Signs and symptoms of disordered eating in pregnancy: a Delphi consensus study

Abstract

BackgroundThis study aimed to establish consensus on the expression and distinction of disordered eating in pregnancy to improve awareness across various health professions and inform the development of a pregnancy-specific assessment instrument.MethodsA three-round modified Delphi method was used with two independent panels. International clinicians and researchers with extensive knowledge on and/or clinical experience with eating disorders formed the first panel and were recruited using structured selection criteria. Women who identified with a lived experience of disordered eating in pregnancy formed the second panel and were recruited via expressions of interest from study advertising on pregnancy forums and social media platforms. A systematic search of academic and grey literature produced 200 sources which were used to pre-populate the Round I questionnaire. Additional items were included in Round II based on panel feedback in Round I. Consensus was defined as 75% agreement on an item.ResultsOf the 102 items presented to the 26 professional panel members and 15 consumer panel members, 75 reached consensus across both panels. Both panels clearly identified signs and symptoms of disordered eating in pregnancy and endorsed a number of clinical features practitioners should consider when delineating disordered eating symptomatically from normative pregnancy experiences.ConclusionA list of signs and symptoms in consensus was identified. The areas of collective agreement may be used to guide clinicians in clinical practice, aid the development of psychometric tools to detect/assess pregnancy-specific disordered eating, in addition to serving as starting point for the development of a core outcome set to measure disordered eating in pregnancy.

Elite athletes get pregnant, have healthy babies and return to sport early postpartum

“…It is interesting to note that despite reported disorded eating (DE) prevalence between 0.6% and 27.8% among pregnant women in general,36 in our study, neither athletes nor controls (as a group) had average BD or DT scores above cut-off prepregnancy or postpartum. The finding related to the increased DT score for the athletes (and not for the controls) postpartum might be explained by the fact that these athletes were eager to achieve their prepregnancy shape and fitness (ideal body composition) as fast as possible to optimise performance.…”

“…It was also an important finding that the number of athletes who met the criteria for ED were lower postpartum compared with prepregnancy and pregnancy. This might indicate that pregnancy per se does not trigger or increase the possibility for maintenance of an ED for elite athletes as indicated in non-athletic women 36…”

Disordered eating measures validated in pregnancy samples: a systematic review

“…A key issue noted in existing literature (Bannatyne et al, 2018;Easter et al, 2013;Pettersson et al, 2016), and confirmed in this review, is the absence of pregnancy-specific measures of disordered eating. This is in contrast to postnatal depression where several instruments specific to the perinatal period have been developed (e.g., the Edinburgh…”

“…For example, the overlap between pregnancy-related symptomatology and disordered eating pathology could potentially increase the percentage of false positives (i.e., over-identifying pregnancy symptoms as 'disordered') or false negatives (i.e., under-identifying cases of disordered eating by attributing symptoms to pregnancy) on an instrument. Furthermore, recent research (e.g., Bannatyne, Hughes, Stapleton, Watt, & MacKenzie-Shalders, 2018) has indicated the expression of disordered eating in pregnancy may include unique pregnancy-specific features that are not assessed in traditional instruments such as overvaluation of the offspring's weight and shape (e.g., desire for the baby to be "small" or "petite"), rationalisation of self-induced vomiting as pregnancyappropriate, and emotional detachment from the pregnancy.…”

Eating disorders mothers and their children: a systematic review of the literature

“…Eating disorders (ED) are mental health disorders characterised by severe disturbances in eating behaviour that significantly impact an individual's emotional, psychosocial and physical well-being (Bannatyne et al 2018). Current diagnostic classifications of ED include anorexia nervosa (AN), bulimia nervosa (BN) and binge-eating disorder (BED) as full threshold ED.…”