New Tool May Identify Pregnant Women With Eating Disorders

Lara Salahi

May 24, 2022

A newly developed screening tool may help clinicians identify pregnant women with eating disorders.

The 12-question instrument is intended to be a quick way to help clinicians identify women who may may need to be referred to a mental health expert for further evaluation, according to the researchers, who reported on the instrument in a study published in Archives of Women's Mental Health.

"It would be most appropriate for clinical encounters so that women can get screened and referred," said Elizabeth Claydon, MD, assistant professor in the Department of Social and Behavioral Sciences at West Virginia University's School of Public Health, in Morgantown, who led the study. "If you miss it, they may carry on their eating disorder throughout their pregnancy."

Pregnant women who have an eating disorder are at increased risk for gestational diabetes, premature birth, labor complications, difficulties nursing, and postpartum depression, according to the National Eating Disorders Association. Their babies are at increased risk for premature birth, low birth weight, and poor development. However, clinicians have not had an accurate way of screening pregnant women who may have an eating disorder.

The American College of Obstetricians and Gynecologists offered its first clinical guidelines for managing anorexia in pregnancy in April 2022. The group's recommendations include regular monitoring of cardiac and liver function, blood pressure, and heart rate, as well as tests to monitor iron, sodium, potassium, bone density, and blood sugar levels. Anorexia, bulimia, binge eating, and subthreshold disorders — also known as other specified feeding or eating disorder — are among the most common eating disorders among pregnant women.

There are no recent data on the incidence or prevalence of eating disorders among pregnant women, according to Lauren Smolar, vice president of mission and education at the National Eating Disorders Association.

"It's hard to capture the number of pregnant women affected, since it so often goes undetected," Smolar said.

Existing screening tools for eating disorders ask patients whether they're currently pregnant; a questionnaire specifically tailored to pregnant women may help to better gather data on the prevalence within this group, Smolar said.

For the new study, Claydon and her colleagues tested the questionnaire among more than 400 mostly White women aged 25–34 years. They found that it could reliably identify women who may have an eating disorder. The questionnaire was validated for women to take during any trimester, according to the findings.

A score of 39 or above would serve as an indicator for follow-up. Women who score at least 39 were up to 16 times more likely to receive a diagnosis of an eating disorder compared to women who scored less, the researchers found.

Eating Disorders Often Escape the Eye

Researchers developed the tool to screen all women, rather than just patients who present with recognizable symptoms, according to Claydon.

"Some people may relapse during pregnancy, some may develop [a disorder] while pregnant," she said. "This makes sure there are no assumptions, because sometimes you can't tell someone has an eating disorder just by looking at them."

The researchers also worked to eliminate stigmatizing language to reduce the possibility of women withholding information about their symptoms.

The tool was developed following a qualitative study by Claydon and her colleagues that was published in 2018. In that study, the researchers analyzed self-perceptions and self-reported experiences of women going through pregnancy with an eating disorder.

"I heard a lot about how difficult it was to disclose eating disorders during pregnancy," Claydon said. "It's wonderful to do something applied to these findings. It's very meaningful and personal work to me."

Claydon said she and her colleagues now plan to test the tool by introducing it into clinics in West Virginia.

The Ophelia Fund/Rhode Island Foundation supported the creation of the tool and dissemination of the tool to clinicians. Research reported in the study was supported by the National Institute of General Medical Sciences of the National Institutes of Health.

Arch Womens Ment Health. Published online May 2, 2022. Full text

Lara Salahi is a journalist living in Boston.

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