New research shows that children born to mothers with eating disorders face a higher risk of asthma and wheezing, regardless of the type of disorder, co-existing depression or anxiety, or the timing of exposure, according to a study published online in Thorax.
The findings highlight the need for dedicated support for pregnant women with eating disorders to protect the respiratory health of their children.
Previous research on maternal mental health and childhood respiratory outcomes has focused mainly on depression, anxiety, or general stress, with limited evidence on less common conditions such as eating disorders. While prior studies consistently report cognitive, social, emotional, behavioral, and eating-related consequences in children of mothers with eating disorders, the evidence on physical health outcomes has been less clear.
To address this gap, researchers analyzed data from 131,495 mother-child pairs across seven European birth cohorts in the EU Child Cohort Network (EUCCN). They examined potential links between maternal eating disorders before pregnancy and the risk of preschool wheezing and school-age asthma in children. The analysis also considered whether associations differed for mothers without depression or anxiety, by type of eating disorder—anorexia or bulimia—and timing of exposure—before, during, or after pregnancy.
The prevalence of maternal eating disorders before pregnancy ranged from nearly 1% to 17% across cohorts, with co-existing depression or anxiety reported in 11% to 75% of these women. Preschool wheezing affected 21% to nearly 50% of children, while school-age asthma ranged from just over 2% to nearly 17.5%.
The study found that a maternal eating disorder before pregnancy was associated with a 25% higher risk of preschool wheeze and a 26% higher risk of school-age asthma. These risks remained largely consistent across cohorts and persisted even after excluding mothers with depression or anxiety. Bulimia was linked to both preschool wheezing and school-age asthma, while anorexia was associated only with asthma. No specific period of susceptibility—before, during, or after pregnancy—was identified.
The researchers cautioned that the study is observational and cannot prove cause and effect. Differences in the prevalence of eating disorders and respiratory conditions across cohorts may affect comparability, but the overall direction and magnitude of the associations were stable.
The underlying mechanisms remain unclear. Researchers suggest that maternal mental ill-health and stress may disrupt the hypothalamic-pituitary-adrenal axis, affecting fetal lung development and immune system maturation, increasing susceptibility to conditions like asthma. Children of mothers with eating disorders are also more likely to experience fetal growth restriction, prematurity, Caesarean delivery, and low birth weight—factors known to increase respiratory risks. Genetic factors affecting immune and inflammatory pathways may also play a role.
The study underscores the importance of including maternal eating disorders in research on early-life respiratory risk factors and integrating screening and support into maternal healthcare to improve outcomes for children.
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