Maternal eating disorders and respiratory outcomes in childhood: findings from the EU Child Cohort Network

Background While maternal depression and anxiety have been linked to adverse childhood respiratory outcomes, the role of eating disorders (EDs) remains less understood. This study examined associations between maternal EDs and offspring respiratory outcomes, considering ED subtypes, exposure windows and comorbid depression/anxiety. Methods Data from 131495 mother–child pairs across seven cohorts from the EU Child Cohort Network were analysed. Primary analyses assessed associations between maternal pre-pregnancy EDs and preschool wheezing and school-age asthma. Secondary analyses explored associations in women without comorbid depression/anxiety, specific ED subtypes (anorexia nervosa, bulimia nervosa), exposure periods (pregnancy, post-pregnancy) and — within two cohorts — school-age lung function. Logistic regression models were fitted for each cohort, and results pooled using random-effects meta-analysis. Results Maternal pre-pregnancy ED prevalence ranged from 0.8% (health records) to 17.0% (self-reported lifetime EDs). Preschool wheezing prevalence ranged from 20.7% to 49.6%, and school-age asthma from 2.1% to 17.3%. Pre-pregnancy EDs were associated with preschool wheezing (OR: 1.25, 95% CI: 1.06 to 1.47, I2: 74%) and school-age asthma (OR: 1.26, 95%CI: 1.10 to 1.46, I2: 9%). These estimates were slightly attenuated but remained directionally consistent with the main analyses after exclusion of mothers with depression/anxiety. There was evidence of a weak positive association with lung function. Associations across ED subtypes were largely consistent with the pre-pregnancy any ED estimate, while no clear pattern emerged by timing of exposure. Conclusions Maternal EDs are associated with a higher risk of wheezing and asthma in children, independently of comorbid depression/anxiety. These findings highlight the need to understand mechanisms and long-term respiratory consequences of maternal EDs to inform interventions for improving offspring respiratory health.