Abstract
BackgroundDifficulty accessing medication and poor patient experience have been implicated as risk factors for termination of pregnancy and suicidal ideation in women with hyperemesis gravidarum. We aimed to gain further insight into these factors in order to further inform and improve patient care.MethodsWe performed a sub-analysis on quantitative data generated through a UK-wide survey of 5071 participants. A qualitative analysis of free text comments was performed using an inductive thematic approach.Results41.2% % of women taking prescribed medications had to actively request them. ‘Extremely poor’ or ‘poor’ experiences were described in 39.4% and 30.0% of participants in primary and secondary care respectively. Protective factors for termination of pregnancy and suicidal ideation include holistic support from family, friends and healthcare providers.ConclusionOptimal care in hyperemesis gravidarum should incorporate timely access to pharmacotherapy, assessment of mental health, consideration of referral to specialist services and care being delivered in a compassionate manner.
Highlights
Hyperemesis gravidarum (HG) is defined as persistent and excessive vomiting starting before the end of the 22nd week of gestation.[1]
We recently reported termination of pregnancy (TOP) rates and suicidal ideation rates in 5071 women with a self-reported diagnosis of HG using an anonymous online survey. 4.9% of women surveyed reported having previously terminated a wanted pregnancy as a consequence of HG with a further 52.1% considering it. 25.5% and 6.6% of women reported occasional and regular suicidal ideation respectively
Both TOP and suicidal ideation were associated with increased severity of sickness, poor functional status and poor perception of quality of care received in both primary and secondary care
Summary
Hyperemesis gravidarum (HG) is defined as persistent and excessive vomiting starting before the end of the 22nd week of gestation.[1]. Adverse impacts on mental health include increased anxiety, depression, postnatal depression and post-traumatic stress disorder.[3,4,5] We recently reported termination of pregnancy (TOP) rates and suicidal ideation rates in 5071 women with a self-reported diagnosis of HG using an anonymous online survey. 25.5% and 6.6% of women reported occasional and regular suicidal ideation respectively Both TOP and suicidal ideation were associated with increased severity of sickness, poor functional status and poor perception of quality of care received in both primary and secondary care. Difficulty accessing medication and poor patient experience have been implicated as risk factors for termination of pregnancy and suicidal ideation in women with hyperemesis gravidarum. Conclusion: Optimal care in hyperemesis gravidarum should incorporate timely access to pharmacotherapy, assessment of mental health, consideration of referral to specialist services and care being delivered in a compassionate manner
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