Perinatal factors and the risk of developing anorexia nervosa and bulimia nervosa

Context: Few prospective studies to date have investigated the role of obstetric complications in anorexia nervosa, and no study to our knowledge exists for this in bulimia nervosa. Objective: To explore the role of obstetric complications in the development of eating disorders. Design: A blind analysis of the obstetric records of a sample of subjects with anorexia nervosa, with bulimia nervosa, and normal subjects was performed. All of the subjects included in the study belong to the same population birth cohort and were born in the 2 obstetric wards of Padua Hospital, Padua, Italy, between January 17, 1971, and December 30, 1979. Settings and Participants: Part of the sample of subjects with eating disorders and all of the controls took part in a prevalence study carried out in 2 randomly selected areas of Padua. In addition, all of the subjects with anorexia nervosa and bulimia nervosa of the same birth cohort who were referred to an outpatient specialist unit were included. The final sample comprised 114 subjects with anorexia nervosa, 73 with bulimia nervosa, and 554 control subjects. Results: Several complications, such as maternal anemia (P=.03), diabetes mellitus (P=.04), preeclampsia (P=.02), placental infarction (P=.001), neonatal cardiac problems (P=.007), and hyporeactivity (P=.03), were significant independent predictors of the development of anorexia nervosa. The risk of developing anorexia nervosa increased with the total number of obstetric complications. In addition, an increasing number of complications significantly anticipated the age at onset of anorexia nervosa (P=.03). The obstetric complications significantly associated with bulimia nervosa were the following: placental infarction (P=.10), neonatal hyporeactivity (P=.005), early eating difficulties (P=.02), and a low birth weight for gestational age (P=.009). Being shorter for gestational age significantly differentiated subjects with bulimia nervosa from both those with anorexia nervosa (P=.04) and control subjects (P=.05). Conclusions: A significantly higher risk of eating disorders was found for subjects with specific types of obstetric complications. An impairment in neurodevelopment could be implicated in the pathogenesis of eating disorders.