Women who have an eating disorder have an increased risk of an adverse pregnancy outcome such as a miscarriage, a baby with a low birth weight or the necessity of a caesarean section. However, few studies have followed the children up for evidence of longer-term health issues. Two studies, including only a total of 64 children born to mothers with an eating disorder, did find some evidence of neurodevelopmental deficits in these children at 1 and 5 years of age.
The aim of this study is to use data from the CPRD to identify women with a history of an eating disorder who become pregnant and identify their subsequent offspring. The occurrence of any indication of a neurodevelopmental deficit in the child, such as autism (ASD), attention deficit hyperactivity disorder (ADHD), learning disabilities or behavioural or emotional disorders and any prescriptions for medications for ADHD will be searched for. The prevalence of these neurodevelopmental measures in the children will be compared amongst mothers who had had an eating disorder before or during pregnancy with mothers who had never had an eating disorder with children of a similar age and who were of a similar age at pregnancy and attending the same GP surgery .
If there is found to be an association with eating disorders and the subsequent neurodevelopment of the children it will be important to provide such mothers with greater nutritional support and advice during pregnancy.
Studies have shown that sodium valproate taken during the first trimester of pregnancy is not only teratogenic, but also has important longer-term effects on the childrens neurodevelopment. It is likely that other first trimester exposures may also have these longer-term effects. However, such studies are difficult to perform, because of the necessity of a long follow-up in large mother-baby cohorts. One small study in 2004 identified both an increased risk of microcephaly (head size smaller than 2 sd of the norm) at birth and neurodevelopmental deficits at 5 years of age in children born to mothers with an eating disorder compared with mothers with no eating disorder.
The primary aim of this study is to determine if the mother experiencing an eating disorder (ED) before or during pregnancy may have an adverse effect on the childs neurodevelopment by age 11 (indicated by any read codes corresponding to ADHD, ASD, learning disabilities or dyspraxia or prescriptions for medicines for ADHD).
The prevalence of these neurodevelopmental measures in the children will be compared amongst mothers with a history of an ED, mothers with an ED during pregnancy and mothers with no history of an ED matched for year of birth, maternal age at pregnancy and GP. Cox proportional hazards regression will be used to analyse time till first diagnosis. Potential confounders, such as maternal smoking and alcohol consumption will be adjusted for using propensity score matching. The influence of siblings or multiple births will be dealt with by performing a sensitivity analysis including only the first birth or one of the multiples.
A secondary aim of this study is to determine if the CPRD will be a useful resource for examining the long term effects in children of different exposures in utero.
Primary Outcomes : Any diagnosis of ADHD, ASD, dyspraxia or learning disabilities and any prescriptions for
drugs prescribed for ADHD (atomexetine, methylphenidate, dexamphetamine, lisdexamphetamine or modafinil).
Any diagnoses of a congenital anomaly, with an emphasis on major congenital anomalies as defined by EUROCAT Guide 1.4 (www.eurcat-network.eu/aboutus/datacollection/guidelinesforregistration/…)
Joan Morris - Chief Investigator - St George's, University of London
Joan Morris - Corresponding Applicant - St George's, University of London
Derek Cook - Collaborator - St George's, University of London
Iain Carey - Collaborator - St George's, University of London
Tess Harris - Collaborator - St George's, University of London
CPRD Mother-Baby Link;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation;Pregnancy Register