PEA-Q: The First Validated Tool to Measure Pregnancy-Specific Eating and Weight Attitudes

The Pregnancy Eating Attitudes-Questionnaire (PEA-Q) is a brief, 11-item self-report survey that measures pregnancy-specific attitudes and beliefs about eating and weight gain. It fills a longstanding gap in perinatal research and clinical care by offering the first psychometrically validated instrument designed specifically to capture these attitudes across all stages of pregnancy.

Description

The PEA-Q assesses three related but distinct dimensions of pregnancy-related eating and weight attitudes: Permissive Eating and Weight Attitudes (relaxed attitudes toward food type/amount and uncertainty about appropriate weight gain), Intentional Eating Changes (perceived need to increase food intake during pregnancy), and Lack of Worry about Eating and Weight (reduced concern about eating and weight gain during pregnancy). Respondents rate each of the 11 items on a 5-point Likert scale (Strongly Disagree to Strongly Agree), and item scores are averaged within each factor to generate three subscale scores. What distinguishes the PEA-Q is its specificity to the pregnancy context and its brevity. Rather than adapting general disordered-eating measures or focusing narrowly on weight alone, the PEA-Q was built from the ground up using both literature review and direct input from clinicians and researchers working with pregnant patients, then refined through exploratory factor analysis. Longitudinal testing further demonstrated that the instrument performs consistently from early through late pregnancy, meaning it can reliably track how these attitudes shift over the course of gestation rather than only offering a single-timepoint snapshot.

Applications

- Clinical screening tool for obstetric and maternal health practices to identify patients who may benefit from nutrition or weight-gain counseling
- Outcome measure for perinatal health and behavioral intervention research studies
- Assessment component in digital health platforms or apps focused on prenatal wellness and nutrition
- Research instrument for pharmaceutical, nutrition, or consumer health companies studying maternal eating behavior
- Training and curriculum tool for maternal health provider education programs

Advantages

- Purpose-built for pregnancy, capturing normative attitudes (e.g., "eating for two," permissiveness around gestational weight gain) that general eating-attitude measures miss
- Demonstrated measurement invariance from early to late pregnancy, allowing valid tracking of attitude changes across the full 40 weeks
- Distinguishes normative pregnancy attitudes from disordered eating pathology, reducing risk of mislabeling typical pregnancy-related eating changes as pathological
- Validated in community samples of pregnant individuals with pre-pregnancy BMI ≥25, a population at elevated risk for adverse eating- and weight-related outcomes

Invention Readiness

The PEA-Q currently exists as a finalized 11-item questionnaire with an established three-factor structure, supported by exploratory factor analysis and longitudinal measurement invariance testing in two independent community samples of pregnant individuals with pre-pregnancy BMI ≥25. The measure has demonstrated acceptable-to-excellent internal consistency and model fit, along with convergent and discriminant validity against measures of gestational weight gain, dietary intake, and eating pathology. Both supporting studies have been published in the peer-reviewed journal Appetite. Further work is needed to confirm the factor structure via confirmatory factor analysis, establish psychometric performance across the full weight spectrum and more racially/ethnically and socioeconomically diverse populations, and evaluate its utility as a clinical screening tool with defined cutoff scores.

IP Status

Copyright

Related Publication(s)

Jouppi, Riley J., et al. "Pregnancy Eating Attitudes-Questionnaire (PEA-Q): Longitudinal measurement invariance from early to late pregnancy in a community sample." Appetite (2025): 108421. https://doi.org/10.1016/j.appet.2025.108421

Call, Christine C., et al. "Pregnancy Eating Attitudes-Questionnaire (PEA-Q): Exploratory factor analysis and psychometric performance in a pregnant community sample with body mass index≥ 25." Appetite 206 (2025): 107828. https://doi.org/10.1016/j.appet.2024.107828