Disordered eating in pregnancy: the development and validation of a pregnancy-specific screening instrument

Student thesis: Doctoral Thesis


Optimising the mental health of women during the perinatal period, inclusive of pregnancy and the first year post-birth, has been identified as a global priority. While much research has focused on depression and related conditions, disordered eating is thought to affect a similar proportion of women. A growing body of research also suggests pregnancy may represent a period of vulnerability for the precipitation, re-emergence, or exacerbation of disordered eating; however, such symptoms are often undetected and undisclosed in pregnancy. Disordered eating in pregnancy has been linked to several negative consequences such as miscarriage, prematurity, low birth weight, increased need for caesarean section, and other obstetric and postpartum difficulties. Eating disorder scholars and advocacy organisations have argued that antenatal care should include questions regarding a woman’s body weight, eating practices/attitudes, and weight control behaviour/s during pregnancy; however, there is mixed guidance as to how this should occur, under what circumstances, and using which methods/instruments. Consequently, screening for disordered eating symptomatology in pregnancy is rare. As such, the overarching aim of this thesis was to improve the identification of disordered eating in pregnancy.
To address this aim and answer the four main research questions, a mixed methodological approach was employed with four sequential studies conducted. Studies 1 and 2 used the Delphi methodology to explore professional and consumer views on the symptom expression of disordered eating in pregnancy and how this is distinguished from pregnancy-appropriate symptomatology. Professional and consumer views on the assessment of disordered eating in antenatal care were also explored. Study 3 aimed to systematically identify and evaluate general measures of disordered eating, using standardised performance criteria, to determine their suitability for use in pregnancy. Study 4 aimed to develop a pregnancy-specific disordered eating screening instrument based on the findings of Studies 1and 2, and then evaluate the psychometric properties of the instrument using a sample of pregnant women in Australia (N = 444). The pregnancy-specific instrument was also compared to two well-known eating disorder measures.
Studies 1 and 2 revealed strong consensus that (i) disordered eating in pregnancy is somewhat similar, yet also distinct, to the experience of disordered eating in a non-pregnant context; (ii) the delineation between disordered eating and pregnancy-appropriate symptomatology is difficult to quantify, but might be assisted using several qualitative and quantitative factors; and (iii) antenatal screening for disordered eating is imperative and should occur in a routine/universal manner using brief psychometric instruments validated for use in pregnancy. The systematic review conducted as Study 3 revealed little to no evidence to support the use of existing disordered eating measures in pregnancy, highlighting the need for a pregnancy-specific measure of disordered eating to be developed and research exploring the validity of existing self-report inventories in pregnancy to be conducted. Study 4 provided preliminary evidence that the Disordered Eating Attitudes in Pregnancy Scale (DEAPS) constitutes a valid and user-friendly instrument to assess and screen for disordered eating attitudes during pregnancy. The DEAPS demonstrated a high level of internal consistency, appropriate content validity, good construct validity, and very strong concurrent criterion-related validity.
Overall, this thesis revealed that disordered eating is a relatively common experience during pregnancy and that routine/universal screening for such symptoms might be warranted in antenatal care, similar to screening for antenatal depression and anxiety. This thesis has also provided preliminary evidence that the implementation of universal screening may be feasible using the DEAPS. While further research is required to confirm the psychometric properties of the DEAPS in additional samples and different settings, this thesis has highlighted a need for policy makers to consider the inclusion of disordered eating screening in perinatal mental health guidelines and the importance of clinicians being educated and aware of such symptoms. Routine screening of disordered eating in pregnancy may facilitate early identification and management, contributing to a positive pregnancy experience and potentially mitigating associated morbidity and costs for mothers, infants, families, and societies. Ongoing research in this area is vital, particularly the development and evaluation of evidence-based interventions to support women experiencing disordered eating during pregnancy.
Date of Award16 Jun 2018
Original languageEnglish
SupervisorPeta Stapleton (Supervisor), Bruce Watt (Supervisor), Roger Hughes (Supervisor) & Kristen MacKenzie-Shalders (Supervisor)

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