Validation of the intuitive Eating Scale for pregnant women Sajeevika Saumali Daundasekara a, * , Anitra Danielle Beasley b , Daniel Patrick O'Connor a , McClain Sampson c , Daphne Hernandez a , Tracey Ledoux a a Department of Health and Human Performance, University of Houston, 3875 Holman Street, Garrison Gym, Room 104, Houston, TX 77204-6015, USA b Obstetrics and Gynecology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA c Graduate College of Social Work, The University of Houston,110HA Social Work Building, Houston, TX 77204-4013, USA article info Article history: Received 17 August 2016 Received in revised form 30 January 2017 Accepted 2 February 2017 Available online 3 February 2017 Keywords: Intuitive eating Pregnant women Intuitive eating scale Validation Confirmatory factor analysis abstract Pre-pregnancy maladaptive eating behaviors have predicted inadequate or excess gestational weight gain and poor dietary intake during pregnancy, but little is known about effects of pre-pregnancy adaptive eating behaviors on pregnancy outcomes. The purpose of this study was to produce a valid and reliable measure of adaptive pre-pregnancy eating behaviors for pregnant women using the Intuitive Eating Scale. Data were collected from 266 pregnant women, aged 18 and older who were attending a private prenatal clinic at Texas Children's Hospital Pavilion for Women in Houston, TX using self- administered questionnaires. Confirmatory factor analysis was performed to validate the factor struc- ture of the Intuitive Easting Scale (IES). Concurrent validity was determined using correlations between the three subscale scores [unconditional permission to eat (UPE), eating for physical not emotional reasons (EPR), and relying on hunger/satiety cues (RIH)], perinatal depression status (Edinburgh Post- natal Depression Scale), and pre-pregnancy body mass index (BMI) calculated from self-reported height and weight. After discarding 6 items, the second order model did not fit the data, however, the first order model with three latent factors had reasonable fit (RMSEA ¼ 0.097, CFI ¼ 0.961, TLI ¼ 0.951 and WRMR ¼ 1.21). The internal consistency of the scale was confirmed by Cronbach's alphas (UPE ¼ 0.781, EPR ¼ 0.878 and RIH ¼ 0.786). All subscale scores were inversely related to perinatal depression status. EPR and RIH subscale scores were inversely related to pre-pregnancy BMI, supporting the measure's validity. Among pregnant women, the revised 15 item pre-pregnancy IES (IES-PreP) should be used to evaluate pre-pregnancy adaptive eating behaviors. © 2017 Elsevier Ltd. All rights reserved. 1. Introduction The Institute of Medicine, Gestational weight gain (GWG) rec- ommendations for pregnancy is based on the pre-pregnancy body mass index (BMI). Women who are normal weight prior to preg- nancy are recommended to gain 11.5e16 kg, the recommendation for overweight women is 7e11.5 kg and for obese women it is 5e9 kg. Inadequate and Excessive GWG are used to describe weight gain below and above this recommendation respectively. Excess GWG and poor dietary intake are related to adverse health out- comes including postpartum weight retention, gestational diabetes, pregnancy induced hypertension, pre term deliveries, fetal growth restriction, fetal macrosomia, large for gestational age infants, neonatal hypoglycemia, and infant and childhood obesity (Dietrich, Federbusch, Grellmann, Villringer, & Horstmann, 2014; Grieger, Grzeskowiak, & Clifton, 2014; Margerison Zilko, Rehkopf & Abrams, 2010; Thangaratinam et al., 2012). According to 2012e2013 United States data, prevalence of inadequate GWG ranged from 12.6% to 25.5% and prevalence of excessive GWG ranged from 38.2% to 54.7%, while only 32.1% of women had adequate weight gain according to Institute of Medicine recom- mendations (Deputy, Sharma, & Kim, 2015). Additionally, a recent study showed that on average, pregnant women do not adequately conform to federal dietary guidelines (United States Department of Agriculture (USDA) Center for Nutrition Policy Promotion Promotion, 1995) with 40% of pregnant women not meeting the minimum recommended number of servings of most food groups, dietary fiber, calcium, vitamin D, iron and folate (Pick, Edwards, * Corresponding author. E-mail addresses: saumali88@gmail.com (S.S. Daundasekara), Anitra.Beasley@ bcm.edu (A.D. Beasley), dpoconno@central.uh.edu (D.P. O'Connor), mmsampson@ uh.edu (M. Sampson), dherna32@Central.UH.EDU (D. Hernandez), TALedoux@uh. edu (T. Ledoux). Contents lists available at ScienceDirect Appetite journal homepage: www.elsevier.com/locate/appet http://dx.doi.org/10.1016/j.appet.2017.02.001 0195-6663/© 2017 Elsevier Ltd. All rights reserved. Appetite 112 (2017) 201e209