Abstract
Hyperemesis gravidarum (HG) is a pregnancy condition characterised by debilitating nausea and vomiting. HG has been associated with depression during pregnancy but the direction of the association remains unclear. The aim of this study was to assess whether previous depression is associated with HG. This is a population-based pregnancy cohort study using data from The Norwegian Mother and Child Cohort Study. The study reviewed 731 pregnancies with HG and 81,055 pregnancies without. Logistic regression analyses were performed to examine the association between a lifetime history of depression and hyperemesis gravidarum. Odds ratios were adjusted for symptoms of current depression, maternal age, parity, body mass index, smoking, sex of the child, education and pelvic girdle pain. A lifetime history of depression was associated with higher odds for hyperemesis gravidarum (aOR = 1.49, 95% CI (1.23; 1.79)). Two thirds of women with hyperemesis gravidarum had neither a history of depression nor symptoms of current depression, and 1.2% of women with a history of depression developed HG. A lifetime history of depression increased the risk of HG. However, given the fact that only 1.2% of women with a history of depression developed HG and that the majority of women with HG had no symptoms of depression, depression does not seem to be a main driver in the aetiology of HG.
Highlights
Nausea and vomiting in pregnancy (NVP) is common and affects up to 80% of all pregnancies (Gadsby et al 1993)
The aetiology and the pathogenesis of hyperemesis gravidarum (HG) are unclear, and it remains unknown whether NVP and HG are independent conditions or if HG represents the extreme of a continuum of NVP
In the binary logistic regression model, a lifetime history of depression was associated with higher odds for HG (unadjusted OR = 1.53, 95% CI (1.29; 1.83))
Summary
Nausea and vomiting in pregnancy (NVP) is common and affects up to 80% of all pregnancies (Gadsby et al 1993). HG has historically been explained by a variety of psychological mechanisms that have been subjected to stigma (Fairweather 1968). HG is today considered a disease of unclear pathophysiology (Grooten et al 2015), clinical practice still includes evaluation of hyperemetic women for psychiatric disease (Kim et al 2009). Women with HG report lack of support from their healthcare providers (Heitmann et al 2016; Poursharif et al 2008), which may have severe consequences such as termination of pregnancy and psychological sequelae (Poursharif et al 2008; Poursharif et al 2007)
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