A prospective cohort study investigating associations between hyperemesis gravidarum and cognitive, behavioural and emotional well-being in pregnancy

Fergus P McCarthy, Ali S Khashan, Robyn A North, Rona Moss-Morris, Philip N Baker, Gus Dekker, Lucilla Poston, Louise C Kenny, SCOPE Consortium, Fergus P McCarthy, Ali S Khashan, Robyn A North, Rona Moss-Morris, Philip N Baker, Gus Dekker, Lucilla Poston, Louise C Kenny, SCOPE Consortium

Abstract

Objectives: To investigate the association between hyperemesis gravidarum and altered cognitive, behavioural and emotional well-being in pregnancy.

Methods: The study cohort consisted of 3423 nulliparous women recruited in the Screening for Pregnancy Endpoints (SCOPE) study performed in Auckland, New Zealand; Adelaide, Australia; Cork, Ireland; Manchester and London, United Kingdom between November 2004 and August 2008. Women were interviewed at 15±1 weeks' gestation and at 20±1weeks' gestation. Women with a diagnosis of hyperemesis gravidarum (HG) were compared with women who did not have a diagnosis of HG. Main outcome measures included the Short form State- Trait Anxiety Inventory (STAI) score (range 6-24), Perceived Stress Scale score (PSS, range 0-30), Edinburgh Postnatal Depression Scale (EPDS) score (range 0-30 or categories a-c) and behavioural responses to pregnancy score (limiting/resting [range 0-20] and all-or-nothing [range 0-28]).

Results: During the study period 164 women suffered from HG prior to their 15 week interview. Women with HG had significantly higher mean STAI, PSS, EPDS and limiting response to pregnancy scores compared to women without HG. These differences were observed at both 15±1 and 20±1 weeks' of gestation. The magnitude of these differences was greater in women with severe HG compared to all women with HG. Women with severe HG had an increased risk of having a spontaneous preterm birth compared with women without HG (adjusted OR 2.6 [95% C.I. 1.2, 5.7]).

Conclusion: This is the first large prospective study on women with HG. Women with HG, particularly severe HG, are at increased risk of cognitive, behavioural and emotional dysfunction in pregnancy. Women with severe HG had a higher rate of spontaneous preterm birth compared to women without HG. Further research is required to determine whether the provision of emotional support for women with HG is beneficial.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Participants recruited.
Figure 1. Participants recruited.

References

    1. Gazmararian JA, Petersen R, Jamieson DJ, Schild L, Adams MM, et al. Hospitalizations during pregnancy among managed care enrollees. Obstet Gynecol. 2002;100:94–100.
    1. Tierson FD, Olsen CL, Hook EB. Nausea and vomiting of pregnancy and association with pregnancy outcome. Am J Obstet Gynecol. 1986;155:1017–1022.
    1. Gadsby R, Barnie-Adshead AM, Jagger C. A prospective study of nausea and vomiting during pregnancy. Br J Gen Pract. 1993;43:245–248.
    1. Organisation WH International Statistical Classification of Diseases and Related Health Problems. 10th Revision. Version for 2007.
    1. Hod M, Orvieto R, Kaplan B, Friedman S, Ovadia J. Hyperemesis gravidarum. A review. J Reprod Med. 1994;39:605–612.
    1. Schiff MA, Reed SD, Daling JR. The sex ratio of pregnancies complicated by hospitalisation for hyperemesis gravidarum. BJOG. 2004;111:27–30.
    1. Bashiri A, Neumann L, Maymon E, Katz M. Hyperemesis gravidarum: epidemiologic features, complications and outcome. Eur J Obstet Gynecol Reprod Biol. 1995;63:135–138.
    1. Vikanes A, Skjaerven R, Grjibovski AM, Gunnes N, Vangen S, et al. Recurrence of hyperemesis gravidarum across generations: population based cohort study. BMJ. 2010;340:c2050.
    1. Tan PC, Vani S, Lim BK, Omar SZ. Anxiety and depression in hyperemesis gravidarum: prevalence, risk factors and correlation with clinical severity. Eur J Obstet Gynecol Reprod Biol. 2010;149:153–158.
    1. Bailit JL. Hyperemesis gravidarium: Epidemiologic findings from a large cohort. Am J Obstet Gynecol. 2005;193:811–814.
    1. Dodds L, Fell DB, Joseph KS, Allen VM, Butler B. Outcomes of pregnancies complicated by hyperemesis gravidarum. Obstet Gynecol. 2006;107:285–292.
    1. Fejzo MS, Poursharif B, Korst LM, Munch S, MacGibbon KW, et al. Symptoms and pregnancy outcomes associated with extreme weight loss among women with hyperemesis gravidarum. J Womens Health (Larchmt) 2009;18:1981–1987.
    1. Tan PC, Jacob R, Quek KF, Omar SZ. Pregnancy outcome in hyperemesis gravidarum and the effect of laboratory clinical indicators of hyperemesis severity. J Obstet Gynaecol Res. 2007;33:457–464.
    1. Paauw JD, Bierling S, Cook CR, Davis AT. Hyperemesis gravidarum and fetal outcome. JPEN J Parenter Enteral Nutr. 2005;29:93–96.
    1. Kitamura T, Sugawara M, Sugawara K, Toda MA, Shima S. Psychosocial study of depression in early pregnancy. Br J Psychiatry. 1996;168:732–738.
    1. Tsang IS, Katz VL, Wells SD. Maternal and fetal outcomes in hyperemesis gravidarum. Int J Gynaecol Obstet. 1996;55:231–235.
    1. Roseboom TJ, Ravelli AC, van der Post JA, Painter RC. Maternal characteristics largely explain poor pregnancy outcome after hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol 2011
    1. Basso O, Olsen J. Sex ratio and twinning in women with hyperemesis or pre-eclampsia. Epidemiology. 2001;12:747–749.
    1. Askling J, Erlandsson G, Kaijser M, Akre O, Ekbom A. Sickness in pregnancy and sex of child. Lancet. 1999;354:2053.
    1. Tan PC, Jacob R, Quek KF, Omar SZ. The fetal sex ratio and metabolic, biochemical, haematological and clinical indicators of severity of hyperemesis gravidarum. BJOG. 2006;113:733–737.
    1. Hedegaard M, Henriksen TB, Sabroe S, Secher NJ. Psychological distress in pregnancy and preterm delivery. BMJ. 1993;307:234–239.
    1. Khashan AS, McNamee R, Abel KM, Mortensen PB, Kenny LC, et al. Rates of preterm birth following antenatal maternal exposure to severe life events: a population-based cohort study. Hum Reprod. 2009;24:429–437.
    1. Khashan AS, McNamee R, Abel KM, Pedersen MG, Webb RT, et al. Reduced infant birthweight consequent upon maternal exposure to severe life events. Psychosom Med. 2008;70:688–694.
    1. McCowan LNR, Taylor R. ACTRN12607000551493. Australian New Zealand Clinical Trials Registry, 2007.
    1. McCowan LM, Dekker GA, Chan E, Stewart A, Chappell LC, et al. Spontaneous preterm birth and small for gestational age infants in women who stop smoking early in pregnancy: prospective cohort study. BMJ. 2009;338:b1081.
    1. Marteau TM, Bekker H. The development of a six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI). Br J Clin Psychol. 1992;31(Pt 3):301–306.
    1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–396.
    1. Adouard F, Glangeaud-Freudenthal NM, Golse B. Validation of the Edinburgh postnatal depression scale (EPDS) in a sample of women with high-risk pregnancies in France. Arch Womens Ment Health. 2005;8:89–95.
    1. Peindl KS, Wisner KL, Hanusa BH. Identifying depression in the first postpartum year: guidelines for office-based screening and referral. J Affect Disord. 2004;80:37–44.
    1. Spence M, Moss-Morris R, Chalder T. The Behavioural Responses to Illness Questionnaire (BRIQ): a new predictive measure of medically unexplained symptoms following acute infection. Psychol Med. 2005;35:583–593.
    1. Gardosi JFA. Customised centile calculator-GROW 6.12 bulk. Gestation Network, 2007.
    1. Brown MA, Hague WM, Higgins J, Lowe S, McCowan L, et al. The detection, investigation and management of hypertension in pregnancy: executive summary. Aust N Z J Obstet Gynaecol. 2000;40:133–138.
    1. McLean M, Bisits A, Davies J, Woods R, Lowry P, et al. A placental clock controlling the length of human pregnancy. Nat Med. 1995;1:460–463.
    1. Warren WB, Gurewitsch ED, Goland RS. Corticotropin-releasing hormone and pituitary-adrenal hormones in pregnancies complicated by chronic hypertension. Am J Obstet Gynecol. 1995;172:661–666.
    1. Swallow BL, Lindow SW, Masson EA, Hay DM. Psychological health in early pregnancy: relationship with nausea and vomiting. J Obstet Gynaecol. 2004;24:28–32.
    1. Fell DB, Dodds L, Joseph KS, Allen VM, Butler B. Risk factors for hyperemesis gravidarum requiring hospital admission during pregnancy. Obstet Gynecol. 2006;107:277–284.
    1. Poursharif B, Korst LM, Fejzo MS, MacGibbon KW, Romero R, et al. The psychosocial burden of hyperemesis gravidarum. J Perinatol. 2008;28:176–181.
    1. Majerus PW, Guze SB, Delong WB, Robins E. Psychologic factors and psychiatric disease in hyperemesis gravidarum: a follow-up study of 69 vomiters and 66 controls. Am J Psychiatry. 1960;117:421–428.
    1. Mazzotta P, Stewart D, Atanackovic G, Koren G, Magee LA. Psychosocial morbidity among women with nausea and vomiting of pregnancy: prevalence and association with anti-emetic therapy. J Psychosom Obstet Gynaecol. 2000;21:129–136.
    1. Seng JS, Oakley DJ, Sampselle CM, Killion C, Graham-Bermann S, et al. Posttraumatic stress disorder and pregnancy complications. Obstet Gynecol. 2001;97:17–22.
    1. Simpson SW, Goodwin TM, Robins SB, Rizzo AA, Howes RA, et al. Psychological factors and hyperemesis gravidarum. J Womens Health Gend Based Med. 2001;10:471–477.

Source: PubMed

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