Eating disorders (ED) affect 5 to 7% of women of reproductive age and usually appear to be under-evaluated during the perinatal period [1, 2]. Many studies have investigated eating disorders during adolescence but fewer have been concerned with the perinatal period.
Epidemiological studies rather than clinical surveys have shown that the effect of ED on the course of pregnancy intensifies when ED are more active [1, 3–6]. When eating disorders are active, most studies show that symptoms attenuate, whereas in studies like Blais  and Micali  they still endure, taking the form of induced vomiting, dissatisfaction with body image, excessive exercise, compensatory dietary restrictions and anxiety. Many women, trusting that pregnancy will help them to overcome ED, consent to eat healthily for the sake of the baby. When ED are residual, pregnancy seems uncomplicated, with importance attached to having a healthy child and a higher level of support for changes in body image.
Women are often reluctant to inform the medical staff about their problems with eating disorders  probably because they feel anxious and guilty about harming the foetus. For women suffering from ED, pregnancies are often unplanned and ED pathology has been associated to various perinatal risks such as delayed development, prematurity, hypotrophy, stillbirth, dystocia delivery and postnatal depression. For these reasons, it can be worthwhile to investigate eating disorders during the perinatal period [1, 5, 8–10]. However, eating disorders are not part of the regular obstetric check-ups [4, 11]. Some authors raise the difficulties to detect and diagnose these troubles with appropriate instruments [8, 7, 12, 13].
Eating disorders may also affect infant’s development and health. In fact, parents with past and current eating disorders have been shown to report problems feeding their infants [14, 15]. The nature of the link between parental eating disturbances and infant feeding difficulties can be explained by many determinants, such as genetic influences, children’s temperament and appetite, parental eating psychopathology, affective psychopathology and learnt behaviours . Children of anorexic and bulimic mothers may also show more emotional, conduct, and hyperactivity disorders . It is therefore necessary to study reciprocal influence between mother’s eating disorders and infants’ feeling behaviour [5,7,16].
Since successfully feeding requires recognition of the baby’s needs and an adapted attitude of the caregiver to soothe his/her hungriness, mothers with prior or active eating disorders could find it difficult to accomplish this task. Studies on mother’s attitudes towards the infant during feeding and interaction are discordant. Waugh and Bulik  found no significant differences between otherwise similar mothers with and without on behavioural interactions between infant (aged 1–4) and parents during mealtimes, mothers without eating disorders addressed more positive comments to their babies. In other studies, e.g. Stein , when compared with controls, mothers who had experienced eating disorders in the post-natal period were more intrusive during their infants’ mealtimes and play and expressed more negative emotions towards their infants during mealtimes but not during play. There are, however, no differences between the groups in their positive expressed emotions.
A controlled style of interaction has been observed in women with eating disorders and offspring who feed with difficulty . There are more conflicts during the meal for mothers with eating disorders. Moreover, mothers with eating disorders feed their babies more irregularly and food is used for non-nutritive purposes. Mothers seem particularly preoccupied by their babies’ weight and appearance, being worried that the baby may be too fat, especially when the baby is a girl [20, 21]. When infants enter early childhood, schemes such as calorie restriction and rigidity in eating rules (no candies or no snacks between meals) begin to appear. Children subjected to these schemes often show a deregulation of eating rhythms and refuse to eat, a disorder characterised by withdrawal and opposing behaviour in communicative exchanges with their mothers. Thus, the child’s growth and development could be affected by conflicts during meals, which have a durable effect by age 10.
However, it is not clear how mothers’ eating disorders before pregnancy and at the time of birth influence when feeding their babies. The mother’s pathological attitudes towards eating, body shape and weight, could have a direct effect on the child and on the way she nurtures him/her, altering the mother’s sensitivity towards the child’s needs and reactions and impinging the quality of the relationship . Micali has asked whether maternal distress and child development and temperament are factors affecting eating behaviours for both mothers and children, concluding that mother’s anxiety and depression could increase feeding difficulties in children and could, in turn, increase distress in both parties over time .
Based on this contemporary literature review, we conclude that subjective aspects of reciprocal mother/infant adaptation and mother sensitivity to the infant’s needs and reactions during feeding have not been explored.
In this study, we aimed to examine mother’s subjective attitude towards their infant and describe parent–child dyads’ interactions during meals (infants’ general characteristics, mothers’ satisfaction, mother’s ease and comfort in feeding, infant regurgitation, satisfaction during meals). We studied a population of women consulting for pregnancy follow-up in an obstetric unit to screen and diagnose different aspects of eating disorders during gestation and to detect possible feeding difficulties with their babies 3 months after delivery.
More precisely, our aims were as follows:
To specify recent or chronic symptoms of eating disorders. How do these symptoms evolve during the maternity period? What are the clinical characteristics of eating disorders and their associated factors such as obesity, and their consequences such as somatic problems throughout pregnancy and post-partum depression?
To find out if eating disorders have an effect on mother-infant reciprocal adaptation during meals.
To collect information about mothers’ attitudes towards feeding practises and establish whether eating disorders influence mothers’ sensitivity during feeding.
To increase the awareness of obstetric and child psychiatric staff about eating disorders and encourage prevention during pregnancy and postpartum care.