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The goal was developing a rapid, nonthreatening test.
Despite the many screening tools available for pregnant patients and for people with eating disorders, one has been overlooked. Until now, a method for rapidly screening pregnant patients for an underlying eating disorder has been lacking. Eating disorders are common during pregnancy. Existing screens are either undesirably long (in the case of the SCOFF test) or may yield false-positives among those who are pregnant. Now, a rapid screen for detecting EDs has been developed by University of West Virginia researchers. Using only 12 questions, the test can reliably and sensitively identify EDs across all trimesters.
As described in a recent article by Dr. Elizabeth A. Claydon and researchers at the West Virginia School of Public Health, Morgantown, WV, the Prenatal Eating Behaviors Screening, or PEBS, tool provides a sensitive, quick, and specific test clinicians can use to identify possible EDs in pregnant patients (Arch Womens Mental Health. 2022 . doi.org/10.1007/s00737-0022-1230-y) .
Mothers with Active AN: Risk of Complications Can Be Reduced
It is commonly believed that women with active AN are less likely to become pregnant. A team from Townsville Hospital and Health Service, Townsville, Australia, performed a systematic review showing that women with active AN are just as likely to become pregnant as those without an ED. Women with active AN have a different profile of complications during pregnancy compared to malnourished women and women in various stages of starvation (J Eat Disord. 2022 10:25).
Dr. Jeremy Ryan Pan and colleagues recommend that clinicians have an early discussion with patients with AN about fertility and complications that can occur during pregnancy. This may help improve physical and psychological symptoms of AN as well as nutritional deficiency during pregnancy, and to ensure adequate caloric intake and the well-being and general health of the mother and infant. They also recommend a psychiatric follow-up after birth for mothers with AN because AN symptoms can also appear during the perinatal period.
A shorter, language-appropriate test
The authors developed a series of questions taken from existing sources, such as the EDE-Q and SCOFF questionnaires, as well as from their own prior work, and designed the test to include appropriate language for women throughout their pregnancy. Content expert review ensured that the questions addressed AN, BN, BED, BN, and eating disorders not otherwise specified, or EDNOS. As part of the survey, participants were asked if they had ever been diagnosed with an ED.
Keeping the test brief and to the point
One of the challenges for all screening tools is brevity, and to that end the authors shortened their original 25-item questionnaire to 12 questions. In the developmental sample, 190 women were identified, most of whom were 25 to 34 years of age, married (n=164), white, 140; 74.4%), and had private insurance (n=129, or 68%). The mean week of pregnancy among the women was 19.26 weeks, reported by the individual patient (first trimester, weeks 4-13; second trimester, weeks 14-27; and third trimester, weeks 28-40).
Women who scored at least 39 points on the shortened screening tool were nearly 16 times more likely to have a diagnosis of an undetected ED than were women with lower scores. The American College of Obstetricians and Gynecologists states that their healthcare providers “should be comfortable screening and recognizing patients with EDs.” The authors suggest that a “professional expert” make the final diagnosis (ACOG 2018). The goal of the authors’ study was just that, to help primary care clinicians detect EDs and to refer the pregnant patient to an ED expert for further care.
The authors noted that their study was limited because their sample included only English-speaking participants, and convenience samplings were used. The data collected for the development and validation sample was conducted at slightly different time points, but within a few months of each other (and a notable strength is the provision of extensive psychometric data).
Future research
This is a valuable new screening tool. The next steps identified by the authors are to distribute informational booklets on how to use the PEBS tool and to develop PEBS translations so it can be used in more diverse populations.