Bold statement: Maternal eating disorders are linked to a higher risk of asthma and wheezing in their children, and this isn’t limited to a single disorder or timing—it's a broader pattern worth taking seriously.
Eating disorders in pregnant women are associated with an increased risk of asthma and wheezing in their children, regardless of the disorder type, the presence of co-occurring depression or anxiety, or the specific timing of the child’s exposure (before, during, or after pregnancy). This conclusion comes from online research published in Thorax.
The researchers argue for including dedicated support for pregnant women with eating disorders within healthcare to help safeguard their children’s respiratory health.
Historically, studies on maternal mental health and children’s respiratory outcomes have focused mainly on depression, anxiety, or general stress, with less attention paid to eating disorders. While there is consistent evidence that maternal eating disorders affect cognitive, social, emotional, behavioral, and eating patterns in children, the physical health outcomes have been less clear.
To strengthen the evidence base, the researchers analyzed data from 131,495 mother–child pairs across seven European birth cohorts within the EU Child Cohort Network (EUCCN). They examined possible links between maternal eating disorders before pregnancy and preschool wheeze and school-age asthma in children.
They also explored whether associations differed for women without depression or anxiety, by eating disorder type (anorexia or bulimia), and by exposure period (pregnancy or after birth).
The prevalence of eating disorders before pregnancy varied from about 1% to 17% across the seven cohorts. Among those with eating disorders, co-existing depression or anxiety ranged from 11% to 75%. Preschool wheeze occurred in 21% to nearly 50% of cases, while school-age asthma ranged from just over 2% to about 17.5%.
Key findings showed that a pre-pregnancy eating disorder was linked to a roughly 25% higher risk of preschool wheeze and about a 26% higher risk of school-age asthma, though the magnitude varied by cohort. When mothers who also had depression or anxiety were excluded, the associations remained but were somewhat weaker.
Similar associations were observed for both anorexia and bulimia with school-age asthma, while preschool wheezing was associated with bulimia alone. Although the strength of associations varied slightly depending on whether exposure occurred before, during, or after pregnancy, there was no single window of heightened susceptibility identified.
As this is an observational study, it cannot establish cause and effect, and the prevalence of eating and respiratory disorders differed across cohorts.
The researchers note that despite some variability between cohorts, the direction and magnitude of the associations were relatively consistent across analyses. The underlying mechanisms remain unclear.
Possible explanations include how maternal mental health and related stress may activate the hypothalamic-pituitary-adrenal axis, potentially affecting fetal lung development and the child’s immune maturation, which could raise susceptibility to immune-mediated conditions like asthma.
Additionally, maternal eating disorders are associated with higher risks of fetal growth restriction, preterm birth, cesarean delivery, and low birth weight—all known factors that can contribute to respiratory problems—suggesting multiple possible mediating pathways linking maternal eating disorders to childhood respiratory outcomes.
There is also consideration of a potential shared genetic or inflammatory pathway between mental health disorders and asthma, which could contribute to both conditions.
Ultimately, the researchers advocate for including maternal eating disorders in research on early-life respiratory risk factors and for integrating eating disorder screening and support into prenatal and maternal healthcare to improve respiratory outcomes for offspring.
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