Eating and Psychological Distress During Pregnancy: The Use of Ecological Momentary Assessment

Kimberly Tremblay

Background: Though some women exhibit disordered eating patterns in pregnancy, little research has been conducted to help distinguish between normative patterns and those warranting clinical concern. Moreover, the role of psychological distress on eating behavior and attitudes has not been examined in pregnancy but has important implications for diagnosis and treatment. Previous research has resulted in equivocal findings for between-person differences in mood and eating behaviors and attitudes. This preliminary study was conducted to address specific methodological challenges of previous research by using Ecological Momentary Assessment (EMA) to help understand the psychological vulnerabilities for maladaptive eating attitudes and behaviors during the unique life phase of pregnancy. Method: Ecological momentary assessment was used to assess the relationship between psychological distress assessed 2-3 times daily for 7 days and retrospective reports of eating behaviors and attitudes. Sixty-two women completed baseline assessments; 39 (63%) had no previous eating disorder diagnoses and completed all follow-up daily assessments. Results: Results from multilevel analysis indicated a robust within-person association between psychological distress (momentary negative mood, anxiety, stress, depression) and eating attitudes and behaviors. For each one-point increase in momentary negative mood scores there was a corresponding 0.03 point increase in eating concern. With each one-point increase in prenatal anxiety and stress scores there was a corresponding 0.07 and 0.12 point increase in binging behavior. Finally, for each one-point increase in prenatal depression scores there was a corresponding 0.21 point increase in global maladaptive eating. These associations were moderated by individual variables of advancing gestation, education level, previous pregnancies, and marital status. These findings demonstrate momentary changes in pregnancy and the significant contribution of individual factors (i.e., gestation, parity, education, marital status) in the eating attitudes and behaviors of pregnant women. Conclusion: Results indicate intraindividual variability in maladaptive eating patterns during pregnancy. Recommendations are provided for prenatal evaluations of psychological symptoms and problematic eating attitudes and behaviors with enhanced ecological and external validity. Importantly, identifying unhealthy eating behaviors and attitudes with intraindividual predictors during pregnancy may reduce concealment of eating symptoms from health providers and ultimately minimize the harmful consequences of prenatal psychological distress and maladaptive eating.

Eating and Psychological Distress During Pregnancy: The Use of Ecological Momentary Assessment

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