Body mass index, eating attitudes, and symptoms of depression and anxiety in pregnancy and the postpartum period

Depression and anxiety trajectories among women who undergo an elective cesarean section

BACKGROUND

Depression and anxiety are important mood changes in childbearing women. However, changes in depression and anxiety over time in women who undergo an elective cesarean section (CS) have not yet been elucidated. We aimed to characterize the trajectories of depressive and anxiety symptoms, and patterns of co-occurrence, and examined the associated predictors of depression and anxiety courses.

METHODS

A prospective longitudinal study of childbearing women (N = 139) who underwent a CS was conducted. Depressive and anxiety symptoms were respectively assessed using the Edinburgh Postnatal Depression Scale and State Anxiety Inventory, in the third trimester and at 1 day, 1 week, and 1 and 6 months postpartum.

RESULTS

Group-based modeling identified three distinct trajectories of depressive symptoms: group 1 (low, 30.9%), group 2 (mild, 41.7%), and group 3 (high, 27.3%). Four group trajectories of anxiety symptoms were identified: group 1 (low, 19.4%), group 2 (mild, 44.6%), group 3 (high, 28.8%), and group 4 (very high, 7.2%). Mild symptoms of both depression and anxiety were the most common joint trajectory. Depression trajectories were significantly related to anxiety trajectories (p<0.001). Predictors of the joint trajectory included the pre-pregnant body mass index (odds ratio (OR): 2.42, 95% confidence interval (CI): 1.1 ∼ 6.3) and a poor sleep score (OR: 3.2, 95% CI: 1.4 ∼ 7.3) in the third trimester.

CONCLUSIONS

Distinctive trajectories and co-occurrence patterns of depressive and anxiety symptoms were identified. Our findings suggest a need for greater attention to continuous assessment of psychological well-being among women who undergo an elective CS.

Obesity and postpartum depression: does prenatal care utilization make a difference?

To identify (1) the association between pre-pregnancy BMI (PP-BMI) and PPD symptoms, and (2) the association between PP-BMI and PPD symptoms after considering PNC utilization as a moderating variable. Data from the 2004 and 2005 Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed from 15 states. The study design utilized two risk-adjustment approaches. One approach included all women in the dataset and used statistical analyses to risk-adjust for pregnancy risk status, and the other approach, through a sensitivity analysis, modified the design of the study by truncating the sample to include only women with healthy pregnancies. An initial association was seen between obesity and PPD symptoms, and PNC and PPD symptoms in the multivariate analyses. However, the inclusion of case-mix variables into the multivariate models removed these associations. Overall, for both approaches, there was no indication of a moderating effect of PNC utilization. Results also revealed that many of the women were significantly affected by a variety of high-risk maternal morbidity (case-mix) variables. Although PNC is important for the health of mothers and babies, it does not appear to moderate the association of PP-BMI and PPD symptoms. However, since this study revealed associations between several high-risk maternal morbidities (included as case-mix variables), and PPD symptoms, it is recommended that future research further investigate the possible association of these morbidities with PPD symptoms. For practice, it is suggested that PNC providers focus on their patients, and establish suitable interventions accordingly.

Impact of a health promotion intervention on maternal depressive symptoms at 15 months postpartum

Given that diet, physical activity, and social support are associated with depression, we examined whether a health promotion intervention designed to modify these factors in low-income, postpartum women would reduce depressive symptoms. This study used a randomized, controlled design to examine the effect of the Just for You (JFY) Program, an educational intervention promoting healthy lifestyles through home visits by nutrition paraprofessionals and motivational telephone counseling, on postpartum depressive symptoms. A total of 679 women income-eligible for the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) were recruited at 6-20 weeks post delivery and randomized to Usual WIC Care or JFY. Using an intention-to-treat analysis, the authors modeled depressive symptoms on the Center for Epidemiologic Studies Depression Scale (CES-D) among 403 women (59%) completing follow-up at a mean of 15 months infant age, adjusting for baseline CES-D, age, household income and randomization strata (body mass index (BMI), race/region). As a secondary analysis, the authors evaluated potential mediators related to social support and self-efficacy to change one or more health behaviors targeted by the intervention. Women randomized to JFY reported 2.5 units lower CES-D score (P = 0.046) compared with those receiving Usual WIC Care alone. This relationship was attenuated by change in self-efficacy (β = -2.3; P = 0.065), suggesting this construct may partially have mediated the effect of JFY on maternal depressive symptoms. A health promotion intervention delivered through home visits and telephone calls can reduce depressive symptoms at 15 months postpartum among low-income, ethnically diverse women.

Aerobic exercise training during pregnancy reduces depressive symptoms in nulliparous women: a randomised trial

QUESTION

Does supervised aerobic exercise during pregnancy reduce depressive symptoms in nulliparous women?

DESIGN

Randomised trial with concealed allocation, blinded assessors, and intention-to-treat analysis.

PARTICIPANTS

80 nulliparous, pregnant women attending for prenatal care at one of three tertiary hospitals in Cali, Colombia.

INTERVENTION

The experimental group completed a 3-month supervised exercise program, commencing at 16 to 20 weeks of gestation. Each session included walking (10 min), aerobic exercise (30 min), stretching (10 min), and relaxation (10 min). The control group continued usual activities and performed no specific exercise.

OUTCOME MEASURES

The primary outcome was symptoms of depression assessed by the Center for Epidemiological Studies Depression Scale (CES-D) at baseline and immediately after the 3-month intervention.

RESULTS

74 women completed the study. After the 3-month intervention, the experimental group reduced their depressive symptoms on the CES-D questionnaire by 4 points (95% CI 1 to 7) more than the control group.

CONCLUSIONS

A supervised 3-month program of primarily aerobic exercise during pregnancy reduces depressive symptoms.

TRIAL REGISTRATION

NCT00872365.

Mediating effects of body image satisfaction on exercise behavior, depressive symptoms, and gestational weight gain in pregnancy

BACKGROUND

Body image satisfaction in pregnancy may have an important influence on maternal biopsychosocial outcomes.

PURPOSE

This study aims to examine the mediating influence of trimesters 2 and 3 body image satisfaction on trimesters 2 and 3 depressive symptoms, exercise behavior, and gestational weight gain.

METHODS

Pregnant women (N = 151; mean age = 30) prospectively completed study measures via mail during their 1st, 2nd, and 3rd trimesters.

RESULTS

As predicted, trimesters 2 and 3 body image satisfaction mediated the relationship between trimester 1 body image satisfaction and trimester 2 depressive symptoms and the relationship between trimester 2 body image satisfaction and trimester 3 depressive symptoms. In contrast to the hypothesis, no mediation was observed for the relationship between body image satisfaction and exercise behavior or gestational weight gain.

CONCLUSIONS

These preliminary findings demonstrate that body image satisfaction is an important psychological determinant of depressive symptoms in pregnancy. Promoting healthy body image may be a non-pharmacological strategy that offers protective effects against depressive symptoms during pregnancy.

Subjective well-being and adaptation to life events: a meta-analysis

Previous research has shown that major life events can have short- and long-term effects on subjective well-being (SWB). The present meta-analysis examines (a) whether life events have different effects on affective and cognitive well-being and (b) how the rate of adaptation varies across different life events. Longitudinal data from 188 publications (313 samples, N = 65,911) were integrated to describe the reaction and adaptation to 4 family events (marriage, divorce, bereavement, childbirth) and 4 work events (unemployment, reemployment, retirement, relocation/migration). The findings show that life events have very different effects on affective and cognitive well-being and that for most events the effects of life events on cognitive well-being are stronger and more consistent across samples. Different life events differ in their effects on SWB, but these effects are not a function of the alleged desirability of events. The results are discussed with respect to their theoretical implications, and recommendations for future studies on adaptation are given.

Maternal obesity support services: a qualitative study of the perspectives of women and midwives

BACKGROUND

Twenty percent of pregnant women in the UK are obese (BMI ≥ 30 kg/m2), reflecting the growing public health challenge of obesity in the 21st century. Obesity increases the risk of adverse outcomes during pregnancy and birth and has significant cost implications for maternity services. Gestational weight management strategies are a high priority; however the evidence for effective, feasible and acceptable weight control interventions is limited and inconclusive. This qualitative study explored the experiences and perceptions of pregnant women and midwives regarding existing support for weight management in pregnancy and their ideas for service development.

METHODS

A purposive sample of 6 women and 7 midwives from Doncaster, UK, participated in two separate focus groups. Transcripts were analysed thematically.

RESULTS

Two overarching themes were identified, 'Explanations for obesity and weight management' and 'Best care for pregnant women'. 'Explanations' included a lack of knowledge about weight, diet and exercise during pregnancy; self-talk messages which excused overeating; difficulties maintaining motivation for a healthy lifestyle; the importance of social support; stigmatisation; and sensitivity surrounding communication about obesity between midwives and their clients. 'Best care' suggested that weight management required care which was consistent and continuous, supportive and non-judgemental, and which created opportunities for interaction and mutual support between obese pregnant women.

CONCLUSIONS

Women need unambiguous advice regarding healthy lifestyles, diet and exercise in pregnancy to address a lack of knowledge and a tendency towards unhelpful self-talk messages. Midwives expressed difficulties in communicating with their clients about their weight, given awareness that obesity is a sensitive and potentially stigmatising issue. This indicates more could be done to educate and support them in their work with obese pregnant women. Motivation and social support were strong explanatory themes for obesity and weight management, suggesting that interventions should focus on motivational strategies and social support facilitation.

The skinny on sexual risk: the effects of BMI on STI incidence and risk

Few studies examine the influence of body mass index (BMI) on sexual risk. The purpose of this study was to determine whether BMI among 704 young mothers (ages 14-25) related to STI incidence and sexual risk. We examined the effect of BMI groups (normal weight, overweight, and obese) at 6 months postpartum on STI incidence and risky sex (e.g., unprotected sex, multiple partners, risky and casual partner) at 12 months postpartum. At 6 months postpartum, 31% of participants were overweight and 40% were obese. Overweight women were more likely to have an STI (OR = 1.79, 95% CI = 1.11-2.89, P < .05) and a risky partner (OR = 1.64, 95% CI = 1.01-2.08, P < .05) at 12 months postpartum compared to normal weight women. However, obese women were less likely to have an STI than normal weight women (OR = .57, 95% CI = .34-.96, P < .01). BMI related to STI incidence and sexual risk behavior. Integrated approaches to weight loss and sexual risk prevention should be explored.

Unmet social support for healthy behaviors among overweight and obese postpartum women: results from the Active Mothers Postpartum Study

BACKGROUND

In the United States, about two thirds of women of reproductive age are overweight or obese. Postpartum is a transitional period. Life changes during this time can put mothers under high levels of stress when interpersonal support is inadequate. This study sought to explore predictors of unmet social support (support inadequacy) for healthy behaviors among postpartum women who were overweight or obese before pregnancy.

METHODS

Potential predictors of unmet social support for healthy behaviors were derived from baseline and 6-month postpartum data from the Active Mothers Postpartum (AMP) study. The Postpartum Support Questionnaire queried three dimensions of social support: (1) informational support, (2) emotional support, and (3) instrumental support. The main outcome, the overall Unmet Social Support Score (USSS), was the sum of the differences between the perceived need of support and perceived receipt of support in all three dimensions. Subscores were defined for each of the three support dimensions.

RESULTS

One hundred ninety women completed the 6-month Postpartum Support Questionnaire. Depression (p=0.018), unmarried status (p=0.049), and postpartum weight gain (p=0.003) were crude predictors for the overall USSS. After controlling for covariates, depression (p=0.009) and living with a spouse (p=0.040) were significant predictors for overall USSS. In adjusted analysis, depression remained a significant predictor for unmet emotional (p=0.035) and instrumental (p=0.001) social support.

CONCLUSIONS

Certain psychosocial factors predict support inadequacy expectations among postpartum women. Targeting the factors related to unmet social support may be a helpful way to promote healthy behaviors among overweight postpartum women.

A psychometric analysis of the functional social support questionnaire in low-income pregnant women

The purpose of this study was to examine the psychometric properties of the Functional Social Support Questionnaire (FSSQ) in pregnant women. A secondary analysis of data from 186 low-income pregnant women in their third trimester was conducted to assess the internal consistency reliability, dimensionality, and concurrent validity of the FSSQ. Cronbach's alpha was .83. Factor analysis supported the unidimensionality of the FSSQ. Correlations with the Interpersonal Support Evaluation List (ISEL) and the Center for Epidemiologic Studies-Depression Scale (CES-D) supported concurrent and construct validity. This secondary analysis provided evidence of the psychometric soundness of the FSSQ in this sample.

The association between prepregnancy obesity and screening positive for postpartum depression

OBJECTIVE

To describe the association between reported prepregnancy body mass index (BMI) and screening positive for depression.

DESIGN

Cohort study.

SETTING

Four urban hospitals in Utah, USA.

POPULATION

Women delivering a term, singleton, live-born infant at one of four urban hospitals in Utah in the period 2005-2007.

METHODS

Women were enrolled immediately postpartum. Demographic, anthropometric, stressors, psychiatric, and medical/obstetric and family-history data were obtained. Prepregnancy height, weight, and pregnancy weight gain were self-reported. The primary exposure variable, prepregnancy BMI, was calculated. Women were stratified into the six World Health Organization BMI categories (underweight, normal weight, pre-obese, or obese class 1-3).

MAIN OUTCOME MEASURE

At 6-8 weeks postpartum, women were screened for depression using the Edinburgh Postnatal Depression Scale (EPDS). The primary outcome measure was a prespecified EPDS score of > or =12.

RESULTS

Among the 1053 women studied, 14.4% of normal weight women screened positive for postpartum depression. This proportion was greater in women classed as underweight (18.0%, n = 11), pre-obese (18.5%, n = 38), obese class 1 (18.8%, n = 16), obese class 2 (32.4%, n = 11), and obese class 3 (40.0%, n = 8) (P < 0.01). Controlling for demographic, psychological, and medical/obstetric factors, prepregnancy class-2 (aOR 2.87, 95% CI 1.21-6.81) and class-3 (aOR 3.94, 95% CI 1.38-11.23) obesity remained strongly associated with screening positive for postpartum depression, compared with women of normal weight.

CONCLUSIONS

Self-reported prepregnancy obesity may be associated with screening positive for depression when measured postpartum.

The influence of prior perinatal loss on parents' psychological distress after the birth of a subsequent healthy infant

OBJECTIVE

To evaluate the long-term influence of a previous perinatal loss on parents' psychological distress during a subsequent childbearing experience.

DESIGN AND SAMPLE

A cohort design was used to examine 36 couples with a history of prior perinatal loss. Data were collected during the third trimester of pregnancy, 3 months postpartum, and again 8 months after birth.

MEASURES

Outcome measures included posttraumatic stress (The Impact of Event Scale), depressive symptoms (Center for Epidemiologic Studies-Depression Scale), anxiety (Spielberger State-Trait Anxiety Inventory), and parental concerns and attitudes (Maternal/Paternal Attitudes Questionnaire).

RESULTS

Levels of depressive symptoms (p<.001), anxiety (p<.001), and posttraumatic stress (p=.046) significantly decreased over time in this population. However, levels of posttraumatic stress remained in the moderate range even at 8 months after birth. Depression was significantly correlated with posttraumatic stress at each time point. In addition, depression was significantly related to posttraumatic stress, anxiety, and concerns parents had about their infant's well-being at T3.

CONCLUSION

While levels of anxiety and depressive symptoms decreased for parents who have experienced a previous perinatal loss, posttraumatic stress levels remained moderately high. It is unclear how this compares to parents without losses. These may be the unique symptoms and concerns these parents have about their new infant. Parents with a history of prior loss should have assessments carefully tailored to their experiences to anticipate continued psychological distress.

Predictors of mothers' postpartum body dissatisfaction

PURPOSE

To investigate changes in mothers' body dissatisfaction from delivery to 9 months postpartum, and the relationship of postpartum body dissatisfaction to weight, other health, and social characteristics.

METHODS

In this prospective longitudinal study, 506 mothers completed surveys at 0-1 and 9 months postpartum. Postpartum changes in body dissatisfaction and weight were evaluated by paired t-tests, and predictors of postpartum body dissatisfaction were identified by stepwise multiple regression analysis.

RESULTS

Mothers' body dissatisfaction increased significantly from 0-1 to 9 months postpartum (mean scores of 15.2 and 18.2, respectively, p < .001). Although women lost an average of 10.1 pounds (sd = 16.3) or 4.6 kg. (sd = 7.4) between 0-1 and 9 months postpartum (p < .001), their weight at 9 months postpartum remained an average of 5.4 pounds (sd = 15.6) or 2.5 kg (sd = 7.1) above their pre-pregnancy weights (p < .001). Body dissatisfaction at 9 months postpartum was associated with overeating or poor appetite, higher current weight, worse mental health (SF-36 Mental Health scale), race other than black, bottle-feeding (vs. breastfeeding), being single (vs. married), and having fewer children.

CONCLUSIONS

Mothers' body satisfaction worsened from 1 to 9 months postpartum, and 9-month body dissatisfaction was associated with eating/appetite abnormalities, greater weight, worse mental health, non-black race, non-breastfeeding status, and fewer immediate family relationships. Given these relationships, it is important to educate women about expected postpartum weight and body changes, and to find ways to enhance mothers' postpartum self-esteem and body satisfaction.

Prepregnancy body mass index, gestational weight gain, and the likelihood of major depressive disorder during pregnancy

OBJECTIVE

We assessed the relation between prepregnancy body mass index (BMI) and the likelihood of major depressive disorder (MDD) during pregnancy and tested whether this association was modified by gestational weight gain.

METHOD

Women (N = 242) were enrolled at < 20 weeks gestation into a prospective cohort study. Diagnosis of MDD was made with the Structured Clinical Interview for DSM-IV at 20, 30, and 36 weeks gestation. Gestational weight gain was compared with the 1990 Institute of Medicine weight gain recommendations. To assess the independent association between prepregnancy BMI and the odds of MDD, MDD at each time point was used as the dependent measure in a multivariable longitudinal logistic regression model employing generalized estimating equations. The data were collected from 2003-2007.

RESULTS

There was a strong, positive dose-response association between prepregnancy BMI and the likelihood of MDD (P = .002). Compared with a BMI of 18, the adjusted odds ratios (95% confidence interval) for BMIs of 23, 28, and 33 were 1.4 (1.1 to 1.7), 1.9 (1.3 to 2.9), and 2.6 (1.4 to 4.3), respectively. Gestational weight gain significantly modified this effect. Among women with weight gains within and above the 1990 Institute of Medicine recommendations, pregravid overweight was associated with a greater likelihood of MDD. In contrast, all women with weight gains below recommended levels had an elevated odds of depression regardless of their pregravid BMI (P < .05).

CONCLUSIONS

Because pregravid overweight, poor gestational weight gain, and MDD all pose substantial risks for fetal development and birth outcomes, health care providers should monitor depression levels in these women to facilitate appropriate depression intervention.

Symptoms of postpartum depression associated with elevated levels of interleukin-1 beta during the first month postpartum

Postpartum depression (PPD) is a devastating disorder that may carry lifetime consequences. Although several psychosocial risks for PPD have been identified, biological contributors are unclear. Elevated inflammatory cytokines contribute to depression in nonpregnant, nonpostpartum populations; yet, their role in PPD has been minimally studied. The objective of this study is to determine whether inflammatory cytokines early in the postpartum period contribute to the development of PPD. Women were recruited within 24 hr of delivery, and 26 provided urine for analysis of interleukin-1 beta (IL-1beta) and interleukin-6 (IL-6) on postpartum days 7, 14, and 28. Participants completed a depression symptom survey (Centers for Epidemiologic Studies Depression Scale; CES-D) on Day 28. An increase in IL-1beta was seen on Day 14 in women with symptoms of depression (CES-D > or = 11) on Day 28 compared to levels in women without depressive symptoms (F = 4.50, p = .045). These preliminary findings suggest elevated IL-1beta early in the postpartum period may increase the risk of PPD. Further studies involving a larger sample of women, including those clinically diagnosed with PPD, are required.

Occurrence and correlates of postpartum depression in overweight and obese women: results from the active mothers postpartum (AMP) study

OBJECTIVE

Postpartum depression (PPD) is a significant concern for new mothers and their infants, as well as the health professionals who care for them. Obesity may be a risk factor for depression, and therefore, for PPD specifically. We examined the occurrence and risk factors for PPD in a sample of overweight and obese new mothers.

METHODS

In this cross-sectional study, 491 women who were overweight or obese prior to pregnancy completed the Edinburgh Postnatal Depression Scale (EPDS) 6 weeks postpartum, along with a number of other health- and pregnancy-related measures. Occurrence of depression was investigated, as well as bivariate and multivariate relationships between depression and demographic and health-related characteristics.

RESULTS

As determined by an EPDS score of 13 or higher, the prevalence of PPD was 9.2%. Three items on the scale stood out as drivers of the total score ("blame myself unnecessarily", "anxious or worried," "feel overwhelmed"). Bivariate correlates of depression included education, income, marital status, and self-reported chronic illness; income remained significant in the multivariate logistic regression model. BMI was not related to postpartum depression.

DISCUSSION

In this group of overweight and obese women, there was no association between BMI group and postpartum depression.

Effect of pre-pregnancy body size on postpartum weight retention

OBJECTIVE

to understand postpartum weight retention among women of different body sizes at pre-pregnancy, and to explore factors influencing this weight retention.

DESIGN

a comparative, descriptive study. Pre-pregnancy body mass indices (BMIs) were determined from hospital records. Dependent variables were measured by self-report questionnaires.

SETTING

a 3,900-bed medical centre in northern Taiwan that delivers approximately 4,000 children each year.

PARTICIPANTS

a systematic sample of 810 women who had delivered children at a medical centre. In total, 602 valid questionnaires were collected.

FINDINGS

the average pre-pregnancy and six month postpartum BMIs were 21.5 [standard deviation (S.D.)=3.32] and 22.48 (S.D.=3.39), respectively. Overweight (OW) and obesity (OB) increased from 18.27% before pregnancy to 27.57% at six months postpartum. Gestational weight gain (GWG) was 14.36, 14.37, 13.07 and 11.15kg among women in the underweight (UW), normal weight (NW), OW and OB groups, respectively; and six month postpartum weight retention was 3.32, 2.57, 1.67 and -0.29kg. GWG was the most significant predictor of postpartum weight change across groups.

KEY CONCLUSIONS

women with different body sizes at pre-pregnancy have common and specific risks for postpartum weight retention.

IMPLICATIONS FOR PRACTICE

individualised interventions should be developed to manage postpartum weight for women of different body sizes. Interventions should establish criteria for GWG and provide strategies to improve body image and modify lifestyle. The overall goal should be to manage postpartum weight gain and to promote women's health.

Association of postpartum depression with weight retention 1 year after childbirth

OBJECTIVE

To examine the extent to which early postpartum depression is associated with weight retention 1 year after childbirth.

METHODS AND PROCEDURES

In a prospective cohort study of 850 women enrolled in Project Viva, mothers reported depressive symptoms on the Edinburgh Postnatal Depression Scale (EPDS) at midpregnancy and 6 months postpartum. A score >12 indicated probable depression. We assessed associations of antenatal and postpartum depression with risk of substantial weight retention (at least 5 kg) 1 year after childbirth.

RESULTS

Seven-hundred thirty-six women (87%) were not depressed during or after pregnancy, 55 (6%) experienced antenatal depression only, 22 (3%) experienced both antenatal and postpartum depression, and 37 (4%) experienced postpartum depression only. At 1 year, participants retained a mean of 0.6 kg (range -16.4 to 25.5), and 12% retained at least 5 kg. In multivariate logistic regression analyses, after adjustment for weight-related covariates, maternal sociodemographics, and parity, new-onset postpartum depression was associated with more than a doubling of risk of retaining at least 5 kg (odds ratio (OR): 2.54, 95% confidence interval (CI): 1.06, 6.09). Antenatal depression, either alone or in combination with postpartum depression, was not associated with substantial weight retention.

DISCUSSION

New-onset postpartum depression was associated with substantial weight retention in the first postpartum year. Interventions to manage depressive symptoms may help reduce excess weight retained postpartum and aid in the prevention of obesity among women.

Effects of obesity on pregnancy

OBJECTIVES

To examine physiologic and psychological outcomes associated with maternal obesity in pregnancy and patterns of pregnancy weight gain. To identify effective interventions for maternal obesity.

DATA SOURCES AND STUDY SELECTION

Search of obesity and pregnancy research conducted over the past 10 years using CIHAHL, Medline ERIC, and PyscInfo databases. Studies including the following keywords were included in the review: obesity, weight gain, body image, pregnancy weight gain, pregnancy obesity complications, preeclampsia and gestational diabetes. Articles were included based on scientific merit and research outcomes.

DATA SYNTHESIS AND CONCLUSIONS

Maternal obesity is a serious condition that significantly impacts not only mothers' health but also the health and future of their children. It is paramount that all levels of health care providers be aware of consequences of obesity and be knowledgeable of effective interventions. No effective long-term interventions have been demonstrated to prevent or control obesity during pregnancy. The paucity of published results of pregnancy and postpartum interventions to address weight gain in pregnancy suggests the need for more community and individualized based intervention studies, especially focusing on long-term effects.

Comparison of centering pregnancy to traditional care in Hispanic mothers

OBJECTIVE

To compare maternal and infant outcomes in Hispanic women participating in the Centering Pregnancy Model (CPM) to those receiving prenatal care via the traditional model and determine acceptability of the CPM.

METHODS

Forty-nine women (n = 24 CPM; n = 25 traditional) participated in this quasi-experimental prospective comparative design. Participants self selected the model of care delivery. Data were collected via questionnaires at the initial visit, 34-36 weeks gestation, and postpartum. Outcome measures included: satisfaction with care delivery model, health behaviors, prenatal/postnatal care knowledge, self-esteem and depression. Breastfeeding initiation and continuation, infant birth weight, gestational age at delivery, mode of delivery and infant length of stay were also collected.

RESULTS

Traditional participants had a history of more pregnancies, more living children, and higher levels of postpartum self-esteem compared to centering participants. Knowledge deficits and health behaviors were similar between groups. No differences were found for infant outcomes.

CONCLUSIONS

This study provides information regarding Hispanic mothers' responses to an alternative care delivery model. Preliminary evidence suggests CPM compares with traditional care and yields a high degree of patient satisfaction. Specific pregnancy-related knowledge deficits were identified in both groups that could focus prenatal education. In light of similar outcomes in both groups; patient and provider satisfaction and economics would therefore be a factor when choosing a model of prenatal care delivery.

Quality of life in obese pregnant women: a longitudinal study

OBJECTIVE

The purpose of this study was to assess the contribution of obesity on quality of a woman's life during pregnancy.

STUDY DESIGN

At the Hospital of Gynecology and Obstetrics in León, Mexico, we followed-up 220 pregnant women (110 obese and 110 nonobese) who completed the 12-item short-form health survey at the beginning and during the third trimester of pregnancy.

RESULTS

The mental component score was lower in obese than in nonobese women at the beginning of gestation and at the third trimester but increased in the entire group during pregnancy. The physical component score (PCS) decreased during pregnancy and was lower in obese than in nonobese pregnant women (43.5 vs 47.2; P = .01) at the third trimester. Baseline body mass index, weight gain, and complications during pregnancy were associated negatively with PCS (R2=0.11; P < .001 for the model).

CONCLUSION

Baseline body mass index, weight gain, and complications during gestation are associated negatively with PCS of quality of life.

The association of pregnancy and the development of obesity - results of a systematic review and meta-analysis on the natural history of postpartum weight retention

OBJECTIVE

The magnitude of the contribution of childbearing to the development of obesity is not entirely understood. Published studies on postpartum weight retention focus on risk factors and clinical interventions. Pooled estimates of postpartum weight retention have not been reported. We summarized the existing evidence of the natural history of postpartum weight retention and estimated the extent of time after delivery that weight retention is attributable to pregnancy.

DESIGN

Systematic review and meta-analysis of qualitatively homogeneous studies.

DATA SOURCES

Medline search of published studies between January 1995 and August 2005; bibliography of candidate studies.

REVIEW METHODS

Eligibility: Observational studies and control groups of randomized controlled trials. Independent review and data abstraction including study design, subject characteristics, women's weight and study quality by two reviewers. Meta-analysis of average postpartum weight retention at different points in time after delivery. Sensitivity analysis for study specific covariates using meta-regression.

RESULTS

Twenty-five studies describing 21 cohorts met eligibility criteria. Sixteen studies appeared homogeneous enough to be included in the meta-analysis. Average postpartum weight retention decreased continuously until 12 months postpartum (6 weeks: 2.42 (95% confidence interval (95% CI): 2.32-2.52) Body mass index (BMI), 6 months: 1.14 (95% CI: 1.04-1.25) BMI, 12 months: 0.46 (95% CI: 0.38-0.54) BMI). Postpartum weight retention was 0.46 BMI lower in studies with follow-up rate > or =80% at 6 weeks postpartum compared to studies with lower follow-up rate (P<0.01).

CONCLUSION

Published studies consistently showed a decline in mean body weight within the first year postpartum. Data on body weight later than 12 months postpartum are scarce. The published evidence suggests a re-increase in body weight. As there are rather lifestyle-related than biological reasons for an increase in body weight after one year postpartum, we suggest using the term 'postpartum weight retention' exclusively within a limited period (for example, up to 12-18 months) postpartum.

Weight loss programs for urban-based, postpartum African-American women: perceived barriers and preferred components

OBJECTIVES

There are currently 1.85 million reproductive-aged women in the United States with diabetes or glucose intolerance. While it is known that postpartum weight retention can lead to obesity and diabetes, particularly among African-American women, little is known about African-American women's preferences for postpartum weight loss programs. Our objective was to explore urban-based African-American women's attitudes toward weight gain, perceived barriers to postpartum weight loss, and preferences for weight intervention strategies.

METHODS

Focus groups of pregnant African-American women (n = 22) were conducted by a race-concordant moderator. Open-ended questions were posed to stimulate discussions which were audio taped and transcribed verbatim. Transcriptions were independently reviewed by two investigators who extracted quotations and coded each statement to identify major themes.

RESULTS

The median age of participants was 26 years. Median pre-pregnancy or first trimester body-mass index was 31 kg/m(2). Fifty-seven percent of the women were multiparous and 68% were Medicaid recipients. We identified 16 themes with the majority of participant comments focused on: (1) effect of postpartum depression on motivation to lose weight; (2) strong desire to lose weight; (3) knowledge of adverse effects of obesity; (4) costs of weight loss programs; (5) negative impact of media coverage of successful celebrity postpartum weight loss; (6) limitations of childcare on ability to exercise; and (7) family-centered lifestyle behaviors that promote unhealthy eating.

CONCLUSIONS

Weight loss interventions for African-American women with postpartum obesity should address psychological effects of childbearing, affordability, and perceptions of body image. Interventions should incorporate family-centered approaches and weight loss maintenance strategies.

Correlates of anxiety symptoms during pregnancy and association with perinatal outcomes: a meta-analysis

OBJECTIVE

The purpose of this study was to identify correlates of anxiety symptoms during pregnancy and determine the strength of the relationship between anxiety symptoms and adverse perinatal outcomes.

STUDY DESIGN

A meta-analytic review was conducted of studies that evaluated the relationship between self-reported anxiety symptoms during pregnancy and potential correlates or perinatal outcomes.

RESULTS

Fifty studies of 48 samples of women met inclusion criteria. Anxiety symptoms during pregnancy were associated with a number of psychosocial variables including depressive symptoms (r = 0.66), stress (r = 0.40), and self-esteem/self-worth (r = -0.47). There were no significant associations of anxiety symptoms with perinatal outcomes (all rs < 0.19).

CONCLUSION

Anxiety symptoms during pregnancy appear to be associated with similar psychosocial variables as anxiety at other times. There is no evidence of an association of anxiety symptoms with adverse perinatal outcomes among those studied thus far. However, significant gaps still exist in the literature in this area.

Is there an association between depressive and urinary symptoms during and after pregnancy?

Depressive symptoms and urinary symptoms are both highly prevalent in pregnancy. In the general population, an association is reported between urinary symptoms and depressive symptoms. The association of depressive and urinary symptoms has not yet been assessed in pregnancy. In this study, we assessed (1) the prevalence of depressive symptoms, over-active bladder (OAB) syndrome, urge urinary incontinence (UUI) and stress urinary incontinence (SUI) during and after pregnancy using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Urogenital Distress Inventory (UDI) and (2) the association of depressive symptoms with urinary incontinence and over-active bladder syndrome during and after pregnancy, controlling for confounding socioeconomic, psychosocial, behavioural and biomedical factors in a cohort of healthy nulliparous women. Our data show a significant increase in prevalence of depressive symptoms, UUI, SUI and OAB during pregnancy and a significant reduction in prevalence of depressive symptoms, SUI and OAB after childbirth. UUI prevalence did not significantly decrease after childbirth. In univariate analysis, urinary incontinence and the OAB syndrome were significantly associated with a CES-D score indicative of a possible clinical depression at 36 weeks gestation. However, after adjusting for possible confounding factors, only the OAB syndrome remained significantly associated (OR 4.4 [1.8–10.5]). No association was found between depressive and urinary symptoms at 1 year post-partum. Only OAB was independently associated with depressive symptoms during pregnancy. Possible explanations for this association are discussed.

A one-item question with a Likert or Visual Analog Scale adequately measured current anxiety

OBJECTIVE

To determine whether a single question with a Likert Scale or a Visual Analog Scale (VAS) response adequately measures current anxiety.

STUDY DESIGN AND SETTING

Consecutive English-speaking adult women attending a dedicated breast clinic in a major Australian city were invited to complete a demographic questionnaire, the State Trait Anxiety Inventory (STAI), and a single question with a five-point Likert Scale response and a VAS in random order. Only women who completed the STAI were included in analyses.

RESULTS

Four hundred of 497 (80%) eligible women agreed to participate. Both measures were adequate predictors of the STAI score; correlation with STAI was 0.78 (95% confidence interval [CI] 0.73-0.82) for the VAS and 0.75 (95% CI 0.70-0.79) for the Likert Scale. However, 11% of women incorrectly completed the VAS limiting its usefulness.

CONCLUSION

A single question with either a Likert Scale or VAS response may be an adequate replacement for the STAI. Both measures quickly and easily assess anxiety and may be useful for research purposes when researchers have very limited time or questionnaire space or need to reduce the burden on participants of completing many measures.

Maternal body mass index and self-reported postpartum depressive symptoms

OBJECTIVES

The association between extremes of body mass index (BMI) and depression in women has been documented, yet little is known about the relationship between obesity and postpartum depression (PPD). This study seeks to characterize the association between BMI and PPD.

METHODS

The 2000-2001 Utah data from Pregnancy Risk Assessment Monitoring System (PRAMS) were used to determine the proportion of women, stratified by prepregnancy body mass index, reporting postpartum depressed mood and stressors during pregnancy.

RESULTS

The prevalence of self-reported moderate or greater depressive symptoms was 27.7% (S.E. +/-2.2) in underweight, 22.8% (+/-1.2) in normal weight, 24.8% (+/-2.9) in overweight and 30.8% (+/-2.5) in obese women. After controlling for marital status and income, normal BMI (19.8-25.9) was associated with the lowest rate of self-reported postpartum depressive symptoms. There was a two-fold increase in self-reported depressive symptoms requiring assistance among overweight and obese women compared to normal weight women (1.53% normal, 2.99% overweight, and 3.10% obese [p < 0.001]). Obese women were significantly more likely to report emotional and traumatic stressors during pregnancy than normal weight women.

CONCLUSION

This population-based survey suggests a potential association between prepregnancy body mass index and self-reported postpartum depressive symptoms. Prospective studies of association between obesity and PPD, with improved diagnostic precision are warranted.

Influence of Nutrition Attitudes and Motivators for Eating on Postpartum Weight Status in Low-Income New Mothers

OBJECTIVE

The purpose of this study was to identify attitudes about nutrition and their influence on weight status in low-income mothers in the first year postpartum.

DESIGN

Nutrition attitudes were assessed at 1.5, 6, and 12 months postpartum. Body weight was measured at each time point and height at 1.5 months to calculate body mass index. Nutrition attitudes at each time were compared with demographic variables and weight status.

SUBJECTS

Subjects were 340 non-Hispanic white (31.3%), non-Hispanic black (25.1%), and Hispanic (43.7%) new mothers (mean age=22.4 years) located in central Texas. Criteria for participation included good health at delivery and low income (</=185% federal poverty guideline).

STATISTICAL ANALYSES

chi(2) tests were used to compare demographic groups to categorical variables. Multivariate analysis of variance was done to investigate the effect of demographic variables on instrument subscale scores. A repeated-measures analysis of variance was used to identify significant changes over time.

RESULTS

Obese women had higher barriers to healthful eating subscale means at 1 year compared with normal and overweight subjects at 1.5 and 6 months, and had more barriers than overweight participants at 12 months. Obese individuals also had higher emotional eating subscale scores than did overweight women at 1.5 months and both normal and overweight subjects at 12 months.

CONCLUSIONS

Women who were obese at 1 year postpartum were more likely to perceive more barriers to healthful eating and respond more to emotional cues to eat. Health professionals could emphasize potential changes and difficulties often faced in postpartum and identify techniques to overcome these obstacles to healthful eating.

Obesity and obstetric anaesthesia

The prevalence of obesity continues to increase despite preventive strategies. Obese parturients are at increased risk of having either concurrent medical problems or superimposed antenatal diseases such as pre-eclampsia and gestational diabetes. Moreover, they have a tendency to labour abnormally contributing to increased instrumental delivery and Caesarean section. Obesity is a risk factor for anaesthesia related maternal mortality. Morbidly obese women must be considered as high-risk and deserve an anaesthetic consultation during their antenatal care. The significant difficulty in administering epidural analgesia should not preclude their use in labour. A more liberalised use of regional techniques may be a means to further reduce anaesthesia-related maternal mortality in the obese population. The mother's life should not be jeopardised to save a compromised fetus. Prophylactic placement of an epidural catheter when not contraindicated in labouring morbidly obese women would potentially decrease anaesthetic and perinatal complications associated with attempts at emergency provision of regional or general anaesthesia. Early mobilisation, aggressive chest physiotherapy and adequate pain control are essential components of effective postoperative care.

The Impact of Fatigue on the Development of Postpartum Depression

BACKGROUND

Previous research suggests early postpartum fatigue (PPF) plays a significant role in the development of postpartum depression (PPD). Predicting risk for PPD via early identification of PPF may provide opportunity for intervention.

OBJECTIVE

To replicate and extend previous studies concerning the impact of PPF on symptoms of PPD and to describe the relationships among PPF, PPD, and other variables using the theory of unpleasant symptoms.

DESIGN

Correlational, longitudinal study.

SETTING

Participants' homes.

PARTICIPANTS

Convenience sample of 42 community-dwelling women recruited before 36 weeks of pregnancy.

MAIN OUTCOME MEASURES

PPF, depressive symptoms, and stress measured during prenatal weeks 36 to 38, and on Days 7, 14, and 28 after childbirth. Salivary cortisol was measured as a physiological marker of stress.

RESULTS

Significant correlations were obtained between PPF and symptoms of PPD on Days 7, 14, and 28, with Day 14 PPF levels predicting future development of PPD symptoms in 10 of 11 women. Perceived stress, but not cortisol, was also correlated with symptoms of PPD on Days 7, 14, and 28. Women with a history of depression had elevated depression scores compared to women without, but no variable was as effective at predicting PPD as PPF.

CONCLUSIONS

Fatigue by Day 14 postpartum was the most predictive variable for symptoms of PPD on Day 28 in this population.

Compliance with dietary guidelines and relationship to psychosocial factors in low-income women in late postpartum

OBJECTIVES

The goals were to evaluate compliance with the Dietary Guidelines among low-income women during late postpartum and to examine the relationship between psychosocial variables and dietary compliance.

SUBJECTS/SETTING

Participants were 146 triethnic, low-income women who were recruited 0 to 1 days after childbirth and who visited a clinic site at 1 year postpartum.

DESIGN

At 1 year postpartum, multiple psychosocial characteristics were measured, and food choices and nutrient intakes were assessed via a validated food frequency questionnaire. Dietary guidelines index scores and measures of adherence to dietary recommendations were computed.

STATISTICAL ANALYSES PERFORMED

Descriptive statistics, analysis of variance with post-hoc Scheffe tests, chi 2 with follow-up tests of independent proportions, and Pearson correlation coefficients were utilized.

RESULTS

For dietary compliance, 60% had adequate intakes of meat, but less than 30% met recommendations for grains, vegetables, fruits, dairy foods, total fat, and added sugar. Healthful weights (body mass index <25) were observed in 37% of women. Those in the highest tertile of dietary compliance had a more positive body image than those in the lowest tertile, and less neglect of self-care, weight-related distress, stress, depressive symptoms, and perceived barriers to weight loss ( P <.05). Dietary compliance and psychosocial scale scores did not vary by ethnicity.

CONCLUSIONS

Adherence to dietary guidelines was limited in the low-income, postpartum women. Psychosocial variables, such as neglect of self-care, weight-related distress, negative body image, stress, and depressive symptoms were associated with less healthful diets and lifestyle in late postpartum. Programs that target diet-related behavior change in low-income women might be improved by inclusion of psychosocial assessment and counseling components.

Adolescent Motherhood and Postpartum Depression

Adolescent mothers undergo unique personal and social challenges that may contribute to postpartum functioning. In this exploratory investigation completed within a risk and resilience framework, 149 adolescent mothers, ages 15 to 19, who participated in school-based teen parents' programs, completed measures of parental stress (social isolation and role restriction), maternal competence, weight/shape concerns, and depression. The sample was quite diverse, and no ethnic differences in base rate levels of the variables were detected. Regression analyses indicated that social isolation, maternal competence, and weight/shape concerns predicted unique variance associated with depression level. The findings are discussed in light of future work and the continued need to inform prevention and treatment programs for young mothers.

Factors Related to Postpartum Depressive Symptoms in Low-Income Women

OBJECTIVE

This study examined the relationship of depressive symptoms to psychosocial and lifestyle variables in postpartum women.

DESIGN

The Mothers' Overweight Management Study (MOMS) was a randomized, weight-gain prevention trial. Baseline data are presented on the Beck Depression Inventory (BDI), Perceived Stress Scale, Social Support Questionnaire, smoking status, body weight, waist circumference, and step counts.

SUBJECTS/SETTING

The study was conducted at the Special Supplemental Feeding Program for Women, Infants, and Children (WIC). Women (N = 151) had to be over the age of 18 years and have a child under two years of age to participate.

RESULTS

Fifty-one percent of the women (mean age = 27 years; mean of 30 weeks postpartum) reported depressive symptoms (27% mild, 21% moderate, and 3% severe). Overall, stress scores were high (Mean = 27.2) and activity levels low (Mean steps = 5984). Mean body mass index was 30.2. Neither body weight nor steps walked were related to depressive symptoms in the bivariate or regression analyses. However, stress and social support were related to symptoms. Women without symptoms reported significantly less stress than the mild and moderate/ severe symptom groups (Means = 23.4, 29.6, and 32.7, respectively, p <.001). Mean social support satisfaction was significantly higher for non-depressed women compared to women in the moderate/severe symptom range (Means = 5.9 and 4.7 respectively, p <.001). Stress and current smoking status explained 46% of the variance in depressive symptoms.

CONCLUSIONS

These data emphasize the need for stress management and other tools such as increasing activity levels to prevent or lessen depressive symptoms.

Women's exercise beliefs and behaviors during their pregnancy and postpartum

Limited research examines women's beliefs about the value of exercise and their actual exercise behaviors during pregnancy and postpartum. A retrospective study of 74 postpartum women was conducted to examine women's behavioral, normative, and control beliefs about exercising during pregnancy and postpartum and to determine their most salient beliefs. In addition, women's prepregnancy, pregnancy, and postpartum exercise behavior was examined. We found that 1) the most common exercise beliefs during pregnancy were that exercise improves mood and physical limitations (e.g., nausea) obstructed exercise participation; 2) the most common exercise beliefs during postpartum were that exercise controls weight gain and a lack of time obstructed exercise participation; 3) women's husband/partner and family members most strongly influenced their pregnancy and postpartum exercise behavior; and 4) women exercised more before they were pregnant than during pregnancy and postpartum. Researchers and health care professionals are encouraged to examine and understand women's beliefs about exercising during their pregnancy and postpartum and design their interventions accordingly, in an attempt to increase women's exercise behavior during their childbearing years.

Depression during Pregnancy

Depression during pregnancy is common, affecting an estimated 20% of women. However, conflicting data exist concerning the outcomes of this disorder. Thus, we reviewed studies that presented evidence for the use of antidepressants and those that examined untreated depression during the gestational period, in terms of clinical and epidemiological aspects.Observational studies have provided reassuring evidence of the safety of antidepressant use during pregnancy. However, due to the reluctance of healthcare providers to prescribe and patients to take medication during the obstetric period, approximately three-quarters of those diagnosed with depression remain untreated. Furthermore, healthcare providers apparently do not recognise the disorder in up to 50% of pregnant women who experience depression. Increased antidepressant dosing during pregnancy may be required to maintain euthymia; however, guidelines for effective dosing levels are absent. Consequently, many patients remain inadequately treated. Substantial maternal and fetal morbidity including substance abuse, functional impairment, increased risk of postnatal depression, and poor pregnancy outcomes have resulted from untreated depression.The consequences of those outcomes are likely to be associated with substantial clinical, social and economic burdens. An incidence-based assessment of the consequences of prenatal depression would be useful in order to: (i) establish the impact on the quality of life of these patients and their families; (ii) assess the associated economic burden on individual families and the healthcare system; and (iii) to provide epidemiological data to enable the provision of suitable management strategies for these patients.

Low Hemoglobin Level Is a Risk Factor for Postpartum Depression

The role of maternal anemia in the development of postpartum depression (PPD) is unclear. PPD is a serious disorder that may negatively affect the physical and emotional health of a new mother and her infant. Although psychosocial factors that increase the risk of developing PPD are known, few studies have identified physiologic factors that predispose a woman to PPD. New mothers were visited at home on d 7, 14 and 28 after an uncomplicated labor and delivery. Hemoglobin (Hb) concentration was measured via finger-prick blood at each visit, and the women completed the Center for Epidemiological Studies-Depressive Symptomatology Scale (CES-D) on d 28. There was a negative correlation between Hb concentration on d 7 postpartum and depressive symptoms on d 28 (r = -4.26; P = 0.009). CES-D scores (means +/- SEM) on d 7 of women with normal Hb levels > 120 g/L (12 g/dL) were significantly lower (6.90 +/- 1.04) than those of women with Hb levels < or = 120 g/L (12 g/dL) [16.36 +/- 3.34; t(35) = -3.632, P = 0.001]. Thus, women suffering early postpartum anemia may be at increased risk of developing PPD.

Postpartum mood disorders: a review of clinical and epidemiological factors

The postpartum period is a time of risk for mood disturbance in women. Postpartum blues occurs commonly, but is self-limited. Postpartum depression occurs in 13% of postpartum women. However, it is estimated that nearly one-half of all cases go undetected. Postpartum psychosis is rare, affecting 1-2 per 1000 women. Postpartum mood disorders can have far-reaching consequences and have been shown to affect the social and psychological development of children. It is critical that healthcare providers understand these disorders and their risk factors to increase detection and to educate women about the risks and treatments of postpartum mood disorders. This review is intended to provide healthcare providers with a better understanding of the descriptive epidemiology, risk factors, and treatments of postpartum mood disorders. The utility of specific screening instruments is also discussed.

Fatigue as a predictor of postpartum depression

BACKGROUND

The postpartum is a time when women commonly report increased fatigue that may contribute to depression. Studies have not examined fatigue alone as a predictor of postpartum depression.

OBJECTIVE

To examine whether and when fatigue in the early postpartum is predictive of postpartum depression.

DESIGN

Correlational, longitudinal study.

SETTING

Two hospitals and participants' homes in central Pennsylvania.

PARTICIPANTS

Convenience sample of 38 healthy women recruited from hospital maternity units within 24 hours after an uncomplicated birth.

MAIN OUTCOME MEASURES

Fatigue was measured using the Modified Fatigue Symptom Checklist (MFSC) on Days 0, 7, 14, and 28 after childbirth. Depression was assessed using the Center for Epidemiological Studies-Depressive Symptomatology Scale (CES-D) on Day 28.

RESULTS

After adjustments for multiple comparisons, a significant correlation was obtained between fatigue as measured by the MFSC and postpartum depression on Day 7 (r = .46; p < .05), Day 14 (r = .57), and Day 28 (r = .70). Fatigue on Day 0 was correlated with fatigue on Day 7 (r = .45), Day 14 (r= .58), and Day 28 (r = .34).

CONCLUSIONS

Fatigue as early as 7 days postpartum is predictive of depression at Day 28 postpartum.

The eating attitudes test: twenty-five years later

This manuscript reviews the literature involved with the Eating Attitudes Test (EAT), first developed in the late 1970s as a self-report, indicative of the symptoms of eating disorders. The EAT has good psychometric properties of reliability and validity, and reasonable sensitivity and specificity for the eating disorders, but very low positive predictive value because eating disorders are relatively uncommon. In addition they exist on a continuum, because of denial and social desirability, the results of a self-report instrument may be affected. A very large literature has documented the use of the EAT in a variety of cultures. It is used to screen eating disturbances in general as the first part of a two-part diagnostic screen, as an ability to compare across groups and to measure change between groups and over time.