Barriers to identifying eating disorders in pregnancy and in the postnatal period: a qualitative approach

Abstract

BackgroundEating Disorders (ED) are mental health disorders that typically effect women of childbearing age and are associated with adverse maternal and infant outcomes. UK healthcare guidance recommends routine enquiry for current and past mental illness in antenatal and postnatal care for all women, and that pregnant women with a known ED are offered enhanced monitoring and support. Midwives and health visitors are ideally placed to identify and support women with ED as they are often the primary point of contact during the antenatal and postnatal periods. However, research on the barriers to identifying ED in the perinatal period is limited. This study aimed to understand the barriers to disclosure and identification of ED in pregnancy and postnatally as perceived by women with past or current ED, and midwives and health visitors working in the UK National Health Service.MethodsTwo studies were undertaken: mixed-measures survey of pregnant and postnatal women with current or past ED; focus groups with student and qualified midwives and health visitors.ResultsFive themes emerged on the barriers to disclosure in pregnancy as perceived by women: stigma, lack of opportunity, preference for self-management, current ED symptomatology and illness awareness. Four themes were identified on the barriers to identification of ED in pregnancy and in the postnatal period as perceived by health professionals: system constraints, recognition of role, personal attitudes, and stigma and taboo.ConclusionsSeveral barriers to the identification of ED during and after pregnancy were described, the main factors were stigma and poor professional training. Perinatal mental health is becoming increasingly prioritised within national policy initiatives; however, ED continue to be neglected and increased awareness is needed. Similarly, clinical guidance aimed at responding to the rising prevalence of obesity focus on changing nutrition but not on assessing for the presence of ED behaviours that might be affecting nutrition. Improving education and training for health professionals may contribute to reducing stigma and increase confidence in identifying ED. The barriers identified in this research need to be addressed if recognition and response to women with ED during the perinatal period is to improve.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1745-x) contains supplementary material, which is available to authorized users.

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“…It would also enable midwives to discover excessive gestational weight in normal weight women, who are otherwise rarely target for interventions, but nevertheless at risk for pregnancy related complications such as preeclampsia, gestational diabetes, fetal macrosomia, cesarean delivery [46,47] and postpartum weight retention [48]. Furthermore, the weighing situation provides an opportunity to detect situation bound anxiety and possibly reveal eating disorders which are otherwise hard to discover [49].…”

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“…The scarcity of studies exploring this phenomenon proves that raising awareness is essential, considering the importance of a balanced diet during pregnancy and the risks of undernutrition for both the mother-to-be and her fetus, such as miscarriage, low birth weight, type 2 diabetes, cardiovascular diseases, neural tube defects, cognitive disorders, placental abruption, maternal anemia, impaired bone mineralization, post-partum depression, and so forth 4,5 . Barriers to the identi cation of eating disorders during pregnancy are principally stigma and poor professional training 22 . In addition, the lack of con dential discussions about weight gain, mental health and body dissatisfaction between pregnant women and their physicians accounts for pregorexia's poor detection and management 4 .…”

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