Disordered eating instruments in the pregnancy cohort: a systematic review update

Figures & data

Figure 1. PRISMA flowchart, including searches of databases and other sources.

Table 1. Overview of characteristics and demographics of included studies.

Article citation	Instrument/s	Country	N	Setting	Data collection	Age (M ± SD)	Gestation (M ± SD)	Trimester (M ± SD)	Pregnancy BMI (M ± SD)	Quality score
Bannatyne (2018)	DEAPS, SCOFF, & EDE-Q	Australia	444	Community	2017	29.27 ± 4.92	22.97 ± 9.62	1^st 17.1% 2^nd 45.7% 3^rd 37.2%	27.63 ± 6.74 (neg screen on DEAPS) 29.18 ± 6.79 (pos screen on DEAPS)	11
Incollingo Rodriguez et al. (2019)	EAT-13	USA	143	Community	NR	28.86 ± 5.03	25.75 ± 8.56	2^nd & 3^rd	NR	9
Nagl et al. (2019)	EDE-Q	Germany	291	Community	2018	31.26 ± 4.17	26.08 ± 9.77	1^st 14% 2^nd 30% 3^rd 56%	NR	9
Stubbs et al. (2019)	EAT-26	USA	1031	Primary care	2008 – 2011	24.73 ± 5.87	NR	1^st & 3^rd	NR	8
Baskin et al. (2020)	EDE-Q	Australia	258	Community	2016 – 2017	29.22 ± 4.96	20.79 ± 2.56	2^nd & 3^rd	NR	9
Dryer et al. (2020)	EAT-26	Australia	408	Community	NR	28.24 ± 5.04	24.08 ± 6.40	1^st 16.2% 2^nd 41.4% 3^rd 42.4%	NR	9
Goutaudier et al. (2020)	EDI-2 (DT & BU subscales only)	France	213	Community	NR	26.70 ± 4.20	24.00 ± 10.60	1^st 23.5% 2^nd 37.8% 3^rd 38.7%	NR	8
Hecht et al. (2021)	EDE-Q	USA	70	Primary care	2013 – 2014	33.12 ± 4.13	22.35 ± 8.84	1^st − 3^rd	NR	8
Claydon et al. (2022)	PEBS	USA	167	Community	2020 – 2021	25 to 34	18.19 ± 9.06	1^st − 3^rd	NR	10
Dörsam et al. (2022) – unpublished data from Howard et al. (2018)	Modified SCOFF	UK	522	Primary care	2014 – 2016	NR	NR	NR	NR	9
Dörsam et al. (2022) – unpublished data from Doersam et al. (2022)	EAT-8	Germany	42	Community	2019	NR	20.79 ± 7.97	1^st − 3^rd	NR	8
Gerges et al. (2022)	A-DEAPS & SCOFF	Lebanon	433	Community	2021	28.55 ± 4.63	23.68 ± 8.68	2^nd & 3^rd	NR	7
Taştekin Ouyaba and Çiçekoğlu Öztürk (2022)	ORTO-11	Turkey	350	Primary care	2020	28.22 ± 5.60	35.14 ± 2.51	3^rd	29.66 ± 5.15	9
Vanderkruik et al. (2022)	EDE-Q	USA	56	Community	2020 – 2021	33.0 ± 4.41	21.00 ± 8.61	2^nd & 3^rd	NR	9
He et al. (2023)	EDE-QS	China	345	Community	2022	29.95 ± 5.58	NR	2.04 ± 0.87	23.87 ± 4.35	9
Gerges et al. (2023) - same sample as Gerges et al. (2022)	EDI-2 (BD subscale only)	Lebanon	433	Community	2021	28.55 ± 4.63	NR	1^st 17.4% 2^nd 40.8% 3^rd 41.8%	27.54 ± 14.05	9
Sommerfeldt et al. (2023)	EDE & EDE-Q	Norway	24	Primary care	NR	32.8 ± 4.64	22.42 ± 8.58	1^st & 3^rd	NR	9
Yamamiya and Omori (2023)	EDI-2 (DT subscale only)	Japan	208	Community	2019	27 ± 1.74	9.3 ± 2.73	1^st	NR	9
Christian et al. (2024)	EDE-Q	USA	454	Community	NR	30.95 ± 5.17	NR	1^st 20.5% 2^nd 39.20% 3^rd 40.3%	NR	9
Hormes (2024)	PEBS	USA/UK	137	Community	2023	31.70 ± 4.83	23.56 ± 9.84	1^st 19.0% 2^nd 40.9% 3^rd 40.1%	NR	9
Jouppi et al. (2024)	EDE-PV & EDE	USA	257	Primary care	2012-2017	28.4 ± 5.5	15.7 ± 2.45	2^nd & 3^rd	25.0 to 58.7	11

DEAPS = Disordered Eating Attitudes in Pregnancy Scale; SCOFF = Sick, Control, One, Fat, Food; EDE-Q = Eating Disorder Examination—Questionnaire; EAT = Eating Attitudes Test; EDI-II = Eating Disorder Inventory; PEBS = Prenatal Eating Behaviour Screening Tool; A-DEAPS = Arabic Disordered Eating Attitudes in Pregnancy Scale; ORTO-11 = Test for the diagnosis of Orthorexia; EDE-Q = Eating Disorder Examination—Questionnaire Short; EDE-PV = Eating Disorder Examination—Pregnancy Version; BU = Bulimia Subscale of the EDI-2; DT = Drive for Thinness Subscale of EDI-2; BD = Body Dissatisfaction Subscale of the EDI-2; NR = Not reported.

Table 2. Overview of screening instruments, methods of administration and psychometric properties in included studies.

		Administration method in study		Validity				Reliability
Article citation	Instrument	Self-report	Clinician	Content	Construct	Convergent	Criterion	Internal consistency	Inter- rater
Bannatyne (2018)	DEAPS	✓		✓	✓	✓	✓	α = .85	N/A
	SCOFF	✓		–	–	✓	–	α = .41	N/A
	EDE-Q	✓		–	–	✓	–	α = .95	N/A
Incollingo Rodriguez et al. (2019)	EAT-13	✓		–	–	–	–	α = .83	N/A
Nagl et al. (2019)	EDE-Q	✓		–	–	–	–	α = .95	N/A
Stubbs et al. (2019)	EAT-26		✓	–	–	–	–	α = .87	–
Baskin et al. (2020)	EDE-Q	✓		–	–	–	–	ω = .94 (T2) ω = .86 (T3)	N/A
Dryer et al. (2020)	EAT-26	✓		–	–	–	–	α = .87	N/A
Goutaudier et al. (2020)	EDI-2 (DT & BU subscales only)	✓		–	–	–	–	α = .84 (DT) α = .81 (BU)	N/A
Hecht et al. (2021)	EDE-Q	✓		–	–	–	–	α = .89	N/A
Claydon et al. (2022)	PEBS	✓		✓	✓	–	✓	α = .95	N/A
Dörsam et al. (2022) – unpublished data from Howard et al. (2018)	Modified SCOFF		✓	✓	–	–	✓	–	–
Dörsam et al. (2022) – unpublished data from Doersam et al. (2022)	EAT-8	✓		–	–	–	✓	–	N/A
Gerges et al. (2022)	A-DEAPS	✓		–	✓	✓	–	α = .80	N/A
	A-SCOFF	✓		–	–	✓	–	α = .35	N/A
Taştekin Ouyaba and Çiçekoğlu Öztürk (2022)	ORTO-11		✓	–	–	–	–	α = .54	–
Vanderkruik et al. (2022)	EDE-Q	✓		–	–	–	–	α = .94	N/A
He et al. (2023)	EDE-QS	✓		–	–	–	–	α = .92	N/A
Gerges et al. (2023) – same sample as Gerges et al. (2022)	EDI-2 (BD subscale only)	✓		–	✓	✓	–	α = .81	N/A
Sommerfeldt et al. (2023)	EDE		✓	–	–	–	–	–	–
	EDE-Q	✓		–	–	–	–	–	N/A
Yamamiya and Omori (2023)	EDI-2 (DT subscale only)	✓		–	–	–	–	α = .89	N/A
Christian et al. (2024)	EDE-Q	✓		–	–	–	–	α = .92	N/A
Hormes (2024)	PEBS	✓		–	–	–	–	α = .80	N/A
Jouppi et al. (2024)	EDE-PV		✓	✓	✓	✓	✓	α = .84 (global) ω = .70-.85 (subscales)	κ = .99
	EDE			–	✓	–	–	ω = .84 (global) ω = .48-.84 (subscales)	–

DEAPS = Disordered Eating Attitudes in Pregnancy Scale; SCOFF = Sick, Control, One, Fat, Food; EDE-Q = Eating Disorder Examination—Questionnaire; EAT = Eating Attitudes Test; EDI-II = Eating Disorder Inventory; PEBS = Prenatal Eating Behaviour Screening Tool; A-DEAPS = Arabic Disordered Eating Attitudes in Pregnancy Scale; ORTO-11 = Test for the diagnosis of Orthorexia; EDE-Q = Eating Disorder Examination—Questionnaire Short; EDE-PV = Eating Disorder Examination—Pregnancy Version; BU = Bulimia Subscale of the EDI-2; DT = Drive for Thinness Subscale of EDI-2; BD = Body Dissatisfaction Subscale of the EDI-2; NR = Not reported.

Table 3. Summary of psychometric instruments used in pregnancy samples in this review.

Instrument	# of items	Administration options stated		Time to complete (mins)	Pregnancy-specific tool	Evaluation period	Item responding		Scales & subscales	Max score	Cut-off scores explored in preliminary research
		Self-report	Clinician				Likert	Dichot-omous
PEBS	12	✓		5	Yes	Within current pregnancy	✓		Global score	60	Preliminary research indicates possible cut-off of 39 for identifying high-risk cases.
DEAPS	14	✓	✓	5	Yes	Previous 1 month (during pregnancy)		✓	Global score	14	Preliminary research indicates possible cut-off of 8 for identifying high-risk cases.
A-DEAPS	10	✓		5	Yes	Previous 1 month (during pregnancy)		✓	Global score	10	Validation analyses have not explored possible cut-off score.
Modified SCOFF	6	✓	✓	2-5	Partially—modified instrument	Previous 3 months		✓	Global score	6	Preliminary research has explored various cut-offs (1 to 4). No specific cut-off provided an adequate balance of sensitivity and specificity.
Original SCOFF	5	✓	✓	2-5	No	Previous 3 months		✓	Global score	5	Validation analyses have not explored possible cut-off score.
EDE	28		✓	45	No	Previous 28 days	✓		Global score & four subscales: Dietary restraint Eating concern Weight concern Shape concern	132 (for 22 core items)	–
EDE-PV	11		✓	20-25	Partially—modified instrument	Previous 28 days	✓		Global score & two subscales: Pregnancy eating & weight change Pregnancy shape and weight concerns	66	–
EAT-8	8	✓		5	No	Previous 6 months		✓	Global score	8	Preliminary research has explored cut-offs of 2 and 3. Neither provided adequate balance of sensitivity and specificity.
EAT-13	13	✓		10-15	No	Previous 6 months	✓		Global score	39	Validation analyses have not explored possible cut-off score.
EAT-26	26	✓		20	No	Previous 6 months	✓		Global score	76	Validation analyses have not explored possible cut-off score.
EDE-Q	28	✓		15	No	Previous 28 days	✓		Global score & four subscales: Dietary restraint Eating concern Weight concern Shape concern	132 (for 22 core items)	Validation analyses have not explored possible cut-off score.
EDE-QS	12	✓		5-10	No	Previous 7 days	✓		Global score	36	Validation analyses have not explored possible cut-off score.
EDI-2	91	✓		30-40	No	Previous 6 months	✓		Global score & main subscales: Drive for thinness Bulimia Body dissatisfaction	Varies	Validation analyses have not explored possible cut-off score.
ORTO-11	11	✓		5-10	No	Previous 3 months	✓			44	Validation analyses have not explored possible cut-off score.

DEAPS = Disordered Eating Attitudes in Pregnancy Scale; SCOFF = Sick, Control, One, Fat, Food; EDE-Q = Eating Disorder Examination—Questionnaire; EAT = Eating Attitudes Test; EDI-II = Eating Disorder Inventory; PEBS = Prenatal Eating Behaviour Screening Tool; A-DEAPS = Arabic Disordered Eating Attitudes in Pregnancy Scale; ORTO-11 = Test for the diagnosis of Orthorexia; EDE-Q = Eating Disorder Examination—Questionnaire Short; EDE-PV = Eating Disorder Examination—Pregnancy Version; BU = Bulimia Subscale of the EDI-2; DT = Drive for Thinness Subscale of EDI-2; BD = Body Dissatisfaction Subscale of the EDI-2.

Table 4. Psychometric performance using Terwee et al. (2007).

	PEBS	DEAPS	A-DEAPS	Modified SCOFF	SCOFF	EDE	EDE-PV	EDE-Q	EDE-QS	EDI-2*	EAT-8	EAT-13/26
Content validity (for pregnancy)	+	+	–	+	–	–	+	–	–	–	–	–
Internal consistency	+	+	+	0	–	–	+	+	+	+ (BD, BU, & DT)	+	+
Criterion validity	+	+	0	+	0	0	+	0	0	0	–	0
Construct validity	0	+	+	0	?	–	+	0	0	+ (BD)	0	0
Reproducibility (agreement)	0	0	0	0	0	0	0	0	0	0	0	0
Reproducibility (reliability)	+	+	0	0	0	0	+	0	0	0	0	0
Responsiveness	+	0	0	0	0	0	0	0	0	0	0	0
Floor and ceiling effects	0	?	0	0	0	0	0	0	0	0	0	0
Interpretability	?	?	0	0	0	0	?	0	0	?	0	0

DEAPS = Disordered Eating Attitudes in Pregnancy Scale; SCOFF = Sick, Control, One, Fat, Food; EDE-Q = Eating Disorder Examination—Questionnaire; EAT = Eating Attitudes Test; EDI-II = Eating Disorder Inventory; PEBS = Prenatal Eating Behaviour Screening Tool; A-DEAPS = Arabic Disordered Eating Attitudes in Pregnancy Scale; EDE-Q = Eating Disorder Examination—Questionnaire Short; EDE-PV = Eating Disorder Examination—Pregnancy Version; BU = Bulimia Subscale of the EDI-2; DT = Drive for Thinness Subscale of EDI-2; BD = Body Dissatisfaction Subscale of the EDI-2; NR = Not reported * EDI-2 reflects subscales only. ORTO-11 excluded due to only screening for orthorexia.

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