Identification and management of eating disorders in pregnancy: a multi-method study of maternity and health visiting services

Student thesis: Doctoral ThesisDoctor of Philosophy


Pregnant women with current and past eating disorders (ED) have heightened risk of adverse maternal and infant outcomes, so it is imperative women are identified and receive enhanced care during and after pregnancy to promote optimal outcomes. However, following recent changes to the classification of ED, it is unclear how many pregnant women have had ED and research is needed to understand the barriers to their care in maternity and health visiting services. A multi-method approach, comprising of four studies, was employed to: (1) investigate the prevalence of ED in pregnant women; and (2) explore the barriers to care from the perspectives of women, midwives and health visitors. Study one found the prevalence of ED before and during pregnancy were 8.8% and 6.7%, respectively, using a self-report questionnaire in 1,022 pregnant women. Study two estimated population prevalence for lifetime and current ED of 15.3% (95% CI, 11.80-19.71%) and 1.4% (95% CI, 0.64-3.35%), respectively, using diagnostic interviews in 543 pregnant women. Study three, which collated survey data from 103 pregnant and postnatal women, found disclosure of ED was low due to perceptions of poor awareness, stigma, lack of continuity in carer and limited capacity in maternity services. Study four, using a two-phased design with questionnaires (N = 265) and focus groups (N = 33) in midwives and health visitors, found the main barriers to identifying and caring for women with ED were insufficient training and related practice. The findings indicate a significant proportion of pregnant women will have had ED, yet women will often be poorly identified and receive inadequate care in maternity and health visiting services. Future research should aim to develop strategies that address the barriers identified in this research to improve care for pregnant and postnatal women with ED to promote optimal outcomes for mother and child.
Date of Award29 Jun 2020
Original languageEnglish
Awarding Institution
  • University College London
SupervisorNadia Micali (Supervisor), Jill Shawe (Supervisor), Debra Bick (Supervisor) & Paul Robinson (Supervisor)


  • eating disorders
  • pregnancy
  • Health services & community care services
  • multi-method
  • mixed methods

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