 years. Lower maternal age, higher levels of child emotionality, and maternal negative affectivity at the childs age 1.5 predicted an increase in picky eating from 1.5 years to 2.5 and 4.5 years. Having siblings protected against the development of picky eating. CONCLUSION Child and maternal temperament at a very early stage in the childs life increase the risk for picky eating later on.

Factors associated with binge eating disorder in pregnancy

OBJECTIVE To identify factors associated with incidence and course of broadly defined binge eating disorder (BED) in pregnancy. METHOD As a part of the Norwegian Mother and Child Cohort Study (MoBa), 45,644 women completed a questionnaire at approximately 18 weeks of gestation. RESULTS Incidence of BED was significantly associated with lifetime sexual abuse, lifetime physical abuse, lifetime major depression, symptoms of anxiety and depression, low life satisfaction, low self-esteem, low partner relationship satisfaction, smoking, alcohol use, lack of social support, and several weight-related factors. Continuation was negatively associated with thoughts of being overweight before pregnancy. Remission was positively associated with thoughts of being overweight before pregnancy and negatively associated with overvaluation of weight. DISCUSSION Onset of BED in pregnancy was associated with psychological, social and weight-related factors, as well as health behaviors and adverse life events. In women with prepregnancy BED, thoughts of being overweight before pregnancy and overvaluation of weight were associated with course of BED during pregnancy.

Attitudes toward weight gain during pregnancy: Results from the Norwegian mother and child cohort study (MoBa)

OBJECTIVE To explore attitudes toward weight gain during pregnancy in women with and without eating disorders and across eating disorder subtypes, and to examine associations among weight-gain attitudes and actual gestational weight gain, infant birth weight, and infant size-for-gestational-age. METHOD Pregnant women (35,929) enrolled in the prospective population-based Norwegian mother and child cohort study (MoBa) provided information at approximately week 18 of gestation regarding eating disorders and weight gain attitudes. We explored these variables in women with anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified, purging type, and binge eating disorder (BED). RESULTS The presence of an eating disorderly was associated with greater worry over gestational weight gain. In women without eating disorders, greater worry was associated with higher gestational weight gain, higher infant weights, greater likelihood of a large-for-gestational-age infant, and reduced likelihood of a small-for-gestational-age infant. Women with BED who reported greater worry also experienced higher weight gains during pregnancy. DISCUSSION Women with eating disorders tend to experience weight-gain-related worry during pregnancy. Early worry about gestational weight-gain may be a harbinger of high gestational gain.

Nausea and vomiting of pregnancy in women with bulimia nervosa and eating disorders not otherwise specified

OBJECTIVE To explore the prevalence of pregnancy-related nausea (PN) and vomiting (PV), and hyperemesis gravidarum (HG), in women with bulimia nervosa (BN) and EDNOS purging subtype (EDNOS-P). METHOD Pregnant women (38,038) enrolled in the Norwegian Mother and Child Cohort Study had questionnaire-based information on eating disorder diagnosis and PN, PV, and HG. We estimated the odds for PN, PV, and HG using logistic regression. RESULTS Women with BN, purging subtype, but not women with BN, nonpurging subtype, had statistically significant higher odds of PN and PV compared to women without eating disorders. The EDNOS-P group showed significantly higher odds of PV. The odds of HG did not differ significantly between those with and without an eating disorder, or across eating disorder subtypes. CONCLUSION Our results suggest that eating disorders marked by the symptom of purging are associated with increased odds of PN and PV.

Maintaining factors of posttraumatic stress symptoms following childbirth: A population-based, two-year follow-up study

BACKGROUND Previous research has established a number of risk factors that are associated with the onset of PTSD following childbirth. However, little is known about factors that maintain PTSD symptoms. METHODS This study is part of the Akershus Birth Cohort. Questionnaire data from pregnancy week 17, 8 weeks postpartum and 2 years postpartum were used. 1473 women completed all these three questionnaires and were included in the analyses. Post-traumatic stress symptoms were measured with the Impact of Event Scale. Potential maintaining factors were personality, sleep, support and life events. The factors that were significantly correlated with post-traumatic stress symptoms were entered into regression analyses. Mediation analyses were run to test whether significant predictors would serve as mediator of post-traumatic stress symptoms at 8 weeks postpartum to post-traumatic stress symptoms at 2 years postpartum. RESULTS We found several low to moderate associations between maintaining factors and PTSD symptoms two years postpartum. Adjusting for the starting point - PTSD symptoms 8 weeks postpartum - only insomnia remained significantly associated. Further, insomnia mediated a small portion of the effect of PTSD symptoms 8 weeks postpartum to PTSD symptoms 2 years postpartum. LIMITATIONS Limitations of the study include a relative homogeneous sample, modest effect sizes, low internal consistency of some of the measures and the challenge to distinguish insomnia from PTSD symptoms. CONCLUSIONS Treatment of postpartum PTSD might benefit from addressing insomnia if present. Alleviating insomnia may itself reduce daytime symptoms of PTSD and it may also increase the efficacy of primary PTSD treatments.

Course and predictors of maternal eating disorders in the postpartum period

OBJECTIVE To investigate course and predictors of eating disorders in the postpartum period. METHOD A total of 77,807 women, participating in the Norwegian Mother and Child Cohort Study (MoBa), completed questionnaires during pregnancy including items covering DSM-IV criteria for prepregnancy anorexia nervosa (AN), bulimia nervosa (BN), eating disorder not otherwise specified (EDNOS-P), and binge eating disorder (BED). Additional questionnaires were completed at 18 and 36 months postpartum. RESULTS Proportions of women remitting at 18 months and 36 months postpartum were 50% and 59% for AN, 39% and 30% for BN, 46% and 57% for EDNOS-P, and 45% and 42% for BED, respectively. However, disordered eating persisted in a substantial proportion of women meeting criteria for either full or subthreshold eating disorders. BN during pregnancy increased the risk for continuation of BN. BMI and psychological distress were significantly associated with course of BED. DISCUSSION This is the first large-scale population-based study on course of eating disorders in the postpartum period. The results indicated that disordered eating persists in a substantial proportion of women with prepregnancy eating disorders. Health care professionals working with women in this phase of life need to pay specific attention to eating disorder symptoms and behaviors.