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

OBJECTIVE: 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 2000-2022 National Inpatient Sample was used for this repeated-cross sectional analysis. Delivery hospitalizations of patients aged 15-54 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 (i) transfusion, (ii) non-transfusion severe maternal morbidity, (iii) postpartum hemorrhage, (iv) hypertensive disorders of pregnancy (including gestational hypertension and preeclampsia), (iv) cesarean delivery, (vi) preterm delivery at <37 and <32 weeks, and (vii) anemia were analyzed with unadjusted and adjusted logistic regression models with unadjusted and adjusted odds ratios (aORs) with 95% 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% CI 5.0%, 8.8%), anorexia (AAPC 11.3%, 95% CI 9.4%, 14.6%), and either diagnosis (AAPC 9.2%, 95% 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, 1.34), non-transfusion severe maternal morbidity (aOR 1.79, 95% 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 US delivery hospitalizations over a 23-year study period and were associated with a range of adverse obstetrical outcomes.