Risk Factors, Trends, and Outcomes Associated with Anorexia Nervosa and Bulimia Nervosa Diagnoses during Delivery Hospitalizations.

OBJECTIVE

The objective of this study is to evaluate trends, risk factors, and outcomes associated with anorexia and/or bulimia nervosa diagnoses during delivery hospitalizations in the United States.

STUDY

DESIGN

The 2000 to 2022 National Inpatient Sample was used for this repeated-cross sectional analysis. Delivery hospitalizations of patients aged 15 to 54 with anorexia and/or bulimia nervosa diagnoses were identified. Temporal trends were analyzed with joinpoint regression reporting the average annual percent change (AAPC). The associations between anorexia and/or bulimia nervosa diagnoses and adverse outcomes including (1) transfusion, (2) nontransfusion severe maternal morbidity, (3) postpartum hemorrhage, (4) hypertensive disorders of pregnancy (including gestational hypertension and preeclampsia), (5) cesarean delivery, (6) preterm delivery at <37 and <32 weeks, and (7) anemia were analyzed with unadjusted and adjusted logistic regression models with unadjusted and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) as measures of association.

RESULTS

Of 87,151,598 delivery hospitalizations identified, 6,309 (7.2 per 100,000) had an anorexia nervosa and/or bulimia nervosa diagnosis, including 3,308 diagnoses of bulimia (3.8 per 100,000) and 3,324 diagnoses of anorexia (3.8 per 100,000). Diagnoses increased significantly over the study period for bulimia (AAPC: 6.6%, 95% confidence interval [CI]: 5.0%, 8.8%), anorexia (AAPC: 11.3%, 95% CI: 9.4%, 14.6%), and either diagnosis (AAPC: 9.2%, 95% CI: 7.8%, 11.4%). Anorexia nervosa and/or bulimia nervosa diagnoses were associated with increased adjusted odds of transfusion (aOR: 1.55, 95% CI: 1.02, 2.34), nontransfusion severe maternal morbidity (aOR: 1.79, 95% CI: 1.17, 2.73), preterm delivery at <37 weeks (aOR: 1.65, 95% CI: 1.34, 2.04) and <32 weeks (aOR: 1.65, 95% CI: 1.05, 2.59) and anemia (aOR: 1.55, 95% CI: 1.35, 1.77).

CONCLUSION

Anorexia nervosa and bulimia nervosa diagnoses increased in a representative sample of U.S. delivery hospitalizations over a 23-year study period and were associated with a range of adverse obstetrical outcomes.

KEY POINTS: · Eating disorder diagnoses increased among delivery hospitalizations on a population basis.. · Eating disorder diagnoses were associated with a range of adverse obstetrical outcomes.. · Diagnoses increased significantly for both bulimia and anorexia..