Hyperemesis gravidarum (HG) has a detrimental effect on physical and mental health. Termination of pregnancy (TOP) is reported in approximately 10%, 1 and qualitative research studies report an association with suicidal ideation. 2 We aimed to determine the consequences of HG on TOP and suicidal ideation, with particular reference to disease severity, functional status, and perception of care. STUDY DESIGN:This national cross-sectional study utilized a 14-item anonymous online survey distributed across the United Kingdom, incorporating demographic details, self-reported disease severity, consequence on functional status, mental health, details of the care experience, and opportunity for open box feedback.

Objective: To develop an international definition for hyperemesis gravidarum to assist in clinical diagnosis and harmonize hyperemesis gravidarum definition for study populations.Study design: A mixed-methods approach was used to identify potential hyperemesis gravidarum definition criteria (i.e. systematic review, semi-structured interviews and closed group sessions with patients and Project Steering Committee input). To reach consensus on the definition we used a webbased Delphi survey with two rounds, followed by a face-to-face consensus development meeting, held in Windsor UK, and a web-based consultation round, in which the provisional hyperemesis gravidarum definition was fed back to the stakeholders. Four stakeholder groups were identified 1) researchers; 2) women with lived experience of hyperemesis gravidarum and their families; 3) obstetric health professionals (obstetricians, gynecologists, midwives); and 4) other health professionals involved in care for women with hyperemesis gravidarum (general practitioners, dieticians, nurses). To reflect the opinions of the international community, stakeholders from countries in all global regions were invited to participate.Results: Twenty-one identified potential criteria entered the Delphi survey. Of the 277 stakeholders invited, 178 completed round one, and 125 (70%) also completed round two. Twenty stakeholders attended the consensus development meeting, representing all stakeholder groups. The consultation round was completed by 96 (54%) stakeholders, of which 92% agreed with the definition as presented. The consensus definition for hyperemesis gravidarum consisted of: start of symptoms in early pregnancy (before 16 weeks gestational age); nausea and vomiting, at least one of which severe; inability to eat and/ or drink normally; strongly limits daily living activities. Signs of dehydration were deemed contributory for the definition for hyperemesis gravidarum. Conclusions: The proposed definition for hyperemesis gravidarum will help clinical studies to achieve more uniformity, and ultimately increasing the value of evidence to inform patient care.

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Background Hyperemesis gravidarum is a condition that affects 1-1.5% of pregnant women, and is characterised by extreme levels of intractable nausea and vomiting. Aims To understand the association between hyperemesis gravidarum and psychological morbidity. Methods A qualitative literature review of the effects of nausea and vomiting in pregnancy and hyperemesis gravidarum was undertaken. An extensive search of multiple databases was undertaken and the results appraised and synthesised. Findings Four main themes and two subthemes emerged in relation to mental health effects. The main themes were: social isolation; unable to care for self and others or change of role; negative psychological effects (depression, anxiety, guilt and loss of self); and sense of dying, suicidal ideation or termination. The subthemes were loss of earnings or employment; and changes to family plans. Conclusion A shift towards an holistic biopsychosocial approach to care for hyperemesis gravidarum is required. Health professionals can help women by allowing them to express their feelings, and validating them. Where required, referral to the perinatal mental health team or a peer support system may be appropriate.