Research trends have suggested that a controlled, longitudinal, cohort study is the most appropriate and comprehensive methodology to examine the prevalence of eating disorders among cesarean or vaginal deliveries. Franko et al. (2001) used a longitudinal, cohort study of women who had either bulimia or anorexia nervosa. There were no controls in their study and they acknowledged that this was a significant weakness of their study. Kouba et al. (2005) employed a control group but their population size was only 49 mothers with eating disorders and 68 controls.
This current study will take the form of a longitudinal, controlled, cohort study of women reporting for delivery at obstetric/gynecological units in 10 urban hospitals. The research questions that will guide this research are: 1. What is the prevalence of eating disorders among pregnant women? 2. Are eating disorders more prevalent in cesarean than normal deliveries? 3. What is the impact of pregnancy on eating disorders? Hypothesis It is hypothesized that eating disorders are more prevalent among women having cesarean deliveries than those who have had normal vaginal deliveries.
Furthermore mothers will report a decrease in eating disorders during the nine months of pregnancy but this will progressively increase postpartum. Subjects The subjects for this study will be recruited from within 10 urban hospitals. All primivarid mothers, that is those with their first pregnancies, reporting for delivery at each of the units will be asked to participate in the study. Stein and Fairburn (1996) support the use of only first-time mothers arguing that they lack prior experience with the concomitant physical changes of pregnancy.
Mothers with other serious known disorders such as diabetes or any other chronic illness will be excluded from participating in the study. Mothers do not need a prior diagnosis of an eating disorder to be included. They must be at least 18 years old and able to provide written informed consent. Mothers agreeing to participate in the study will be administered the Eating Disorder Examination (EDE) either just before or soon after delivery. The EDE is an instrument designed by Fairburn and Cooper in 1993. It is widely used to assess the presence of any of the spectrum of eating disorders.
The data gathered is retrospective to the previous 28 days. The instrument assesses eating behaviors and attitudes towards eating and has a high rate of inter-rater reliability (Grave and Simona, 2007; Franko and Spurrell, 2000; Stein and Fairburn, 1996). Two specialists in interviewing with the instrument will be employed for this survey. Each of the hospital units will be visited once-weekly, based on an agreed schedule and all patients not previously interviewed will be asked to participate in the study. Data will be gathered over the period of 9 months, beginning in July.
The use of this lengthy recruitment period is to ensure that a representative population is selected. It is difficult to predict the population size since the researchers will have very little control over how many mothers report to the units for delivery or on who decides to participate in the study. Data on type of delivery outcomes will be gathered from patients’ medical charts or hospital records. The researchers will record the number of cesarean deliveries, vaginal births, live or still birth, birth weight and other clinically relevant outcomes.
Demographic data on each patient, including age, sex, socioeconomic status, will also be gathered from patient charts. Each patient will be followed-up for a period of one year following the initial interview and the same EDE instrument will be used in assessment. Patients will be re-interviewed at 3, 6, 9 and 12 month. Other information to be gathered in these interviews is the mortality of the child and cause of death if any. Measures will be employed to ensure that there is an adequate distribution of participants based on the type of delivery – whether vaginal or cesarean, however this will be difficult to control.
Overall the research should be useful in helping to clarify the long-term effects of type of delivery on eating disorders and to see how these change over time.
References
Franko, D. L. , Blais, M. A. , Becker, A. E. , Delinsky, S. S. , Greenwood, D. N. , Flores, A. T. , & Ekeblad, E. R. et al. (2001). Pregnancy complications and neonatal outcomes in women with eating disorders. American Journal of Psychiatry, 158(9), 1461-1466. Franko, D. L. , & Spurrell, E. B. (2000). Detection and management of eating disorders during pregnancy.
Obstetrics & Gynecology, 95(6), 942-946. Grave, R. D. , & Simona, C. (2007). Eating disorder not otherwise specified in an inpatient unit: The impact of altering the DSM-IV criteria for anorexia and bulimia nervosa. European Eating Disorders Review, 15(5), 340-349. James, D. C. (2001). Eating disorders, fertility, and pregnancy: Relationships and complications. Journal of Perinatal and Neonatal Nursing, 15(2), 36-48. Kouba, S. , Hallstrom, T. , Lindholm, C. , & Hirschberg, A. L. (2005). Pregnancy and neonatal outcomes in women with eating disorders.
American College of Obstetricians and Gynecologists, 105(2), 255-260. Martos-Ordonez, C. (2005). Pregnancy in women with eating disorders: A review. British Journal of Midwifery, 13(7), 446-448. Mazzeo, S. E. , Landt, M. C. , Jones, I. , Mitchell, K. , Kendler, K. S. & Neale, M. C. et al. (2006). Associations among postpartum depression, eating disorders, and perfectionism in a population-based sample of adult women. International Journal of Eating Disorders. 39(3), 202-211. Mehlenbeck, R. (2007). Identifying and treating eating disorders in young children.
Brown University Child & Adolescent Behavior Letter, 23(8), 1-6. Newton, M. S. , & Chizawsky, L. L. (2006). Treating vulnerable populations: The case of eating disorders during pregnancy. Journal of Psychosomatic Obstetrics & Gynecology, 27(1), 5-7. Patel, P. , Lee, J. , Wheatcroft, R. , Barnes, J. , & Stein, A. (2005). Concerns about body shape and weight in the postpartum period and their relation to women’s self-identification. Journal of Reproductive and Infant Psychology, 23(4), 347-364. Stein, A. , & Fairburn, C. G. (1996). Eating habits and attitudes in the postpartum per