International Journal of Eating Disorders: The Association between Preconception Loss of Control Over Eating and Depressive Symptom Trajectories from Childhood through First Pregnancy

Loss of control over eating (the ingestion of food accompanied by the perception of being unable to control the amount of food consumed) is the core psychological phenomenon associated with binge eating.  Loss of control over eating during pregnancy impacts prenatal health and often co-occurs with depressive symptoms. Importantly, both loss of control over eating and depression during pregnancy confer risk for poor maternal health and adverse birth outcomes, and among offspring, risk for developmental delays and health difficulties later in life. 

To improve our understanding of when the association between depressive symptoms and loss of control over eating is most relevant, investigators including Kelsey Magee, PhD (postdoctoral scholar); Alison Hipwell, PhD, ClinPsyD (Professor of Psychiatry and Psychology); and Michele Levine, PhD (Professor of Psychiatry and Obstetrics, Gynecology, and Reproductive Sciences, and Psychology), from Pitt Psychiatry, examined the associations between depressive symptoms trajectories and loss of control over eating prior to a person’s first pregnancy. The study is published in the International Journal of Eating Disorders.

“While we recognize that loss of control over eating around pregnancy increases risk for maternal health problems, less is known about early, preconception risk factors for problematic eating during the perinatal period. The longitudinal Pittsburgh Girls Study provided us with a unique opportunity to identify patterns of depressive symptoms across childhood and adolescence that increase risk for disordered eating within the year prior to conception that can be targeted by preventative interventions to improve maternal and child health,” said Dr. Magee, the study’s first author.

The scientists examined data from 1,031 predominantly Black first-time mothers enrolled in the Pittsburgh Girls Study. Participants completed the Children's Eating Attitudes Test, a self-report questionnaire that assesses eating attitudes and behaviors and includes one item assessing the frequency of binge eating. Depressive symptoms from childhood through first pregnancy were measured via caregiver report, and later via self-report. Height and weight in the year prior to pregnancy, and gestational weight gain data were abstracted from medical records. 

More than a quarter of child-bearing participants reported loss of control over eating since childhood. Among the participants that endorsed loss of control over eating, 76% reported experiencing loss of control over eating at least once across the period from childhood, through adolescence, and young adulthood, whereas about 24% reported loss of control over eating in the year prior to first pregnancy, a period when the risks associated with disordered eating may be detrimental to both maternal and fetal health. In the entire sample, results confirmed the investigators’ hypothesis that trajectories of depressive symptoms from childhood through first pregnancy would be associated with loss of control over eating.

“Examining eating behaviors prior to conception can highlight targets for interventions to improve maternal mental health. However, it’s rare to have the ability to characterize preconception health. Using the well characterized Pittsburgh Girls Study sample, we found that the experience of a loss of control over eating during the year prior to conception was linked to depressive symptoms, which validates the importance of understanding eating behaviors in the perinatal period, a key correlate of maternal mental and physical health.” said Dr. Levine, the study’s senior author. 

The association between preconception loss of control over eating and depressive symptom trajectories from childhood through first pregnancy
Magee KE, Qu Y, Cheng Y, Hipwell AE, Levine MD
International Journal of Eating Disorders. 2023;1–6. DOI: 10.1002/eat.24004