Abstract
BACKGROUND: Anorexia nervosa has the potential to affect fetal neurodevelopment. We examined the association between maternal anorexia nervosa and mental, substance-related, and neurodevelopmental morbidity in offspring. METHODS: We conducted a retrospective cohort study of 1,269,370 children in Quebec, Canada, between 2006 and 2022. The main exposure was maternal anorexia nervosa requiring admission. The outcome was childhood hospitalization for mental, substance-related, or neurodevelopmental disorders between birth and age 17 years, with follow-up ending in 2023. We estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association between maternal anorexia nervosa and child outcomes using Cox regression models adjusted for patient characteristics. RESULTS: In total, 2,447 (0.2%) children had a mother admitted for anorexia nervosa. Children of mothers with anorexia nervosa had higher hospitalization rates for mental, substance-related, and neurodevelopmental morbidity than other children (104.7 vs. 51.4 per 1,000 by age 17 years). Children whose mothers had anorexia nervosa were particularly at risk of mental health hospitalization (HR 2.30, 95% CI 1.52-3.49), especially for anorexia nervosa (HR 10.62, 95% CI 5.06-22.29) and anxiety and stress disorders (HR 1.84, 95% CI 1.09-3.08), compared with unexposed children. Maternal anorexia nervosa was associated with substance-related (HR 2.01, 95% CI 1.26-3.21) and neurodevelopmental morbidity in children (HR 1.55, 95% CI 1.19-2.01). CONCLUSION: Maternal anorexia nervosa is associated with childhood hospitalization for mental health, substance-related, and neurodevelopmental morbidity, although results should be interpreted with caution owing to potential confounders. Mothers with anorexia nervosa may benefit from psychosocial support to prevent mental and neurodevelopmental morbidity in offspring.