Lately, there has been an upsurge in the prevalence of eating disorders (including anorexia, bulimia, orthorexia and recently, pregorexia), mainly due to changes in sociocultural factors 1. Body image disorders are not benign. They dictate risky behaviors that engender major physical and mental health harms, as well as damages to social life 1. Throughout the history of mankind, the concept of beauty has evolved in a way that nowadays, thinness represents success among women. It is postulated that 15% of them suffer from body dissatisfaction, thus willing to lose weight 2.
Although pregnancy being a miraculous process, and despite all the blessings it provides to the mothers-to-be, such as becoming parents and acquiring new qualities, it remains, though, a complex “biopsychosocial phenomenon” that witnesses the emergence of concerns about weight, body image, femininity, and self-esteem 3. Those preoccupations are usually triggered by the pregnancy’s emotional hormonal ambivalence, hence inducing new eating disorders or exacerbating previously existing ones, in order to cope with its associated bad feelings as anxiety or even phobic and obsessive-compulsive traits 3.
Consequently, pregnancy may serve as a propitious basis for the flourishing of “Pregorexia” (also called “Mummyrexia”): a notion of popular psychology designating a newly emerging eating disorder. The term “Pregorexia” first appeared in “The Early Show and Fox” press in 2008, referring to the excessive fear of the pregnancy-induced weight gain, and the drive to control it through various measures; for instance, the extreme restriction of calories intake, excessive exercising, or even diuretics and/or laxatives consumption 4,5.
This modern nomination results from combining pregnancy + anorexia. Pregorexia is neither considered a medical diagnosis, nor classified in the DSM-5 eating disorders criteria. Additionally, it has not been assigned any international formal or medical definition yet 6. We might simply define it as anorexia nervosa occurring for the first-time during pregnancy 5, keeping in mind that “pregorexic” women might experience anorexia and bulimia simultaneously 4, through a vicious cycle interaction. Some alarming signs: “red flags” include skipping meals, eating alone, and talking about pregnancy as if it is not real (state of denial) 4. Notably, this phenomenon was also described in “The Perfect Little Bump”, a magazine article released far back in 2004, reporting how some pregnant women in New York City were exercising to the stage of pushing their heart rates beyond safe limits, as an apocalyptic resource to minimize their weight gain 7.
Remarkably, the occurrence of eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorders, eating disorders not otherwise specified…) during pregnancy was of a wide divergence between studies, ranging from 0.6% to not lesser than 27.8% 8–18. These disparities could be explained by the diversity of assessment tools, varying from self-reported questionnaires (based on adapted versions of pre-existing scales for eating disorders, or designed on items derived from the DSM-4 or DSM-5 criteria) to structured interviews 9, hence emphasizing the need for an international consensual and accurate pregnancy-specific screening tool, as previously suggested by a Delphi study 19, to make comparisons easier in research, and to minimize the probability of false negative and false positive tests. On top of that, a recent systematic review refuted the suitability of the traditional existing measures for evaluating eating disorders in pregnancy, pointing out that among sixteen scales applied across countries, not more than four were presented along with documented psychometric characteristics, yet none was able to stand up for a meritorious level of clinical pertinence (in terms of psychometric performance as internal consistency, criterion-related validity, screening accuracy…) to the point of being set as a “gold standard” measure or substituting the need for a specifically conceived instrument for identifying dysfunctional eating symptoms during pregnancy 20.
Besides, when it comes to pregorexia, the only documented prevalence worldwide is 5% 21. Nevertheless, most healthcare professionals are unaware of this condition 6. The scarcity of studies exploring this phenomenon proves that raising awareness is essential, considering the importance of a balanced diet during pregnancy and the risks of undernutrition for both the mother-to-be and her fetus, such as miscarriage, low birth weight, type 2 diabetes, cardiovascular diseases, neural tube defects, cognitive disorders, placental abruption, maternal anemia, impaired bone mineralization, post-partum depression, and so forth 4,5. Barriers to the identification of eating disorders during pregnancy are principally stigma and poor professional training 22. In addition, the lack of confidential discussions about weight gain, mental health and body dissatisfaction between pregnant women and their physicians accounts for pregorexia’s poor detection and management 4.
Furthermore, literature remarkably highlighted the associations between disordered eating during pregnancy and maternal psychological distress (anxiety, stress, depression) 16,23, emphasizing the threatening impact of these conditions on mental health. In light of these facts, our role as researchers is only fulfilled when we provide healthcare professionals with an efficient and accurate screening tool for the early detection of pregorexia’s cognitive tendencies and toxic behaviors, in order to optimize diagnostic and treatment procedures, hence circumventing fatal repercussions. However, for this sake, it is only in 2019 that Bannatyne et al. generated a brief pregnancy-specific instrument in furtherance of screening for antenatal eating disorders: the DEAPS (Disordered Eating Attitudes in Pregnancy Scale), which demonstrated a high level of internal consistency and good validity 17, and whose items were selected according to the results of their Delphi study that distinguished disordered symptomatology from the normal anodyne pregnancy-induced changes in eating habits 24. In order to be applied among Lebanese pregnant women, its cross-cultural adaptation requires a translation process into Arabic (Lebanon’s native language). Therefore, our study's objective was to linguistically validate and examine the reliability and psychometric properties of the Arabic version of this previously established pregnancy-specific scale among Lebanese pregnant women.