Maternal mental health conditions are becoming recognised as a major determinant of childhood respiratory health. Earlier research suggested that there is a link between maternal depression, stress, and anxiety and an increased risk of childhood wheezing, asthma, and impaired lung function. The potential impact of maternal eating disorders (EDs) like anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) is largely overlooked, despite their prevalence in women of reproductive age and their known link with adverse maternal behaviors, psychiatric comorbidities, and pregnancy complications. Current evidence is inconsistent with one cohort study, which suggests that maternal EDs increase infant wheezing, but replication in an independent population and assessment of broader respiratory results are lacking.
This study aimed to assess whether maternal EDs evaluated before, during, or after pregnancy are linked to elevated risk of recurrent wheeze, school-age asthma, ever asthma diagnosis, and childhood lung function, and to assess the degree to which psychiatric comorbidities, ED subtypes, and exposure timing influence these associations.
A larger FAIR complaint harmonised data which comprised about 250,00 children from European pregnancy and birth cohorts within the EU Child Cohort Network (EUCCN). Seven cohorts with relevant exposure and results were included: ALSPAC, BiB, CHOP, DNBC, Generation R, MoBa, and NINFEA, which yielded 189,263 mother and child pairs with data on at least one exposure and outcome. Maternal Eds were primarily self-reported (6 cohorts) or detected by GP records (1 cohort), defined as pre-pregnancy EDs, EDs during pregnancy, or EDs occurring in 4 years postpartum. Primary outcomes involved preschool wheezing (0 to 4 years) and current school-age asthma (7.5 years), which were assessed by using ISAAC-based questionnaires and MeDALL criteria, respectively.
Secondary outcomes involved asthma diagnosis and spirometry-based lung function (FEV1, FVC, and FEV1/FVC z-scores) ever in ALSPAC and Generation R. Confounders selected a priori involved maternal age, education, predicted household income, ethnicity, and maternal asthma, with depression and anxiety assessed in the sensitivity analyses. Statistical analyses used remote pseudonymised individual participant data by using DataSHIELD, with complete case logistic regression and linear regression models fitted in cohorts and combined by using random effects meta-analysis, where at least three cohorts contributed data. Heterogeneity was assessed by using I², Cochran’s Q, and prediction intervals.
Results showed that maternal pre-pregnancy EDs were linked with higher risk of preschool wheezing (odds ratio [OR]: 1.25, 95% confidence interval [CI]: 1.06 to 1.47) though substantial heterogeneity (I² = 74%) and with school-age asthma (OR: 1.26, 95% CI: 1.10 to 1.46) with minimal heterogeneity (I² = 9%). This suggests that there are more consistent findings for asthma. Leave-one-out analysis supported the robustness of these links and effects estimated were marginally changed by adjustment for confounders. Secondary analysis revealed that BN but not AN was linked with preschool wheezing, whereas both AN and BN showed the same links with school-age asthma (AN= OR: 1.34, 95% CI: 1.06 to 1.69, BN= OR: 1.28, 95% CI: 1.0 to 1.57).
Results showed that exposure to environmental disturbances during pregnancy was correlated with preschool wheezing, which was comparable to pre-pregnancy EDs. Pregnancy EDs showed no significant association (OR: 1.00, 95% CI: 0.77 to 1.45) for childhood asthma. Post-pregnancy EDs had a strong link with asthma (OR: 1.41, 95% CI: 1.16 to 1.73) in the MoBa cohort with complete exposure timing. The links diminished when analyzing mothers without anxiety or depression, which suggests that mental health comorbidities do not fully account for these relationships. Pre-pregnancy EDs were linked to asthma diagnosis (OR: 1.18, 95% CI: 1.04 to 1.33). Lung function analyses indicated weak and nonspecific positive links to FEV1 and FVC influenced by biases instead of true biological effects because of cohort discrepancies between ALSPAC and Generation R.
This analysis indicates that maternal pre-pregnancy EDs increased the risk of preschool wheezing and school-age asthma in children, independent of confounding factors like maternal anxiety or depression. The link is consistent in different cohorts and ED types, with bulimia nervosa showing a strong link with early wheezing. No specific exposure window was detected because of the chronic nature of EDs. Possible contributing factors involve biological stress responses, smoking, nutrition, perinatal complications, and genetic vulnerabilities. These results stress the need to detect maternal EDs in perinatal risk assessment and to give integrated mental health support to help reduce respiratory issues in children.
Reference: Popovic M, Maule M, Moccia C, et al. Maternal eating disorders and respiratory outcomes in childhood: findings from the EU Child Cohort Network. Thorax. 2025. doi:10.1136/thorax-2025-223718
