Psychological morbidity associated with hyperemesis gravidarum: a systematic review and meta‐analysis

Abstract

Background Psychological illness occurring in association with hyperemesis gravidarum (HG) has been widely reported.Objective To determine if there is a higher incidence of psychological morbidity in women with HG compared with women without significant nausea and vomiting in pregnancy.Search strategy PubMed, MEDLINE, Embase and PsychINFO were searched up to September 2015.Selection criteria Articles referring to psychological morbidity in relation to HG. For meta-analysis case-control studies using numerical scales to compare psychological symptoms.Data collection and analysis Articles were independently assessed for inclusion by two reviewers and methodology was appraised using the Newcastle Ottawa Scale. Comparison was made using the standard mean difference (SMD) in symptom scale scores.Main results In all, 59 articles were included in the systematic review, 12 of these were used in the meta-analysis. Meta-analysis of depression scale scores demonstrated a very large effect with statistically significantly higher depression scale scores in women with HG (SMD 1.22; 95% CI 0.80-1.64; P ≤ 0.01) compared with controls. Meta-analysis of anxiety scores demonstrated a large effect with statistically significantly higher anxiety disorder scale scores in women with HG (SMD 0.86; 95% CI 0.53-1.19; P ≤ 0.01). In both analyses significant heterogeneity was identified (depression and HG I 2 = 94%, P ≤ 0.01; anxiety and HG I 2 = 84%, P = 0.02).Conclusions Our systematic review and meta-analysis have shown a significantly increased frequency of depression and anxiety in women with HG. The findings should prompt service development for women with HG that includes provision of psychological care and support.Keywords Anxiety, depression, hyperemesis gravidarum, pregnancy, sickness, vomiting.Tweetable abstract Meta-analysis demonstrates an increase in #PsychologicalMorbidity in women with #HyperemesisGravidarum Please cite this paper as: Mitchell-Jones N, Gallos I, Farren J, Tobias A, Bottomley C, Bourne T. Psychological morbidity associated with hyperemesis gravidarum: a systematic review and meta-analysis. BJOG 2017;124:20-30.

Management of severe pregnancy sickness and hyperemesis gravidarum

“…As yet, no single tool is validated for holistically assessing women’s symptoms, however questioning can seek to understand how symptoms are affecting quality of life, the economic burden,1516 and psychosocial effects 67. The Quality of Life question on the PUQE score does not directly contribute to the score, but helps to provides a holistic assessment of the impact of symptoms on women, particularly for women experiencing profound nausea without vomiting or retching, and it has been validated to correspond inversely with the PUQE score 13…”

“…HG can have profound psychosocial consequences 67. Negative psychological effects of NVP and HG include loss of identity, social isolation, feelings of guilt and suicidal ideation,7 and pressure to terminate the pregnancy 33.…”

“…The non-specialist’s role is to identify and support, or refer for support, women with HG. Medical treatments may be somewhat limited in effectiveness for HG, quality of life can be enhanced by supportive care and psychological support 6. Evidence suggests that psychological intervention, such as counselling, in conjunction with medical treatment, may improve outcomes 71…”

“…It is not unusual for HG to persist throughout pregnancy 45. The psychosocial burden of HG can be heavy for women and their families, but effective and holistic treatment may reduce this 67…”

The Evaluation of Attachment Style and Temperament in Patients With Hyperemesis Gravidarum: Does the Idea That Hyperemesis Gravidarum Has a Psychological Origin Persist?

“…A recent meta-analysis by Mitchell-Jones et al, reported a relationship between HG and depression and anxiety in pregnancy. Mitchell-Jones et al, concluded that their meta-analysis demonstrated an increase in psychological morbidity in women with HG (6). It has been reported in some studies that depression risk enhanced in HG patients with a history of depression (7,8), however, on the contrary, it has been reported in some studies that depression risk enhanced in HG patients with Copyright (9,10).…”