Background
Methods
Participants (Panellists)
Procedure
Round I
Source type | Number included | Example/s |
---|---|---|
Websites (general educational materials, pamphlets, news articles, forums) | 72 | https://www.thewomens.org.au/health-information/pregnancy-and-birth/mental-health-pregnancy/eating-disorders-in-after-pregnancy/http://www.cci.health.wa.gov.au/docs/ACF383.pdf |
Empirical journal articles | 84 | |
Clinical guidelines or reports | 18 | National Eating Disorders Collaboration (2015) [16] |
Conference proceedings | 3 | Burton (2014) [60] |
Theses | 6 | Tremblay (2015) [61] |
Books | 17 | American Psychiatric Association (2013) [1] Franko (2006) [62] |
Round II
Round III
Results
Panel demographics
Professional panel
Demographic variable | n (%) |
---|---|
Residing country | |
Australia | 12 (46.2%) |
United States | 6 (23.1%) |
United Kingdom | 4 (15.4%) |
Canada | 2 (7.7%) |
Sweden | 2 (7.7%) |
Highest level of education | |
Doctorate / PhD | 19 (73.1%) |
Masters Degree | 4 (15.4%) |
Postgraduate Degree (unspecified) | 2 (7.7%) |
Undergraduate Degree | 1 (3.8%) |
Professional field | |
Psychology / Psychiatry | 21 (80.1%) |
Dietetics | 4 (15.4%) |
Obstetrics | 2 (7.7%) |
Midwifery | 1 (3.8%) |
Professional activities | |
Researcher also involved in clinical practice | 11 (42.3%) |
Clinician with no research activities | 8 (30.8%) |
Researcher with no current clinical practice | 4 (15.4%) |
Clinician with some research involvement | 2 (7.7%) |
Other | 1 (3.8%) |
Consumer panel
Section 1: Signs and symptoms of disordered eating in pregnancy
Panel | Mean (SD) | Mode | % of panel agreement | Consensus | |
---|---|---|---|---|---|
Behavioural symptom items | |||||
Dietary consumption that does not support a healthy pregnancy | P | 4.88 (.33) | 5.00 | 100% | Yes |
C | 4.67 (1.05) | 5.00 | 93.3% | Yes | |
Dieting behaviours (e.g., calorie counting) | P | 4.15 (.68) | 4.00 | 92.3% | Yes |
C | 4.13 (1.41) | 5.00 | 80.0% | Yes | |
Inflexibility and rigidity with diet (i.e., strict consumption of diet foods only) | P | 4.88 (.33) | 5.00 | 100% | Yes |
C | 4.07 (1.03) | 4.00 | 86.7% | Yes | |
Fasting and/or skipping meals | P | 4.88 (.33) | 5.00 | 100% | Yes |
C | 4.53 (1.06) | 5.00 | 93.3% | Yes | |
Use of meal replacements (when not advised by a health professional) | P | 4.54 (.81) | 5.00 | 88.5% | Yes |
C | 4.40 (1.40) | 5.00 | 86.7% | Yes | |
Repeated weighing | P | 3.85 (.78) | 4.00 | 76.9% | Yes |
C | 4.67 (1.05) | 5.00 | 93.3% | Yes | |
Refusing to eat outside of one’s home | P | 4.65 (.56) | 5.00 | 96.2% | Yes |
C | 4.33 (1.23) | 5.00 | 86.7% | Yes | |
Eating in secret | P | 4.73 (.45) | 5.00 | 100% | Yes |
C | 4.60 (1.06) | 5.00 | 93.3% | Yes | |
Eating an objectively large amount of food | P | 3.85 (.54) | 4.00 | 76.9% | Yes |
C | 3.93 (1.03) | 4.00 | 80.0% | Yes | |
Eating for “two” | P | 2.46 (.76) | 2.00 | 7.7% | No |
C | 3.33 (.72) | 3.00 | 33.3% | No | |
Eating when not physically hungry | P | 3.08 (.56) | 3.00 | 19.2% | No |
C | 4.13 (.52) | 4.00 | 93.3% | Yes | |
Using food to cope with/soothe strong emotions, or reward oneself | P | 3.92 (.63) | 4.00 | 84.6% | Yes |
C | 4.07 (1.10) | 4.00 | 80.0% | Yes | |
Eating rapidly and until uncomfortably full | P | 4.31 (.62) | 4.00 | 92.3% | Yes |
C | 4.13 (1.13) | 5.00 | 80.0% | Yes | |
Self-induced vomiting | P | 4.85 (.46) | 5.00 | 96.2% | Yes |
C | 4.53 (1.13) | 5.00 | 86.7% | Yes | |
Obsessively exercising for the purpose of controlling weight and shape | P | 4.15 (.54) | 4.00 | 92.3% | Yes |
C | 4.60 (1.06) | 5.00 | 93.3% | Yes | |
Exercising against medical recommendations | P | 4.92 (.27) | 5.00 | 100% | Yes |
C | 4.60 (1.06) | 5.00 | 93.3% | Yes | |
Exercising in secret | P | 4.88 (.33) | 5.00 | 100% | Yes |
C | 4.80 (.56) | 5.00 | 93.3% | Yes | |
Refusing to purchase maternity clothing | P | 2.96 (.82) | 3.00 | 15.4% | No |
C | 2.93 (1.22) | 2.00 | 33.3% | No | |
Wearing specific clothing to conceal pregnancy | P | 2.88 (.71) | 3.00 | 15.4% | No |
C | 3.67 (1.05) | 4.00 | 68.8% | No | |
Misuse of gestational diabetes medication | P | 4.96 (.20) | 5.00 | 100% | Yes |
C | 4.80 (.78) | 5.00 | 93.3% | Yes | |
Use of laxatives or enemas to reduce gestational weight gain/induce weight loss | P | 4.92 (.27) | 5.00 | 100% | Yes |
C | 4.80 (.78) | 5.00 | 93.3% | Yes | |
Use of appetite suppressants or “diet pills” | P | 4.88 (.43) | 5.00 | 96.2% | Yes |
C | 4.80 (.78) | 5.00 | 93.3% | Yes | |
Use of natural supplements (e.g., tea detox) | P | 4.81 (.49) | 5.00 | 96.2% | Yes |
C | 4.67 (.82) | 5.00 | 93.3% | Yes | |
Body checking behaviours | P | 4.00 (.49) | 4.00 | 88.5% | Yes |
C | 4.80 (.41) | 5.00 | 100% | Yes | |
Self-harm | P | 4.85 (.37) | 5.00 | 100% | Yes |
C | 4.40 (.91) | 5.00 | 86.7% | Yes | |
Not consuming enough food during pregnancy to produce milk or sustain breastfeeding, resulting in weight loss and/or binge eating behaviours a | P | 4.87 (.34) | 5.00 | 100% | Yes |
C | 4.60 (.63) | 5.00 | 93.3% | Yes | |
Spending an excessive amount of time (i.e., multiple hours per week) researching about the most effective ways to reduce pregnancy weight gain and/or ways to lose weight after birth | P | – | – | – | – |
C | 4.93 (.26) | 5.00 | 100% | Yes | |
Searching for or seeking information about disordered eating in pregnancy | P | – | – | – | – |
C | 4.53 (.92) | 5.00 | 86.7% | Yes | |
Using the pregnancy as a ‘valid’ excuse/reason to avoid feared foods and/or not violate dietary rules | P | – | – | – | – |
C | 4.53 (.52) | 5.00 | 100% | Yes | |
Obsessively recording anticipated and achieved weight gain and calculating calorie intake and exercise output to ensure only the absolute minimum weight gain (and feeling distressed if anything interferes with this) | P | – | – | – | – |
C | 5.00 (.00) | 5.00 | 100% | Yes | |
Preferring to ensure the nausea and ignore physical hunger signals due to fear of weight gain or changes to shape | P | – | – | – | – |
C | 5.00 (.00) | 5.00 | 100% | Yes | |
Going to bed hungry at the end of the day and thinking about food, but not allowing oneself to eat to subside this hunger | P | – | – | – | – |
C | 4.93 (.26) | 5.00 | 100% | Yes | |
Excessively reassuring doctors/midwives that low weight during pregnancy OR lack of weight gain is nothing to be concerned about by reporting vague eating habits (e.g., “I eat heaps”) | P | – | – | – | – |
C | 4.80 (.78) | 5.00 | 93.3% | Yes | |
Requesting early discharge from hospital because of the food that might be served and feeling anxious is this early discharge does not or cannot occur | P | – | – | – | – |
C | 4.73 (.59) | 5.00 | 93.3% | Yes | |
Frequent ‘fat talk’ (i.e., if a pregnant woman talks a lot about how ‘fat’ she looks or is) | P | – | – | – | – |
C | 4.40 (.91) | 5.00 | 86.7% | Yes | |
Chewing and spitting out large amounts of food, particularly forbidden foods | P | – | – | – | – |
C | 4.93 (.26) | 5.00 | 100% | Yes | |
Physical symptom items | |||||
Low body weight | P | 3.96 (.53) | 4.00 | 96.2% | Yes |
C | 3.80 (.56) | 4.00 | 73.3% | No | |
Losing weight while pregnant | P | 4.73 (.60) | 5.00 | 92.3% | Yes |
C | 3.80 (.68) | 4.00 | 80.0% | Yes | |
Inadequate gestational weight gain | P | 4.77 (.65) | 5.00 | 96.2% | Yes |
C | 4.46 (.64) | 5.00 | 93.3% | Yes | |
Excessive gestational weight gain | P | 3.88 (.65) | 4.00 | 80.8% | Yes |
C | 3.80 (.68) | 4.00 | 66.7% | No | |
Rapid gestational weight gain | P | 3.92 (.56) | 4.00 | 80.8% | Yes |
C | 3.60 (.83) | 4.00 | 66.7% | No | |
Dizziness and/or fatigue | P | 3.54 (.76) | 3.00 | 46.2% | No |
C | 2.93 (.80) | 3.00 | 13.3% | No | |
Feeling nauseated most of the time | P | 2.08 (.85) | 2.00 | 7.7% | No |
C | 2.67 (1.18) | 3.00 | 20.0% | No | |
Severe morning sickness that does not stop after the first trimester (hyperemesis gravidarum) | P | 4.31 (.84) | 5.00 | 84.6% | Yes |
C | 2.00 (1.36) | 1.00 | 20.0% | No | |
Dehydration | P | 4.58 (.58) | 5.00 | 96.2% | Yes |
C | 3.27 (.80) | 3.00 | 33.3% | No | |
Abdominal bloating | P | 3.04 (.60) | 3.00 | 11.5% | No |
C | 2.93 (.80) | 3.00 | 13.3% | No | |
Gastrointestinal discomfort | P | 3.00 (.63) | 3.00 | 19.2% | No |
C | 2.47 (.99) | 2.00 | 13.3% | No | |
Unborn baby is small/underdeveloped for gestational age a | P | 3.96 (.48) | 4.00 | 87.0% | Yes |
C | 3.47 (.74) | 3.00 | 33.3% | No | |
Asymmetrical or slow foetal growth a | P | 3.96 (.48) | 4.00 | 87.0% | Yes |
C | 3.53 (.74) | 3.00 | 40.0% | No | |
The woman’s blood tests show electrolyte imbalances (e.g., low potassium) a | P | 4.31 (.84) | 5.00 | 84.6% | Yes |
C | 4.13 (.74) | 4.00 | 80.0% | Yes | |
Cognitive symptom items | |||||
Overvaluation of body shape and weight | P | 4.42 (.50) | 4.00 | 100% | Yes |
C | 4.93 (.26) | 5.00 | 100% | Yes | |
Perceptual disturbance (e.g., perceiving self to be overweight for pregnancy stage, when objectively not) | P | 4.42 (.50) | 4.00 | 100% | Yes |
C | 4.87 (.35) | 5.00 | 100% | Yes | |
Poor body image | P | 4.12 (.52) | 4.00 | 92.3% | Yes |
C | 4.47 (.99) | 5.00 | 80.0% | Yes | |
Low self-esteem | P | 3.77 (.65) | 4.00 | 73.0% | No |
C | 4.20 (.56) | 4.00 | 93.3% | Yes | |
Rumination about gestational weight gain | P | 4.04 (.53) | 4.00 | 88.5% | Yes |
C | 4.87 (.35) | 5.00 | 100% | Yes | |
Rumination about health of baby | P | 3.08 (.63) | 3.00 | 15.4% | No |
C | 3.07 (.80) | 3.00 | 20.0% | No | |
Fixation on post-partum weight loss | P | 4.12 (.52) | 4.00 | 92.3% | Yes |
C | 4.80 (.56) | 5.00 | 93.3% | Yes | |
Self critical thoughts and fear of criticism | P | 3.31 (.79) | 3.00 | 42.3% | No |
C | 4.20 (.56) | 4.00 | 93.3% | Yes | |
Comparing personal eating habits to others | P | 3.77 (.59) | 4.00 | 76.9% | Yes |
C | 3.87 (.74) | 4.00 | 80.0% | Yes | |
Need for pregnancy to be “perfect” | P | 3.88 (.71) | 4.00 | 76.9% | Yes |
C | 4.20 (.78) | 4.00 | 93.3% | Yes | |
Desire for baby to be “small” or “petite” | P | 4.73 (.53) | 5.00 | 96.2% | Yes |
C | 4.20 (1.08) | 5.00 | 80.0% | Yes | |
Suicidal thoughts/ideation | P | 4.62 (.94) | 5.00 | 88.5% | Yes |
C | 4.40 (.83) | 5.00 | 80.0% | Yes | |
Frequent comparison of weight and shape, with pregnant and non-pregnant women a | P | 4.74 (.45) | 5.00 | 100% | Yes |
C | 4.67 (.62) | 5.00 | 93.3% | Yes | |
Belief that vomiting will not adversely impact the fetus/baby because “all pregnant women vomit” a | P | 4.78 (.52) | 5.00 | 96.0% | Yes |
C | 4.60 (.74) | 5.00 | 86.7% | Yes | |
Obsessive thoughts during pregnancy that relate to food (e.g., fear of food contamination, “clean eating” to avoid pesticides) a | P | 4.74 (.45) | 5.00 | 100% | Yes |
C | 4.47 (.83) | 5.00 | 93.3% | Yes | |
Obsessive thoughts regarding health and normality of pregnancy a | P | 3.96 (.64) | 4.00 | 87.0% | Yes |
C | 4.07 (.85) | 4.00 | 80.0% | Yes | |
Thoughts during pregnancy about using breastfeeding as a purgatory method and/or prolonging breastfeeding for weight loss | P | – | – | – | – |
C | 4.73 (.80) | 5.00 | 93.3% | Yes | |
Agonising and debating the absolute necessity of every food item consumed and/or bargaining with oneself | P | – | – | – | – |
C | 4.93 (.26) | 5.00 | 100% | Yes | |
Urges and thoughts of wanting to vomit to relieve physical or psychological tension | P | – | – | – | – |
C | 2.93 (1.22) | 2.00 | 33.3% | No | |
Thoughts that one does not deserve to eat, and having to justify food consumption ‘for the baby’ | P | – | – | – | – |
C | 5.00 (.00) | 5.00 | 100% | Yes | |
Thoughts of wanting to be ‘just bump’ (i.e., weight gain is only acceptable in ‘pregnancy-appropriate’ areas such as the stomach, but not the arms/thighs etc) | P | – | – | – | – |
C | 4.33 (.82) | 4.00, 5.00 | 93.3% | Yes | |
Thoughts of returning to a restrictive diet once the baby is no longer dependent on mother’s body (e.g., to grow in the womb, for breastfeeding, etc) | P | – | – | – | – |
C | 4.60 (.74) | 5.00 | 86.7% | Yes | |
Preoccupation with diets, weight management information, and the lack of weight gained by other pregnant individuals and/or admiration for how rapidly these individuals ‘snap back’ to their pre-pregnancy body weight and shape | P | – | – | – | – |
C | 4.93 (.26) | 5.00 | 100% | Yes | |
Affective symptom items | |||||
Distress regarding changing shape + fear of fatness | P | 4.27 (.45) | 4.00 | 100% | Yes |
C | 4.53 (1.06) | 5.00 | 86.7% | Yes | |
Distress or guilt after eating “unhealthy” or “bad” foods | P | 4.19 (.49) | 4.00 | 96.2% | Yes |
C | 4.53 (.83) | 5.00 | 93.3% | Yes | |
Mood disturbance | P | 3.92 (.80) | 4.00 | 84.6% | Yes |
C | 3.13 (.99) | 3.00 | 33.3% | No | |
Anxiety about certain foods/food groups | P | 4.08 (.56) | 4.00 | 84.6% | Yes |
C | 4.67 (.49) | 5.00 | 100% | Yes | |
Feeling “out of control” of one’s body | P | 4.27 (.45) | 4.00 | 100% | Yes |
C | 4.60 (.91) | 5.00 | 86.7% | Yes | |
Feeling a “loss of control” over eating | P | 4.77 (.59) | 5.00 | 92.3% | Yes |
C | 4.53 (1.06) | 5.00 | 93.3% | Yes | |
Guilt after eating (any food) | P | 4.35 (.49) | 4.00 | 100% | Yes |
C | 4.73 (.46) | 5.00 | 100% | Yes | |
Feelings of shame + disgust about body | P | 4.92 (.27) | 5.00 | 100% | Yes |
C | 4.80 (.41) | 5.00 | 100% | Yes | |
Sensitivity to comments regarding weight, shape, or appearance | P | 4.04 (.60) | 4.00 | 92.3% | Yes |
C | 4.20 (.94) | 5.00 | 80.0% | Yes | |
Emotional detachment from pregnancy | P | 4.46 (.86) | 5.00 | 84.6% | Yes |
C | 4.27 (.82) | 4.00 | 80.0% | Yes | |
Social isolation | P | 4.31 (.97) | 5.00 | 84.6% | Yes |
C | 4.47 (.74) | 5.00 | 86.7% | Yes | |
Interpersonal mistrust | P | 3.73 (.72) | 4.00 | 76.9% | Yes |
C | 3.73 (.88) | 4.00 | 73.3% | No | |
Feeling relieved or thankful for pregnancy serving as a valid explanation to avoid certain foods or eating very little | P | – | – | – | – |
C | 4.87 (.35) | 5.00 | 100% | Yes | |
Distress in relation to increased appetite during pregnancy | P | – | – | – | – |
C | 4.87 (.35) | 5.00 | 100% | Yes | |
Feeling resentful toward the baby for needing constant food and nutrients to grow in the womb, followed by significant guilt and shame for feeling resentful | P | – | – | – | – |
C | 4.60 (1.12) | 5.00 | 93.3% | Yes |
Section 2: Distinguishing disordered eating from pregnancy-appropriate symptoms
Distinguishing foci
| Panel | Mean (SD) | Mode | % of panel agreement | Consensus |
---|---|---|---|---|---|
Severity of behaviours | P | 4.88 (.43) | 5.00 | 96.2% | Yes |
C | 4.80 (.41) | 5.00 | 100% | Yes | |
Severity of cognitions | P | 4.88 (.43) | 5.00 | 96.2% | Yes |
C | 5.00 (.00) | 5.00 | 100% | Yes | |
Frequency of behaviours | P | 4.85 (.46) | 5.00 | 96.2% | Yes |
C | 4.87 (.35) | 5.00 | 100% | Yes | |
Frequency of cognitions | P | 4.85 (.46) | 5.00 | 96.2% | Yes |
C | 5.00 (.00) | 5.00 | 100% | Yes | |
Dietary behaviours in excess to recommended guidelines | P | 4.46 (.71) | 5.00 | 88.5% | Yes |
C | 4.13 (.64) | 4.00 | 86.7% | Yes | |
Dietary behaviours in deficit to recommended guidelines | P | 4.73 (.60) | 5.00 | 92.3% | Yes |
C | 4.33 (.62) | 4.00 | 93.3% | Yes | |
Exercise behaviours in excess to recommended guidelines | P | 4.35 (.75) | 5.00 | 84.6% | Yes |
C | 4.33 (.49) | 4.00 | 100% | Yes | |
Exercise behaviours in deficit to recommended guidelines | P | 3.19 (.90) | 3.00 | 34.6% | No |
C | 3.33 (1.11) | 3.00 | 40.0% | No | |
Appropriateness of gestational weight gain | P | 3.96 (.45) | 4.00 | 88.5% | Yes |
C | 4.20 (.56) | 4.00 | 93.3% | Yes | |
Health risk or distress to fetus | P | 4.88 (.43) | 5.00 | 96.2% | Yes |
C | 5.00 (.00) | 5.00 | 100% | Yes | |
Health risk or distress to mother | P | 4.85 (.54) | 5.00 | 92.3% | Yes |
C | 5.00 (.00) | 5.00 | 100% | Yes | |
Distress of (or worry by) family | P | 3.92 (.48) | 4.00 | 92.3% | Yes |
C | 4.13 (.92) | 4 /5.00 | 80.0% | Yes | |
History of pregnancy complications (e.g., miscarriage, premature labour) | P | 3.96 (.48) | 4.00 | 84.6% | Yes |
C | 4.67 (.72) | 5.00 | 86.7% | Yes | |
Level of physical impairment or impact | P | 4.04 (.66) | 4.00 | 88.5% | Yes |
C | 4.93 (.26) | 5.00 | 100% | Yes | |
Level of psychological impairment or impact (e.g., affective state of mother) | P | 4.31 (.66) | 4.00 | 92.3% | Yes |
C | 5.00 (.00) | 5.00 | 100% | Yes | |
Level of social impairment or impact | P | 4.12 (.59) | 4.00 | 88.5% | Yes |
C | 4.93 (.26) | 5.00 | 100% | Yes | |
Level of relational impairment or impact | P | 4.04 (.59) | 4.00 | 84.6% | Yes |
C | 4.93 (.26) | 5.00 | 100% | Yes | |
Degree of flexibility with dietary rules | P | 4.58 (.58) | 5.00 | 96.2% | Yes |
C | 4.47 (.52) | 4.00 | 100% | Yes | |
Level of insight and/or denial | P | 4.81 (.49) | 5.00 | 96.2% | Yes |
C | 4.40 (.83) | 5.00 | 93.3% | Yes | |
Discrepancy between self-reported functioning and medical observations | P | 4.81 (.49) | 5.00 | 96.2% | Yes |
C | 5.00 (.00) | 5.00 | 100% | Yes | |
Discrepancy between the woman’s report and partner/family reports | P | 4.73 (.53) | 5.00 | 96.2% | Yes |
C | 4.73 (.46) | 5.00 | 100% | Yes | |
Available coping strategies (e.g., emotion regulation skills) | P | 4.00 (.63) | 4.00 | 88.5% | Yes |
C | 4.80 (.41) | 5.00 | 100% | Yes | |
Available social support | P | 4.92 (.69) | 4.00 | 92.3% | Yes |
C | 4.73 (.46) | 5.00 | 100% | Yes | |
History of any psychiatric condition | P | 4.08 (.69) | 4.00 | 88.5% | Yes |
C | 5.00 (.00) | 5.00 | 100% | Yes | |
History of an eating disorder | P | 4.85 (.46) | 5.00 | 96.2% | Yes |
C | 5.00 (.00) | 5.00 | 100% | Yes | |
History of subclinical disordered eating behaviours | P | 4.85 (.46) | 5.00 | 96.2% | Yes |
C | 4.93 (.26) | 5.00 | 100% | Yes | |
Family history of an eating disorder | P | 4.00 (.57) | 4.00 | 92.3% | Yes |
C | 4.20 (.56) | 4.00 | 93.3% | Yes | |
Younger age (< 30 years) | P | 2.88 (.59) | 3.00 | 7.7% | No |
C | 1.40 (1.06) | 1.00 | 6.7% | No | |
Older age (> 30 years) | P | 2.85 (.54) | 3.00 | 3.8% | No |
C | 1.53 (1.25) | 1.00 | 13.3% | No | |
Ethnicity | P | 2.73 (.67) | 3.00 | 0.0% | No |
C | 1.60 (1.12) | 1.00 | 6.7% | No | |
Primigravidity (first pregnancy) | P | 2.96 (.44) | 3.00 | 7.7% | No |
C | 2.20 (1.52) | 1.00 | 20.0% | No | |
Multigravidity (subsequent pregnancies) | P | 2.88 (.52) | 3.00 | 3.8% | No |
C | 2.13 (1.41) | 1.00 | 20.0% | No | |
Ability to return to “normal eating” and regain feelings of control (w/out being restrictive) after bouts of pregnancy-related appetite changes a | P | 4.52 (.47) | 5.00 | 86.9% | Yes |
C | 4.73 (.53) | 5.00 | 100% | Yes | |
Intent behind the behaviour (e.g., restricting one’s food intake is only problematic if the intention is to minimise weight gain or lose weight during pregnancy, as opposed to restricting due to nausea) | P | – | – | – | – |
C | 4.93 (.26) | 5.00 | 100% | Yes |
• How often is the symptom/s occurring, and with what intensity? • What is the context and/or intent of the symptom? (e.g., is a woman’s dietary restriction to reduce nausea or minimise gestational weight gain?) • Does the symptom deviate from clinical recommendations during pregnancy (e.g., deficits in dietary intake, excess in exercise behaviours)? • Is the woman’s weight in a healthy range relative to pregnancy stage? Could the symptom negatively impact gestational weight gain? • Is there an actual or anticipated health risk or distress to the mother and/or unborn child? • Does a woman’s family express concern about the symptom/s? • Does the woman have a history of pregnancy complications (e.g., miscarriage, premature labour)? • Is the symptom/s causing physical, psychological, social, and/or relational impairment/difficulty for the woman? • Does the woman have insight into the presence and impact of the symptom/s? • Is the woman open to addressing the concern? • Is there a discrepancy between a woman’s self-reported functioning and the results of medical tests/observations? • Is there a discrepancy between a woman’s report of functioning and partner/family reports of functioning? • Does the woman have a history of mental health conditions, particularly eating disorders/disordered eating? • Is there a history of disordered eating in the woman’s family? |