Disordered eating measures validated in pregnancy samples: a systematic review

Abstract

Although disordered eating in pregnancy has been linked to numerous negative consequences, there is currently no published instrument specifically devised to identify or measure such symptoms in pregnancy. As such, this study systematically reviewed the literature to evaluate the performance of general measures of disordered eating in pregnancy samples. A systematic search of the following electronic databases was undertaken from inception to April 2019: Scopus, Medline, PsycINFO, Embase, ProQuest Dissertations and Theses, and the Cumulative Index to Nursing and Allied Health Literature. From 1724 citations, 8 publications met the inclusion criteria and were included in the review. Most of the included studies (6/8) were of reasonable quality. Overall, three self-report inventories (EDE-Q, EDI-2, and DEBS) and one semi-structured clinical interview (EDE) had some form of psychometric information available. Most studies reported reliability, with only two reporting validity. No studies assessed screening accuracy. Other than the EDE-Q, which had preliminary evidence to suggest possible utility in pregnancy, the findings of this review revealed little to no evidence to support the use of general measures of disordered eating in pregnancy. A strong need for research exploring the validity of existing measures in pregnancy samples, including the EDE-Q, was also evident. DISORDERED EATING MEASURES VALIDATED IN PREGNANCY 3 Disordered Eating Measures Validated in Pregnancy Samples: A Systematic Review Although mental health concerns are one of the most common morbidities during pregnancy and in the postnatal period (Howard et al., 2014), assessing maternal mental health and wellbeing during pregnancy has often been less salient than ensuring optimal physical health for the mother and improving birth outcomes (Bauer, Parsonage, Knapp, Lemmi, &

Screening instruments for eating disorders in pregnancy: Current evidence, challenges, and future directions

“…Our three studies utilized different screening approaches for EDs in antenatal samples in Germany and the UK: the general ED questionnaire EAT‐8 (Richter et al, 2016) via online dissemination in an unselected sample (Study 1), a modified‐SCOFF (Morgan et al, 1999; Study 2) and self‐reported ED history (Study 3) in preselected samples with elevated scores on other screeners for mental health burden (Howard et al, 2018; Mueller et al, 2020). Our findings align with recent aggregated evidence (Bannatyne et al, 2021) and confirm that there are no available screening instruments that can be recommended for antenatal samples. Related to screening pregnant women for previous EDs, the options based on validated instruments are limited as most focus on current symptoms (Lindvall Dahlgren & Wisting, 2016; Schaefer et al, 2021), which is especially important to consider given that most women will experience a temporary remission during pregnancy.…”

“…Much research has focused on screening for depression in pregnant women (Howard et al, 2018; O'Connor et al, 2016), whereas little attention has been paid to identifying eating disorders (EDs) in pregnancy. The prevalence of EDs during pregnancy ranges between 1.5% and 7.6% (Bye et al, 2020; Easter et al, 2013; Watson et al, 2013), with discrepancies largely attributable to differences in psychometric instruments employed and operationalized diagnostic criteria (Bannatyne et al, 2021; Bye et al, 2018). The prevalence of EDs has been estimated to be around 15% in pregnant women by a recent review (Bye et al, 2021).…”

“…For instance, antenatal screening for depression and anxiety based on such self‐report tools is implemented in some health care systems and settings (Bhat et al, 2022). However, despite the need to identify EDs in the perinatal period, no screening tool specifically developed for use in antenatal populations is available (Bannatyne et al, 2021). An open question is whether it is appropriate to rely on established and widely used general population ED measures.…”

“…A recent systematic review (Bannatyne et al, 2021) assessed the appropriateness of using traditional ED assessment instruments for use in a pregnancy context by identifying and evaluating the psychometric characteristics, that is, reliability (consistency) and validity (accuracy) of the Eating Disorder Examination (EDE), the Eating Disorder Examination Questionnaire (EDE‐Q), the Eating Disorder Inventory‐2 (EDI‐2), and the Disordered Eating Behavior Scale (DEBS) in pregnancy samples ( n = 1642 participants; 8 articles included). Results revealed insufficient evidence to support the use of general measures of ED in pregnancy, since no study assessed screening accuracy (i.e., sensitivity and specificity) and only two studies reported criterion‐related validity (Bannatyne et al, 2021). More research is needed to establish the sensitivity and specificity of screening tools for current EDs in pregnant women.…”

Validation of the Arabic version of the Disordered Eating Attitudes in Pregnancy Scale (A- DEAPS) among Lebanese pregnant women: A step closer to Pregorexia Awareness

“…These disparities could be explained by the diversity of assessment tools, varying from self-reported questionnaires (based on adapted versions of pre-existing scales for eating disorders, or designed on items derived from the DSM-4 or DSM-5 criteria) to structured interviews 9 , hence emphasizing the need for an international consensual and accurate pregnancy-speci c screening tool, as previously suggested by a Delphi study 19 , to make comparisons easier in research, and to minimize the probability of false negative and false positive tests. On top of that, a recent systematic review refuted the suitability of the traditional existing measures for evaluating eating disorders in pregnancy, pointing out that among sixteen scales applied across countries, not more than four were presented along with documented psychometric characteristics, yet none was able to stand up for a meritorious level of clinical pertinence (in terms of psychometric performance as internal consistency, criterion-related validity, screening accuracy…) to the point of being set as a "gold standard" measure or substituting the need for a speci cally conceived instrument for identifying dysfunctional eating symptoms during pregnancy 20 .…”