Individual and contextual factors associated with orthorexia nervosa tendency during pregnancy.

backgroundOrthorexia nervosa (ON) refers to a pattern of excessive preoccupation with healthy eating rather than an established clinical diagnosis. Interest in orthorexia-related eating attitudes has increased during pregnancy, a period characterized by heightened nutritional awareness and health-related responsibility. However, evidence regarding the psychosocial, behavioral, and contextual factors associated with such eating attitudes in pregnant women remains limited. This study aimed to examine individual and contextual psychosocial and behavioral factors associated with orthorexia-related eating attitudes during pregnancy.

methodsThis descriptive cross-sectional study was conducted between November 5, 2022 and July 5, 2023 in the obstetrics outpatient clinic and non-stress test unit of a state hospital in Türkiye. A total of 480 pregnant women aged ≥ 18 years with healthy singleton pregnancies participated. Data were collected through face-to-face interviews using the Pregnant Woman Information Form, the Orthorexia Nervosa-11 Scale (ORTO-11), the Pregnancy Self-Perception Scale, and the Brief Psychological Resilience Scale. The ORTO-11 was analyzed as a continuous measure of eating-related attitudes rather than a diagnostic instrument, and lower scores indicate stronger orthorexia-related eating attitudes. Group comparisons were conducted using independent samples t-tests and one-way analysis of variance (ANOVA). Associations between variables were evaluated using Pearson correlation analysis. Variables associated with ORTO-11 scores were examined using hierarchical multiple linear regression analysis.

resultsThe mean age of the participants was 28.79 ± 5.02 years, and age was not associated with ORTO-11 scores. Weak correlations were observed between ORTO-11 scores and body mass index and pre-pregnancy weight. Lower ORTO-11 scores (indicating stronger orthorexia-related eating attitudes) were observed among women with higher educational level, persistent nausea and vomiting, discontinuation of dietary supplements, and avoidance of caffeine intake. More frequent pregnancy-related information seeking and discussions with family or friends were also associated with lower ORTO-11 scores. Several psychosocial variables, including pregnancy-related fear, health anxiety, maternal self-perception, partner relationship quality, partner support, and perceived social support, showed weak but statistically significant correlations with ORTO-11 scores. In hierarchical multiple regression analysis, sociodemographic and obstetric variables explained a limited proportion of variance, whereas psychological and behavioral variables contributed additional explanatory value. The final model explained 19.9% of the variance in ORTO-11 scores (adjusted R² = 0.159, p < 0.001). After adjustment, higher educational level, higher pregnancy-related fear, lower maternal self-perception, more frequent pregnancy-related information seeking, and changes in caffeine consumption remained independently associated with ORTO-11 scores.

conclusionOrthorexia-related eating attitudes during pregnancy appear to occur within a multidimensional biopsychosocial context rather than being explained by obstetric or medical characteristics alone. Given the modest effect sizes and the limited proportion of explained variance, these findings should be interpreted as context-dependent eating-related attitudes rather than evidence of a clinical disorder. Accordingly, the ORTO-11 should not be considered a diagnostic or screening indicator in pregnant populations based on the present data.The findings describe associative patterns observed in a clinical sample, and their clinical relevance and temporal direction require confirmation in longitudinal and population-based studies before any screening or intervention implications can be considered.