Numerous neuropsychiatric and mental health outcomes have been linked to higher risks in pregnant women with hypereremesis gravidarum, the largest study on the condition. In a study by King’s College London and South London and Maudsley NHS Foundation Trust, 476,857 pregnant patients with hyperemesis gravidarum (HG) from 135 medical facilities across the globe participated. For women with HG, the study is the first to examine a variety of neuropsychiatric and mental health outcomes. The TriNetX Global Collaborative Network, which gathers anonymized electronic health record data from 18 nations, was used to conduct a retrospective cohort research.
The prevalence of hyperemesis gravidarum (HG) in pregnancy can reach 3.6%. The majority of HG cases (though not all) resolve by the second trimester of pregnancy, making it the most frequent reason for hospitalization during the first trimester. Women with HG lose weight and become dehydrated as a result of their intense and protracted nausea and vomiting. Women may have feelings of loneliness, anxiety about leaving home, and uncertainty about their ability to handle the remainder of their pregnancy. Many mental health issues, including anxiety and despair, have been reported by people with HG, and more than half of the women have thought about ending their pregnancies.
There are several different biological risk factors for HG, including as thyroid and parathyroid illness, Type 1 diabetes, or previous pregnancy histories, as well as socioeconomic disadvantage and ethnicity. Furthermore, sensitivity to a hormone known as GDF-15 may be a contributing factor to the condition, according to a study released last year.
Researchers examined 24 outcomes linked to mental health and neuropsychiatry that were reported within a year of diagnosis. Post-partum psychosis and post-traumatic stress disorder were among the 13 disorders for which they discovered a greater than 50% higher risk. The risks were doubled for eating disorders, depression, especially postpartum depression, which was 2.7 times more likely, Wernicke’s encephalopathy (a neurological condition caused by a vitamin B1 deficiency), and refeeding syndrome (complications that arise when food is introduced too quickly to someone who has been malnourished).
“Many pregnant women experience nausea and vomiting, but for women with HG, this occurs at a level which is far from “normal,” and as such, it can be profoundly debilitating,” stated Dr. Hamilton Morrin, Doctoral Fellow at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London. In addition to confirming the findings of earlier research that women with HG are more likely to experience anxiety, depression, and PTSD, our study also showed that women with HG are more likely to experience severe mental health conditions, such as eating disorders and psychosis, as well as Wernicke’s encephalopathy, a serious neuropsychiatric disorder in which a lack of vitamin thiamine causes memory and coordination issues. To guarantee the safety of both mother and child, many of these conditions would necessitate an immediate referral to specialized specialists for evaluation and treatment.
The World Health Organization’s most recent International Classification of Diseases, ICD-11, divides HG into two subcategories: “mild HG” and “HG with metabolic disturbance.” The latter is typified by electrolyte imbalance, dehydration, or carbohydrate deprivation. The association between this classification and mental health outcomes was also examined by the researchers. Crucially, compared to moderate HG, patients of HG with metabolic disturbance—which is thought to be more severe—showed a much lower incidence of depression. Regardless of the perceived severity, this study emphasizes the significance of providing all women with HG with proper mental health screening and care.
We discovered that the globally accepted classification of HG based on metabolic imbalance is effective in identifying people who need medical attention, but it might not always be appropriate for identifying people who require mental health assistance. Dr. Hamilton Morrin stated, “As clinicians, it is our duty to make sure these women receive appropriate integrated care across both physical and mental health, as the severity of HG does not directly correlate with the degree of impact on mental health.”
“Until recently, there was something of a disconnect between how the medical community regarded the mental health impact of HG and how women themselves describe their experience,” said Dr. Thomas Pollak, the study’s senior author and Clinical Reader and Consultant Neuropsychiatrist at King’s College London. Our results demonstrate that this disparity is not only real but also potentially quite dangerous. HG is linked to serious mental illnesses that need to be identified immediately and treated with integrated physical and mental health treatment from the beginning of pregnancy.
The Lancet Obstetrics, Gynecology, & Women’s Health released a retrospective cohort research on the neuropsychiatric and mental health effects of hyperemesis gravidarum.
The National Institute for Health Research (NIHR) is providing funding for the project.
