Abstract

Objective. During pregnancy, the body undergoes extreme changes that can lead to dissatisfaction and a loss of self-esteem. This vulnerability arises from objective physical changes and societal pressures to conform to beauty norms. This study aimed to investigate the presence of eating symptoms and their association with depression and anxiety in a sample of Italian pregnant women.

Methods. An ad hoc online survey investigated eating symptoms (Eating Disorder Examination Questionnaire, EDE-Q), depressive symptoms  (Patient Health Questionnaire-9, PHQ-9), and anxiety symptoms  (General Anxiety Disorder-7, GAD-7). Correlations and multistep linear regression analyzed associations between eating symptoms, depression, and anxiety.

Results. Within our sample  (N = 711), one in ten subjects reported eating symptoms during pregnancy, with nearly half experiencing symptoms indicative of anxiety and depression. Eating symptoms were found to be associated with anxious-depressive symptoms and with a history of depression.

Conclusions. The conspicuous prevalence of eating symptoms, associated with depression and anxiety, suggests considering the issue of body experience as an indicative marker of perinatal emotional distress. This justifies the need for in-depth exploration within clinical settings, where opportunities for therapeutic interventions can be explored.

INTRODUCTION

During pregnancy, women undergo significant anatomical and physiological changes to accommodate increasing physical and metabolic demands, necessitating adaptations across various body systems 1. These changes are accompanied by profound hormonal shifts and interactions with the developing fetus, which induce complex alterations in brain structure 2. While these adjustments serve adaptive purposes in preparation for the caregiving role, they also elevate vulnerability to mental disorders during the peripartum period 2. Pregnancy represents a critical phase of higher mental health vulnerability, characterized by a spectrum of symptoms and disorders such as depression, anxiety, and self-harm 3. Extensive research has focused on mood disorders and psychosis in pregnancy 4,5. Specifically, numerous studies show that 23% of pregnant women experience anxiety, with the prevalence of anxiety disorders being 15% 6. Additionally, 13% of pregnant women suffer from mood disorders 7.

In addition to psychological challenges, pregnant women often experience significant increases in body mass index (BMI) and adiposity, which may contribute to feelings of dissatisfaction as they face acceptance of their evolving shape and size within a relatively short period 8,9. Body dissatisfaction during pregnancy refers to negative feelings, frustrations, or concerns about physical appearance during the prenatal period 10. While previous research has suggested that women generally adapt favorably to pregnancy body changes and have less concern about body weight 11, more recent studies indicate increasing dissatisfaction with body weight during pregnancy 12,13. Causes for this phenomenon include objective changes in body shape, size, and appearance but also the increasing pressure to conform to societal expectations regarding pregnancy and peripartum body appearance, which can lead to disappointment if expectations are not met 14-16. Recent investigations suggest that approximately one-third of pregnant women experience dissatisfaction with their body image 17.

Body dissatisfaction is recognized as a significant risk factor and contributor to eating disorders (EDs) 18,19. The prevalence of active EDs during pregnancy varies considerably, ranging from 1.9% to 7.6%, while lifetime prevalence estimates range from 3.3% to 18.6% 20-26,17. Debates continue regarding variations in EDs during pregnancy, with some studies suggesting that ED symptoms tend to diminish to prioritize fetal well-being 27,28, while others indicate that can lead to a resurgence of ED symptoms 29,27, influenced by cultural and social factors. Postpartum periods often exacerbate the risk of some ED, with increased risks of relapse and symptoms such as binge eating 30,26,31. Despite the high prevalence of EDs during pregnancy, international research in this area remains limited, primarily focusing on the potential of EDs to predict mood and anxiety symptoms 32-38,17.

In Italy, pregnancy and motherhood are deeply rooted in cultural traditions, emphasizing the importance of these roles within society 39,40. As a result, pregnant women are often viewed as particularly vulnerable and are culturally advised to prioritize rest and reduce physical activity to ensure the safety and well-being of the fetus 40. Such advice is often accompanied by a network of social support, where family and community members play a significant role in assisting and caring for pregnant women39. This traditional approach, while aimed at safeguarding maternal and fetal health, also shapes the overall experience of pregnancy, influencing behaviors and expectations during this critical period 39,41. Research on mental health in Italian pregnant women has primarily focused on anxiety, depression, and psychosis 42-46, with limited attention to EDs. The few existing studies involving Italian pregnant women have examined the association between obesity, body dissatisfaction, and eating symptoms 47,48. Additionally, research in Italy has shown associations between BMI fluctuations during pregnancy and the presence of eating symptoms, highlighting potential health implications associated with excessive weight gain 48,49. A notable Italian study found that EDs, subthreshold EDs, and body satisfaction improved during mid-pregnancy but returned to baseline levels post-delivery 50.

To our knowledge, no prior studies in Italy have specifically investigated eating symptoms using pregnancy-adapted questionnaires. Our study aims to fill this gap by exploring these aspects for the first time. The main objectives of our research are (1) to assess the presence of eating symptoms in a sample of Italian pregnant women and (2) to examine their associations with symptoms of depression and anxiety.

MATERIALS AND METHODS

Study design and participants

We conducted an ad hoc cross-sectional online survey using Google Forms, administered from May 5, 2022, to June 5, 2022. The survey link was distributed through social media platforms such as Facebook, WhatsApp, and Instagram. Participants were required to meet specific inclusion criteria: (a) being pregnant, (b) being of legal age, (c) having proficiency in Italian, (d) being able and willing to provide informed consent, and (e) completing all sections and questions of the survey. The study adhered to the ethical principles outlined in the Declaration of Helsinki.

Procedures and measures

The survey comprised four main sections addressing different domains. The first section focused on sociodemographic information, including age, nationality, educational level, and occupation. Multiple-choice categories were aligned with data from CedAP, an annual report by the Italian Ministry of Health that provides detailed analyses on births, maternal demographics, and infant-related statistics 51. The second section explored pregnancy-related factors through multiple-choice questions regarding primiparity status, current gestation trimester, and any reported pregnancy risks. The third section centered on weight and nutrition, featuring questions about previous and current BMI, monitoring of excessive weight gain during pregnancy through gynecological follow-up, and histories of diabetes, arterial hypertension, and obesity. The fourth section regarded into mental health, using multiple-choice questions to assess self-reported histories of major depressive disorder (MDD), anxiety disorder (AD), personality disorder (PD), anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Additionally, standardized instruments such as the Eating Disorder Examination Questionnaire (EDE-Q) 52, Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms 53, and General Anxiety Disorder-7 (GAD-7) for anxiety symptoms 54 were employed to evaluate eating symptoms, depression, and anxiety, respectively.

The EDE-Q is the self-report questionnaire derived from the EDE, a semistructured interview that is considered the gold standard for the assessment of ED psychopathology (Fairburn and Beglin, 1994; Luce et al., 2008). The EDE-Q 6.0 consists of 28 questions that investigate the frequency of ED core symptoms over the past 28 days. The EDE-Q global score is based on four subscale scores (Restraint, Eating Concern, Weight Concern, and Shape Concern) designed to reflect the main features of ED psychopathology. We used an optimized version of the EDE-Q 6.0 designed for the prepartum period 55,30. This optimized version of the EDE-Q excludes items 6 (flat stomach), 19 (eating in secret), and 24 (reaction to prescribed weighting), as well as items 13 to 18, which do not contribute to the scores. A total score cutoff of ≥ 2.8 was used to suspect eating/self-image concerns, as recommended in primary settings 56.

The PHQ-9 is a self-administered tool for assessing the severity of depression 53. It consists of nine questions based on the nine DSM IV criteria for diagnosing MDD. Each item can be scored from 0 (not at all) to 3 (nearly every day), reflecting the frequency of the symptom. In general settings, the standard cutoff value ≥ 10 is optimal for identifying major depression 57. The authors of the scale used the following cut points to divide the PHQ-9 scores into categories of increasing severity: 5 (mild), 10 (moderate), 15 (moderately severe), and 20 (severe). The PHQ-9 has also been validated in pregnant populations 58.

The GAD-7 is a self-report questionnaire used to screen the presence and monitor the severity of anxiety symptoms 54. It consists of seven questions that represent specific anxiety-related symptoms. The respondents rate how often they have experienced each symptom over the past two weeks on a scale from 0 (not at all) to 3 (nearly every day). Scores of 5, 10, and 15 are taken as the cutoff points for mild, moderate, and severe anxiety, respectively. The GAD-7 has been validated for screening purposes among pregnant women 59.

Statistical analysis

Data analysis was performed using Statistical Package for Social Science for MacOS (SPSS) software, Version 24.0 (IBM Corp, Armonk, NY). Categorical variables were summarized as frequencies and percentages (N; %), and continuous variables were reported as the mean and standard deviation (SD). After analyzing the continuous variables for skewness, kurtosis, and normality distribution through the Shapiro-Wilk test, parametric or nonparametric statistical tests were used when appropriate. We employed Kruskal-Wallis and Mann-Whitney U tests to assess differences in mean scores of eating symptoms across distinct categories of primiparity, trimester, and pregnancy risk. We used Kendall’s Tau correlations and linear regressions to investigate the relationship between eating symptoms and the mental health domain, controlling for a set of variables. In particular, to address potential confounding factors, we performed Kendall’s linear regression analyses while controlling for four sets of variables: sociodemographic (including age, nationality, educational level, and occupation), pregnancy-related (such as parity, trimester, and risk-related pregnancy), weight-nutritional (comprising BMI, expected weight gain, and self-reported history of metabolic syndrome), and psychological factors (self-reported history of MDD, AD and ED). The level of significance was set at α ≤ 0.05, and all hypotheses were two-tailed.

RESULTS

Sample characteristics

The findings of the descriptive analysis encompassing sociodemographic, pregnancy-related, weight-nutritional, and mental health domains are summarized in Table I. The study included a total of 711 pregnant women with an average age of 30.8 years (± SD = 4.6). The vast majority of the sample reported being Italian (n = 674; 94.9%). In relation to educational attainment, a substantial proportion of the participants held a bachelor’s degree (n = 338; 47.5%) or possessed a high school diploma (n = 316; 44.4%). Employment status indicated that the majority were employed (n = 577; 81.2%), with smaller percentages reporting being a homemaker (n = 56; 7.9%), unemployed (n = 62; 8.8%), or student (n = 16; 2.3%).

In the domain of pregnancy-related factors, the majority of women were primiparae (n = 514; 72.3%). The distribution across pregnancy trimesters revealed a higher representation in the second trimester (n = 314; 44.2%), followed by the third trimester (n = 266; 37.4%) and the first trimester (n = 131; 18.4%). The majority of subjects reported having a low-risk pregnancy (n = 571; 80.3%).

Regarding the weight-nutritional domain, the analysis indicated that 60.9% of the sample (n = 433) possessed a normal prepregnancy weight, with an average prepregnancy BMI of 24.1 kg/m2 (SD ± 5). Weight gain during pregnancy was predominantly reported as expected (n = 345; 48.5%), with smaller proportions indicating weight gain slightly above expectations (n = 156; 21.9%), significantly higher (n = 52; 7.3%), slightly lower (n = 108; 15.2%), and much lower (n = 50; 7%). A minority of the sample reported a medical history comprising diabetes (n = 32; 4.5%), arterial hypertension (n = 9; 1.3%), and obesity (n = 42; 5.9%), collectively characterized as metabolic syndrome (n = 76; 10.7%).

The mental health domain, as outlined in Table I and Table II, revealed that one-fifth of the sample had a history of AD (n = 154; 21.7%), while a smaller proportion reported a history of MDD (n = 48; 6.8%). The data pertaining to diagnoses of ED included BED (n = 16; 2.3%), BN (n = 14; 2%), and AN (n = 13; 1.8%). Based on the PHQ-9 scores, 17% (n = 121) manifested symptoms indicative of moderate depression, 4.5% (n = 32) exhibited moderate-severe depression, and 1.1% (n = 8) indicated severe depression. Based on GAD-7 scores, 47.3% (n = 336) reported mild anxiety symptoms, 14.6% (n = 104) experienced moderate anxiety, and 8% (n = 57) presented severe anxiety symptoms.

Eating symptoms

The EDE-Q scores revealed the presence of general eating symptoms (n = 69; 9.7%), restraint (n = 47; 6.6%), eating concern (n = 61; 8.5%), weight concern (n = 92; 12.9%), and shape concern (n = 116; 16.3%) in approximately a tenth of the sample. Kruskal-Wallis and Mann-Whitney Tests revealed no significant differences in levels of eating symptoms, eating concern, weight concern, and shape concern across different trimesters and pregnancy risk groups. However, the Mann-Whitney test identified a statistically significant difference in the levels of eating symptoms between primiparae and pluriparae (U = 44,706.000; p = 0.016). Specifically, 8.9% (n = 46) of primiparae and 11.7% (n = 23) of pluriparae exhibited relevant levels of general eating symptoms.

Association between eating symptoms, depression, and anxiety

Positive correlations were identified between EDE-Q scores and PHQ-9 scores (r = 0.297; p < 0.01), as well as GAD-7 scores (r = 0.268; p < 0.01). Additionally, statistically significant correlations were observed with a previous history of MDD (r = 0.071; p < 0.05) and a previous history of AD (r = 0.097; p < 0.01). Similarly, positive correlations were ascertained between EDE-Q subscales and PHQ-9 scores, GAD-7 scores, and reported history of MDD or AD.

Unadjusted linear regression analyses conducted on these paired variables (Tab. III) reaffirmed the significant associations between EDE-Q scores and PHQ-9 scores (β = 1.528; SE = 0.128; t = 11.975; p < 0.001; F (1, 709) = 143.400; R2 = 0.167), GAD-7 scores (β = 1.379; SE = 0.144; t = 9.544; p < 0.001; F (1, 709) = 91.090; R2 = 0.113), a reported history of MDD (β = 0.022; SE = 0.008; t = 2.589; p < 0.05; F (1, 709) = 6.705; R2 = 0.008), and a reported history of AD (β = 0.029; SE = 0.014; t = 2.061; p < 0.05; F (1, 709) = 4.246; R2 = 0.005).

Adjusted linear regression analyses (Tab. IV) confirmed the statistically significant association between EDE-Q scores and PHQ-9 scores (β = 0.102; SE = 0.009; t = 10.775; p < 0.001; F (17, 692) = 13.344; R2 = 0.228), GAD-7 scores (β = 0.074; SE = 0.009; t = 8.322; p < 0.001; F (17, 692) = 10.211; R2 = 0.181), and a reported history of MDD (β = 0.367; SE = 0.170; t = 2.164; p < 0.05; F (16, 693) = 5.936; R2 = 0.100). Conversely, the association between EDE-Q scores and the reported history of AD lost statistical significance.

DISCUSSION

Our study enrolled 711 pregnant women, predominantly of Italian nationality and with an average age of 30.8 years. The prevalence of eating symptoms, including general symptoms (9.7%), restraint (6.6%), eating concern (8.5%), weight concern (12.9%), and shape concern (16.3%), varied across the sample. Significant differences in eating symptoms were found between primiparae (8.9%) and pluriparae (11.7%). Additionally, we observed a positive association between measures of eating symptoms and various indicators of mental health. Specifically, higher scores on assessments of eating symptoms correlated with elevated scores on measures of depressive and anxiety symptoms, as well as with a history of MDD and AD. Adjusted analyses further underscored these relationships, revealing significant associations between eating symptoms and both depressive and anxiety symptoms, along with a history of MDD.

Our study showed a slightly lower prevalence of eating symptoms within our population (approximately 10%) compared to previous studies, which have reported eating symptoms in up to one-quarter to one-third of pregnant individuals 20,17. Conversely, concerns regarding restrictive behaviors and food-related issues were less prevalent, affecting less than 10% of the individuals. Approximately 4.6% of our sample had a documented history of ED, consistent with epidemiological data regarding the lifetime prevalence of EDs in Western countries 60. Although previous research documented an increase in body dissatisfaction during the course of pregnancy 38, our study showed that the trimester of pregnancy and pregnancy risk may not substantially impact eating symptoms.

Our findings contribute to the existing literature by highlighting the association between depression, anxiety, and eating symptoms during pregnancy. This relationship has been previously noted in research linking eating symptoms to perinatal depression or anxiety 61,35,32,62,38. Consistent with prior findings, our results underscore a robust connection between eating symptoms and symptoms of anxiety and depression among pregnant women. It is well-documented that individuals with EDs frequently experience psychiatric comorbidities, notably mood and anxiety disorders 63-66. Perinatal depression often presents with higher anxiety symptoms compared to non-perinatal depression, highlighting the significant role of anxiety in peripartum depression 67,68. The overlapping symptoms among anxiety, depression, and EDs suggest tortuous interrelationships between these factors 32,35,17.

This interconnectedness is likely influenced by the emotional dynamics inherent in pregnancy and the available support network for women 69,70. When emotional conflicts are not adequately addressed, they may manifest through concerns about body image, which can obscure underlying psychological issues. Recognizing and addressing these complexities underscores the significance of considering societal and cultural factors that shape maternal experiences during the perinatal period 71,72. During the peripartum period, there exist strong societal pressures to maintain an idealized body appearance 73,74,15, despite the natural body changes that occur during pregnancy and postpartum. These unrealistic expectations can be exacerbated by exposure to social media and prevailing body image trends, which contribute to negative moods, feelings of guilt, and ultimately body dissatisfaction 75-79.

Clinical implications of our findings emphasize the importance of broadening mental health assessments during pregnancy beyond the typical focus on anxiety, depression, and psychosis 80-83,6. Our study reveals the significant relevance of eating symptoms alongside these conditions, highlighting the need for thorough evaluation of EDs during pregnancy 22. Addressing these issues comprehensively is essential not only for maternal well-being but also for the health of the offspring. Research indicates that high maternal stress during pregnancy and preterm delivery can increase the risk of offspring developing eating symptoms 84. Additionally, maternal nutrition plays a critical role in placental and fetal organ development, pregnancy outcomes, and offspring well-being 85. To effectively manage these complexities, routine screening for eating symptoms alongside assessments could help in identifying the presence of EDs and assessing the risk of relapse 86,87. Women identified with EDs should receive specialized care from multidisciplinary ED services during pregnancy and the postnatal period. This comprehensive approach should include guidance on healthy infant feeding practices and weaning strategies 86.

This study has several strengths, including the fact that it is, to our knowledge, the first to apply the optimized version of the EDE-Q 6.0 specifically to an Italian sample of pregnant women, it benefits from a large sample size (N = 711), and it addresses a relatively unexplored topic in Italy. At the same time, we must acknowledge some limitations.. First, our investigation may underestimate the true prevalence of eating symptoms among pregnant women. This is in accordance with prior research, such as Bye et al. (2018) 86, which suggests that some participants may have been hesitant to openly discuss their symptoms during research interviews, possibly due to fear of social stigma. Second, our study is susceptible to selection bias, primarily attributable to the recruitment method employed, which relied on online platforms and social media. This approach may not yield a comprehensive representation of the broader population of pregnant women. Our study predominantly captured responses from Italian participants, typically around 30 years of age, characterized by elevated educational attainment and active employment status. This sample composition introduces a notable degree of bias into our findings. Future research should seek to expand the sample’s diversity and inclusiveness by implementing a more targeted approach to data collection, such as administering the questionnaire within specific settings like pregnancy outpatient services, neighborhood social services, or other relevant contexts. Third, we must address the limitations associated with the use of the EDE-Q in our study. While the EDE-Q is a widely used tool for assessing EDs and eating symptoms, it is not formally validated for use during pregnancy. Furthermore, the utilization of an optimized truncated version of the EDE-Q in our research, although potentially indicative of eating symptoms, cannot replace the diagnostic capabilities of the comprehensive 36-item version. Consequently, the findings, while valuable, should be interpreted with caution, particularly in the context of diagnosing EDs during pregnancy. Further research utilizing validated instruments specific to pregnancy may be necessary to provide a more accurate assessment of eating symptoms in this population.

CONCLUSION

In conclusion, this study highlights the significant prevalence of eating symptoms during pregnancy. Our findings reveal a strong connection between eating symptoms and affective symptoms related to anxiety and depression, emphasizing the primary influence of internal emotional experiences on body image perceptions. This association underlines the peculiar nature of psychopathological experiences during pregnancy, calling for increased clinical attention. Consequently, a thorough approach to maternal mental health care during pregnancy and the postpartum period is essential. Further research using a representative sample and validated tools tailored to the specific contexts of pregnancy is necessary to deepen our understanding of eating symptoms in this demographic and to develop more effective clinical interventions.

Acknowledgments

We would like to thank Fondazione Gruber for constant support.

Conflict of interest statement

The authors declare no conflict of interest.

Funding

The authors declare that no funds, grants, or other support were received in relation to the preparation of this manuscript.

Ethical consideration

Referring to the Italian Legislative Decree no. 211/2003, no ethical approval is required in Italy for observational studies as they are not defined as medical/clinical research. This study complied with the Declaration of Helsinki and with the Italian privacy law, specifically the ‘Code on the protection of personal data (Legislative Decree 196/2003), updated with the new legislative decree (Legislative Decree 101/2018).’ The statistical evaluation of collected data was carried out after complete anonymization.

Author contributions

Conceptualization, A.R.A., M.M., S.T.V., S.A., and V.B.; methodology, S.T.V. and S.A.; formal analysis, S.T.V.; investigation, A.A. and S.A.; data curation, S.T.V.; writing—original draft preparation, S.T.V. and A.A.; writing—review and editing, A.R.A. and M.M.; supervision, D.D.R. All the authors have read and approved the final manuscript.

The authors acknowledge the use of ChatGPT as a tool to improve the English grammar and refine the language of this manuscript. ChatGPT was not used to contribute to the conceptualization, analysis, or content generation of the study. All ideas, data, and conclusions presented in this work are the authors’ own.

Data Availability statement

The dataset analyzed during the current study is available from the corresponding author upon request.

Figures and tables

Sociodemographic domain
Variable Answer n %
Age (years old) ≤ 20 6 0.9
20-29 265 37.3
30-39 412 57.9
≥ 40 28 3.9
Average age (years old ± SD) 30.8 ± 4.6
Nationality Italian 674 94.9
Other 36 5.1
Educational level Inferior middle license 57 8.1
Superior middle license 316 44.4
University degree 338 47.5
Occupation Employed 577 81.2
Homemaker 56 7.9
Unemployed 62 8.8
Student 16 2.3
Pregnancy domain
Variable Answer n %
Primiparity Yes 514 72.3
Trimester First 131 18.4
Second 314 44.2
Third 266 37.4
Low-risk pregnancy Yes 571 80.3
Weight-nutritional domain
Variable Answer n %
Pregravidic BMI category Normal weight 433 60.9
Overweight 152 21.4
Obesity I 52 7.3
Obesity II 20 2.8
Obesity III 9 1.3
Underweight 45 6.3
Average Preg. BMI (kg/m2 ± SD) 24.1 ± 5.0
Weight gain as expected Yes 345 48.5
Slightly more 156 21.9
Significantly more 52 7.3
Slightly less 108 15.2
Significantly less 50 7
History of Metabolic Syndrome Yes 76 10.7
History of Diabetes Yes 32 4.5
History of Hypertension Yes 9 1.3
History of Obesity Yes 42 5.9
Psychic domain
Variable Answer n %
History of AD Yes 154 21.7
History of MDD Yes 48 6.8
History of AN Yes 13 1.8
History of BN Yes 14 2
History of BED Yes 16 2.3
Legend. AD, anxiety disorder; AN, anorexia nervosa; BED, binge eating disorder; BMI, body mass index; BN, bulimia nervosa; GAD-7, general anxiety disorder-7; MDD, major depressive disorder; Preg., pregnancy; SD, standard deviation.
TABLE I. Results of descriptive analysis regarding sociodemographic, pregnancy, weight-nutritional and psychic domains.
Psychic assessment
Scale Clinical relevance N %
PHQ-9 Nonsignificant depression 234 33
Mild depression 316 44.4
Moderate depression 121 17
Moderate-severe depression 32 4.5
Severe depression 8 1.1
GAD-7 Nonsignificant anxiety 214 30.1
Mild anxiety 336 47.3
Moderate anxiety 104 14.6
Severe anxiety 57 8
EDE-Q Total score* 69 9.7
Restraint* 47 6.6
Eating concern* 61 8.5
Weight concern* 92 12.9
Shape concern* 116 16.3
Legend. EDE-Q, Eating Disorder Examination Questionnaire; GAD-7, General Anxiety Disorder-7; PHQ-9, Patient Health Questionnaire-9; *, values above the threshold of clinical relevance (= 2.8).
TABLE II. Scores of depressive or anxious symptoms and body dissatisfaction during pregnancy.
β SE t p F R2
PHQ-9 1.528 .128 11.975 .000 143.400 .167
GAD-7 1.379 .144 9.544 .000 91.090 .113
MDD .022 .008 2.589 .010 6.705 .008
AD .029 .014 2.061 .040 4.246 .005
Legend. β, Nonstandardized regression coefficient; AD, Anxiety Disorder; F, F-statistic; GAD-7, General Anxiety Disorder-7; MDD, Major Depressive Disorder; p, Significance; PHQ-9, Patient Health Questionnaire-9; R2, R-squared; SE, Standard error; t, Significance of B coefficient.
TABLE III. Unadjusted Linear Regressions between EDE-Q (independent variable) and Depression and Anxiety (dependent variables).
β SE t p F R2
PHQ-9* .102 .009 10.775 .000 13.344 .228
GAD-7* .074 .009 8.322 .000 10.211 .181
MDD* .367 .170 2.164 .031 5.936 .100
AD* .056 .101 .555 .579 5.936 .100
Legend. β, Nonstandardized regression coefficient; AD, Anxiety Disorder; F, F-statistic; GAD-7, General Anxiety Disorder-7; MDD, Major Depressive Disorder; p, Significance; PHQ-9, Patient Health Questionnaire-9; R2, R-squared; SE, Standard error; t, Significance of B coefficient.
*Adjusted linear regression. Four sets of covariates were used: sociodemographic (including age, nationality, educational level, and occupation), pregnancy-related (such as parity, trimester, and low-risk pregnancy), weight-nutritional (comprising BMI, expected weight gain, and self-reported history of metabolic syndrome), and psychological factors (self-reported history of MDD, AD, ED)
TABLE IV. Adjusted Linear Regressions between EDE-Q (independent variable) and Depression and Anxiety (dependent variables).

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Silvia Tempia Valenta - Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy https://orcid.org/0009-0002-6295-0741

Anna Andreotti - Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy

Sofia Aldrovandi - Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy

Valentina Baldini - Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy

Marco Menchetti - Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy

Diana De Ronchi - Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy

Anna Rita Atti - Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy

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Tempia Valenta, S., Andreotti, A., Aldrovandi, S., Baldini, V., Menchetti, M., De Ronchi, D., & Atti, A. R. (2024). Beyond Expectations: Understanding Eating Symptoms and Mental Health Among Pregnant Women in Italy. Italian Journal of Psychiatry, 10(3). https://doi.org/10.36180/2421-4469-2024-587
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