Maternal Eating Disorders and Early Infant Growth: Mechanisms, Evidence, and Clinical Implications

Abstract

Background: Eating disorders (EDs)—including anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), and purging disorder (PD)—commonly affect women of reproductive age. Growing evidence suggests that maternal ED history influences fetal development, birth outcomes, and the trajectory of infant growth during the critical first year and early childhood.

Objective: This narrative review synthesizes the current literature examining the relationship between maternal EDs and early infant growth, from intrauterine development through the first years of life, and considers the biological, behavioral, and psychosocial mechanisms that may explain the observed associations.

Methods: Peer-reviewed cohort studies, systematic reviews, and meta-analyses published between 1988 and 2023 were reviewed. Key population-based cohorts—including the Norwegian Mother and Child Cohort Study (MoBa) and the Avon Longitudinal Study of Parents and Children (ALSPAC)—provided the strongest evidence base.

Results: Maternal AN is consistently associated with lower birth weight, small-for-gestational-age status, and reduced infant weight-for-length growth. Maternal BED and, in some cohorts, BN are associated with larger birth size and more rapid postnatal growth. Feeding difficulties, altered dietary patterns, retarded head growth, and subtle neurocognitive delays have also been documented in offspring of affected mothers. Pregravid body mass index (BMI) and gestational weight gain mediate many of these associations.

Conclusion: Maternal ED history represents a modifiable risk factor for atypical infant growth. Preconception and antenatal screening, coordinated multidisciplinary care, and sensitive infant feeding support may reduce adverse outcomes.