Fertility treatment, twin births, and unplanned pregnancies in women with eating disorders: findings from a population-based birth cohort

Authors

  • N Micali,

    Corresponding author
    1. Behavioural and Brain Sciences Unit, UCL Institute of Child Health, London, UK
    • Correspondence: Dr N Micali, Brain and Behavioural Sciences Unit, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK. Email N.micali@ucl.ac.uk

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  • I dos-Santos-Silva,

    1. Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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  • B De Stavola,

    1. Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
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  • J Steenweg-de Graaf,

    1. The Generation R Study Group, Erasmus Medical Centre, Rotterdam, the Netherlands
    2. Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands
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  • V Jaddoe,

    1. The Generation R Study Group, Erasmus Medical Centre, Rotterdam, the Netherlands
    2. Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands
    3. Department of Paediatrics, Erasmus Medical Centre – Sophia Children's Hospital, Rotterdam, the Netherlands
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  • A Hofman,

    1. Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands
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  • FC Verhulst,

    1. Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Centre – Sophia Children's Hospital, Rotterdam, the Netherlands
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  • EAP Steegers,

    1. Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, the Netherlands
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  • H Tiemeier

    1. Department of Epidemiology, Erasmus Medical Centre, Rotterdam, the Netherlands
    2. Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Centre – Sophia Children's Hospital, Rotterdam, the Netherlands
    3. Department of Psychiatry, Erasmus Medical Centre, Rotterdam, the Netherlands
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Errata

This article is corrected by:

  1. Errata: Corrigendum Volume 122, Issue 6, 892, Article first published online: 18 April 2015

Abstract

Objective

To investigate fertility treatment, twin births, and unplanned pregnancies in pregnant women with eating disorders in a population-based sample.

Design

A longitudinal population-based birth cohort (Generation R).

Setting

Rotterdam, the Netherlands.

Sample

Women from the Generation R study who reported a history of (recent or past) anorexia nervosa (n = 160), bulimia nervosa (n = 265), or both (n = 130), and a history of psychiatric disorders other than eating disorders (n = 1396) were compared with women without psychiatric disorders (n = 4367).

Methods

Women were compared on the studied outcomes using logistic regression. We performed crude and adjusted analyses (adjusting for relevant confounding factors).

Main outcome measures

Fertility treatment, twin births, unplanned pregnancies, and women's feelings towards unplanned pregnancies.

Results

Relative to women without psychiatric disorders, women with bulimia nervosa had increased odds (odds ratio, OR, 2.3; 95% confidence interval, 95% CI, 1.1–5.2) of having undergone fertility treatment. Women with all eating disorders had increased odds of twin births (anorexia nervosa, OR 2.7, 95% CI 1.0–7.7; bulimia nervosa, OR 2.7, 95% CI 1.1–6.6; anorexia and bulimia nervosa, OR 3.795% CI 1.3–10.7). Anorexia nervosa was associated with increased odds of unplanned pregnancies (OR 1.8, 95% CI 1.2–2.6) and mixed feelings about these pregnancies (adjusted OR 5.0, 95% CI 1.7–14.4). Pre-pregnancy body mass index did not explain the observed associations.

Conclusions

Eating disorders are associated with increased odds of receiving fertility treatment and twin births. Women with anorexia nervosa were more likely to have an unplanned pregnancy and have mixed feelings about the unplanned pregnancy. Fertility treatment specialists should be aware that both active and past eating disorders (both anorexia nervosa and bulimia nervosa) might underlie fertility problems.

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