Abstract
Hyperemesis gravidarum (HG) is a pregnancy condition characterised by severe nausea and vomiting during early pregnancy. The experience of HG is for many women a traumatic event. Few studies have investigated a possible association between HG and birth-related posttraumatic stress. The objective of the current study was to assess whether HG increases the risk of birth-related posttraumatic stress symptoms (PTSS). This was a population-based pregnancy cohort study using data from the Akershus Birth Cohort Study (ABC study). A linear mixed model was used to estimate the association between the degree of nausea (no nausea (n = 574), mild nausea (n = 813), severe nausea (n = 522) and HG (hospitalised due to nausea, n = 20)) and PTSS score at 8 weeks and 2 years after birth. At 8 weeks postpartum, women with HG had higher PTSS scores compared to women with no nausea (p = 0.008), women with mild nausea (p = 0.019) and women with severe nausea (p = 0.027). After 2 years, women with HG had higher PTSS scores compared to women with no nausea (p = 0.038). Women with HG had higher PTSS scores following childbirth compared to women with less pronounced symptoms or no nausea at all. After 2 years, women with HG still had higher PTSS scores compared to women with no nausea. Although the overall differences in PTSS scores were small, the results may still be of clinical relevance.
Highlights
Nausea and vomiting in pregnancy affects up to 80% of all pregnancies, predominantly during the first trimester (GadsbyElectronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Oslo, Norway 5 Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany 6 Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany et al 1993), and is a common cause of sick leave (Dorheim et al 2013)
One of the main hypotheses of today involves the rise of the pregnancy hormone, human chorionic gonadotrophin, which coincides with the occurrence of Hyperemesis gravidarum (HG)
The aim of the present study was to estimate the association between the degree of nausea in pregnancy and birth-related posttraumatic stress symptoms (PTSS) and whether PTSS change from 8 weeks to 2 years after childbirth
Summary
An estimated 0.3 to 2% of women develop a very severe form, known as hyperemesis gravidarum (HG), which may include metabolic disturbances and nutritional deficiencies (Eliakim et al 2000; World Health Organization 2004), and lead to hospitalisation (Gazmararian et al 2002). Several conditions associated with increased hCG, such as molar pregnancy and multiple gestation, are associated with increased risk of developing HG (Grooten et al 2015). Another hypothesis involves genetics as HG is inherited along the maternal line (Vikanes et al 2010a). A growing body of research has shown an association between HG and maternal depression and anxiety during pregnancy (Mitchell-Jones et al 2017); the causal direction of this association remains elusive (Aksoy et al 2015; Fell et al 2006; Kjeldgaard et al 2017a; Pirimoglu et al 2010; Seng et al 2007)
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