Spiseforstyrrelsesprosjektet i MoBa (Eating Disorders and Pregnancy Outcome in 100,000 Births) - prosjektbeskrivelse
Prosjektet har som hensikt å identifisere kvinner i Den norske mor og barn-undersøkelsen (MoBa) som har en spiseforstyrrelse når de blir gravide.
Prosjektet er finansiert av National Institutes of Health i USA (National Institute of Child Health and Human Development, NICHD), og er et samarbeid mellom forskere ved Folkehelseinstituttet og University of North Carolina, USA.
En rekke tidligere studier har vist at kvinner med spiseforstyrrelser har økt risiko for svangerskaps- og fødselskomplikasjoner. Enkelte studier har og vist at mødrene opplever matingen av barna som problematisk, noe som kan forklare hvorfor barna har økt risiko for svak vektøkning og utvikling av egne spiseproblemer. Tidligere studier baserer seg imidlertid på små kliniske utvalg, eller store studier som ikke har hatt gode nok mål på spiseforstyrrelser. Den norske mor- og barnundersøkelsen (MoBa) er unik ved at det er et stort populasjonsutvalg med nesten 100 000 mødre, med utfyllende informasjon om spiseforstyrrelser og spiseproblemer hos både mor og barn.
Formålet med studien
Prosjektet ønsker å identifisere kvinner som har en spiseforstyrrelse når de blir gravide for å svare på fire hovedspørsmål:
- Hvordan påvirker det å bli gravid spiseforstyrrelsen?
- Hvordan påvirker det å ha en spiseforstyrrelse svangerskap og fødsel?
- Hvilke miljømessige faktorer kan bidra til en eventuell overføring av spiseforstyrrelser fra mor til barnet?
- Kan komplikasjoner under svangerskap og fødsel påvirke forekomsten av spiseproblemer over tre generasjoner?
- Hvilke gener kan disponere for spiseforstyrrelser hos barna, og hvordan samvirker genene med ulike miljøfaktorer?
Spørreskjemaet kvinnene fyller ut under svangerskapet inneholder en rekke ulike spørsmål om holdninger til kropp/vekt samt ulike slankemetoder. Med bakgrunn i denne informasjonen identifiserer vi kvinnene vi antar har en spiseforstyrrelse: i løpet av de siste 6 månedene før graviditet, samt under graviditet. Vi identifiserer fire ulike hovedkategorier av spiseforstyrrelser: anorexi, bulimi, overspisningslidelse, og uspesifisert spiseforstyrrelse. Senere spørreskjemaer inneholder også spørsmål om spiseforstyrrelser slik at vi kan studere det videre sykdomsforløpet hos kvinnene.For mer informasjon om spiseforstyrrelsene gå til våre faktaark.
Studien har vært finansiert av National Institute of Child Health and Human Development i USA (NICHD).
23 vitenskapelige artikler er foreløpig publisert (t.o.m. 2015), og flere er under arbeid. To doktorgradsavhandlinger er fullført og godkjent.
Prosjektleder: Cynthia M. Bulik, W and J Jordan Distinguished Professor of Eating Disorders
Department of Psychiatry, School of Medicine
Professor of Nutrition, School of Public Health
Director, UNC Eating Disorders Program
University of North Carolina at Chapel Hill
Andre forskere ved UNC er: Pat Sullivan, Anna Maria Siega-Riz, Ann Von-Holle, Jocilyn E. Dellava, Stephanie Zerwas, Lauren Reba-Harreleson, Robert M Hamer, Hunna J Watson .
Medprosjektleder: Ted Reichborn-Kjennerud, M.D. Avdeling for psykiske lidelser, genetikk, miljø og psykisk helse, Område for psykisk og fysisk helse.
Andre forskere ved Folkehelseinstituttet er: Leila Torgersen, Eivind Ystrøm, Cecilie Knoph-Berg, Helle Margrethe Meltzer, Margaretha Haugen, Per Magnus, Camilla Stoltenberg.
Torgersen et al, 2015, Appetite, 84, 291-298. Maternal eating disorder and infant diet. A latent class analysis based on the Norwegian Mother and Child Cohort Study (MoBa)
Lupattelli A et al, 2015, PLoS ONE 10(7): e0133045. doi:10.1371/journal.pone.0133045. Medication Use before, during, and after Pregnancy among Women with Eating Disorders: A Study from the Norwegian Mother and Child Cohort Study.
Perrin E M et al, International Journal of Eating Disorder, 2015; 48:406–414. Weight-for-Length Trajectories in the First Year of Life in Children of Mothers with Eating Disorders in a Large Norwegian Cohort.
Watson HJ et al, Norsk Epidemiologi, 2014; 24 (1-2): 51-62. Eating disorders, pregnancy, and the postpartum period: Findings from the Norwegian Mother and Child Cohort Study (MoBa).
Zerwas SC et al, European Eating Disorder Review, 2014; 22, 397–404. Gestational and Postpartum Weight Change Patterns in Mothers with Eating Disorders
Watson, H J et al, Psychological Medicine, 2013; 43, 1723–1734. Remission, continuation, and incidence of eating disorders during early pregnancy: A validation study on a population-based birth cohort.
Knoph C et al, International journal of eating disorder, 2013; 46:355–368. Course and Predictors of Maternal Eating Disorders in the Postpartum Period.
Watson HJ et al, Psychological Medicine, 2012; 20, 1-12. Remission, continuation and incidence of eating disorders during early pregnancy: a validation study in a population-based birth cohort.
Conclusion: We validated previously estimated rates of remission, continuation and incidence of eating disorders during pregnancy. Eating disorders, especially BED, during pregnancy were relatively common, occurring in nearly one in every 20 women. Pregnancy was a window of remission from BN but a window of vulnerability for BED.
Ulman TF et al, Sleep, 2012; 35, 1403-11. Sleep disturbances and binge eating disorder symptoms during and after pregnancy. Conclusion: BED before and during pregnancy was associated with sleep problems during pregnancy and dissatisfaction with sleep 18 months after childbirth.
Zerwas S et al, International Journal of eating disorders, 2012; 45, 546–555. Maternal Eating Disorders and Infant Temperament: Findings from the Norwegian Mother and Child Cohort Study. Conclusion: Women with an eating disorder were more likely to report extreme fussiness in their child than those with no eating disorders.
Siega-Riz AM et al, International Journal of eating disorders, 2011; 44, 428–434. Gestational Weight Gain of Women with Eating Disorders in the Norwegian Pregnancy Cohort. Conclusion: Women with bulimia nervosa (BN) and binge eating disorder (BED) gained significantly more weight during pregnancy than those with no eating disorders. Women with anorexia nervosa had a lower risk of gaining inadequately while women with BN and BED were more likely to gain excessively.
Dellava JE et al, International Journal of eating disorders, 2011; 44, 325–332. Dietary Supplement Use Immediately Before and During Pregnancy in Norwegian Women with Eating Disorders. Conclusion: Overall dietary supplement use in this sample (MoBa) is similar in women with and without eating disorders.
Berg CK et al, International Journal of eating disorders, 2011; 44, 124–133. Factors Associated with Binge Eating Disorder in Pregnancy. Conclusion: Onset of binge eating disorder (BED) in pregnancy was associated with psychological, social and weight-related factors, as well as health behaviors and adverse life events. In women with pre-pregnancy BED, thoughts of being overweight before pregnancy and overvaluation of weight were associated with course of BED during pregnancy.
Bulik CM et al, Obstetrics & Gynecology, 2010; 116, 1136-1140. Unplanned Pregnancy in Women With Anorexia Nervosa. Conclusion: A higher rate of unplanned pregnancies and abortion were reported by mothers with anorexia nervosa.
Reba-Harreleson L et al, Eating Behaviors, 2010; 11,54-61. Patterns of maternal feeding and child eating associated with eating disorders in the Norwegian Mother and Child Cohort Study (MoBa). Conclusion: Child anxiety symptoms, child eating problems and patterns of restrictive feeding were more often reported by mothers with bulimia nervosa and binge eating disorder, when their child was 36 months old. No difference emerged across eating disorder group regarding pressure to eat.
Torgersen L et al, Maternal and child nutrition, 2010; 6, 243-252. Breast-feeding Practice in Mothers with Eating Disorder. Conclusion: Mothers with anorexia nervosa and mothers with eating disorder not otherwise specified- purging subtype had increased risk for early cessation of breastfeeding.
Swann RA et al. International Journal of Eating Disorders, 2009, 42, 394-401. Attitudes Toward Weight Gain During Pregnancy: Results from the Norwegian Mother and Child Cohort Study (MoBa). Conclusion: The presence of an eating disorder was associated with greater worry over gestational weight gain.
Bulik CM et al, Acta Obstetricia et Gynecologica 2008; 1-3, iFirst article Maternal eating disorders influence sex ratio at birth. Conclusion: Sex ratio at birth (proportion of male live births) was studied in women with various eating disorders. Fewer male live births were seen in the anorexia and bulimia groups, while binge eating disorders and not otherwise specified-purging type were associated with a higher proportion of male births. Maternal eating disorders may influence offspring sex and that the direction of effect may vary by eating disorder subtype.
Bulik CM et al, International Journal of Eating Disorders, 2008; Aug 21. Birth outcomes in women with eating disorders in the Norwegian Mother and Child cohort study (MoBa). Conclusion: Detecting eating disorders in pregnancy could identify modifiable factors (e.g., high gestational weight gain, binge eating, and smoking) that influence birth outcomes.
Torgersen L et al, International Journal of Eating Disorders, 2008; DOI 10.1002/eat.20564 Nausea and vomiting of pregnancy in women with bulimia nervosa and eating disorders not otherwise specified. Conclusion: Our results suggest that eating disorders marked by the symptom of purging are associated with increased odds of pregnancy-related vomiting.
Knoph Berg C et al, Australian and New Zealand Journal of Psychiatry, 2008; 42(5):396-404. Psychosocial factors associated with broadly defined bulimia nervosa during early pregnancy: findings from the Norwegian Mother and Child Cohort Study. Conclusion: Onset of bulimia nervosa during pregnancy is associated with mood and anxiety symptoms. Remission of bulimic symptoms and new onset of bulimia nervosa are associated with opposite profiles of self-esteem, and life satisfaction measures.
Siega-Riz AM et al, American Journal of Clinical Nutrition, 2008; 87(5): 1346-1355 Nutrient and food group intakes of women with and without bulimia nervosa and binge eating disorder during pregnancy. Conclusion: Women with bulimia nervosa before and during pregnancy and those with binge-eating disorder before pregnancy exhibit dietary patterns that differ from those in women without eating disorders, reflecting their symptomatology and maybe influencing pregnancy outcomes.
Bulik CM et al, Psychological Medicine 2007 Aug;37(8):1109-18. Epub 2007 May 10 Patterns of remission, continuation and incidence of broadly defined eating disorders during early pregnancy in the Norwegian Mother and Child Cohort Study (MoBa). Conclusion: Pregnancy appears to be a catalyst for remission of some eating disorders but also a vulnerability window for new onset of broadly defined binge eating disorders, especially in economically disadvantaged individuals. Vigilance by health-care professionals for eating disorders in pregnancy is warranted.