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Reviewing the effect of hyperemesis gravidarum on women's lives and mental health

02 February 2018
20 min read
Volume 26 · Issue 2

Abstract

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.

Hyperemesis gravidarum (HG) is a pregnancy condition characterised by extreme levels of intractable nausea and vomiting, fatigue, distorted olfaction responses and hypersalivation. Symptoms can lead to dehydration, malnutrition, and secondary complications such as Wernicke's encephalopathy, oesophageal tears, hypocalcaemia and thyroid dysfunction (Dean and Gadsby, 2013; MacGibbon et al, 2015).

An estimated 30% of pregnant women suffer high levels of morbidity from nausea and vomiting in pregnancy (NVP) without receiving a diagnosis of HG (Gadsby and Barnie-Adshead, 2011a). Symptoms of NVP appear on a spectrum ranging from normal to severe, and HG is considered to be at the extreme end of that spectrum, affecting 1-1.5% of the pregnant population (Einarson et al, 2013), and accounting for approximately 25 000 hospital admissions annually (Gadsby and Barnie-Adshead, 2011b).

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