Reproductive health outcomes in eating disorders

Authors

  • Milla S. Linna MD,

    Corresponding author
    1. Hjelt Institute, Department of Public Health, University of Helsinki, Finland
    • Correspondence to: Milla Linna, Hjelt Institute, Department of Public Health, University of Helsinki, Finland. E-mail: milla.linna@helsinki.fi

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  • Anu Raevuori MD, PhD,

    1. Hjelt Institute, Department of Public Health, University of Helsinki, Finland
    2. Department of Adolescent Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
    3. Institute of Clinical Medicine, Child Psychiatry, University Of Turku, Finland
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  • Jari Haukka PhD,

    1. Hjelt Institute, Department of Public Health, University of Helsinki, Finland
    2. Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
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  • Jaana M. Suvisaari MD, PhD,

    1. Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
    2. Department of Social Psychiatry, Tampere School of Public Health, Finland
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  • Jaana T. Suokas MD, PhD,

    1. Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
    2. Department of Psychiatry, Helsinki University Central Hospital, Finland
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  • Mika Gissler MD, PhD

    1. National Institute for Health and Welfare, Helsinki, Finland
    2. Nordic School of Public Health, Gothenburg, Sweden
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  • The authors are most grateful to M. Grainger for her contribution to data management and computational issues.

  • Disclosure of conflicts All authors declare no financial relationships with any organizations that might have an interest in the submitted work; no other relationships that could appear to have influenced the submitted work. The funders were not involved in the conduct of the study, collection, management, or analysis and interpretation of the data. The researchers were completely independent from the funders.

  • Authors JTS and JMS have been involved in a research collaboration with Janssen-Cilag. Author JTS has received fees for giving expert opinions to Lightlake Sinclair and attended one international conference supported by Janssen-Cilag. Author JH has been in research collaboration with Janssen-Cilag and Eli Lilly, and has been a member of the expert advisory group for Astellas. Author AR attended two medical seminars supported by Janssen-Cilag. Other authors ML report no conflicts of interest.

ABSTRACT

Objective

Eating disorders are common psychiatric disorders in women at childbearing age. Previous research suggests that eating disorders are associated with fertility problems, unplanned pregnancies, and increased risk of induced abortions and miscarriages. The purpose of this study was to assess how eating disorders are related to reproductive health outcomes in a representative patient population.

Method

Female patients (N = 2,257) treated at the eating disorder clinic of Helsinki University Central Hospital during 1995–2010 were compared with matched controls identified from the Central Population Register (N = 9,028). Patients had been diagnosed (ICD-10) with anorexia nervosa (AN), atypical AN, bulimia nervosa (BN), atypical BN, or binge eating disorder (BED, according to DSM-IV research criteria). Register-based data on number of children, pregnancies, childbirths, induced abortions, miscarriages, and infertility treatments were used to measure reproductive health outcomes.

Results

Patients were more likely to be childless than controls [odds ratio (OR) 1.86; 95% confidence interval (CI) 1.62–2.13, p < .001]. Pregnancy and childbirth rates were lower among patients than among controls. BN was associated with increased risk of induced abortion compared to controls (OR 1.85; 95% CI 1.43–2.38, p < .001), whereas BED was associated with elevated risk of miscarriage (OR 3.18; 95% CI 1.52–6.66, p = .002).

Discussion

Reproductive health outcomes are compromised in women with a history of eating disorders across all eating disorder types. Our findings emphasize the importance of reproductive health counseling and monitoring among women with eating disorders. © 2013 Wiley Periodicals, Inc.(Int J Eat Disord 2013; 46:826–833)

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