Depression, anxiety, and post-traumatic stress disorder symptoms after hyperemesis gravidarum: a prospective cohort study

Abstract

Objective

To determine the prevalence of depression, anxiety, and posttraumatic stress disorder (PTSD) years after hyperemesis gravidarum (HG) and its association with HG severity.

Material and methods

This prospective cohort study consisted of a follow-up of 215 women admitted for HG, who were eligible to participate in a randomized controlled trial and either declined or agreed to be randomized between 2013 and 2016 in 19 hospitals in the Netherlands. Participants completed the Hospital Anxiety and Depression Scale (HADS) six weeks postpartum and during follow-up and the PTSD checklist for DSM-5 (PCL-5) during follow-up. An anxiety or depression score ≥8 is indicative of an anxiety or depression disorder and a PCL-5 ≥ 31 indicative of PTSD. Measures of HG severity were symptom severity (PUQE-24: Pregnancy Unique Quantification of Emesis), weight change, duration of admissions, readmissions, and admissions after the first trimester.

Results

About 54/215 participants completed the HADS six weeks postpartum and 73/215 participants completed the follow-up questionnaire, on average 4.5 years later. Six weeks postpartum, 13 participants (24.1%) had an anxiety score ≥8 and 11 participants (20.4%) a depression score ≥8. During follow-up, 29 participants (39.7%) had an anxiety score ≥8, 20 participants (27.4%) a depression score ≥8, and 16 participants (21.9%) a PCL-5 ≥ 31.

Multivariable logistic regression analysis showed that for every additional point of the mean PUQE-24 three weeks after inclusion, the likelihood of having an anxiety score ≥8 and PCL-5 ≥ 31 at follow-up increased with OR 1.41 (95% CI: 1.10;1.79) and OR 1.49 (95% CI: 1.06;2.10) respectively.

Conclusion

Depression, anxiety, and PTSD symptoms are common years after HG occurred.

Keywords:

• Hyperemesis gravidarum
• depression disorder
• postpartum depression
• anxiety disorder
• posttraumatic stress disorder

Acknowledgements

The authors thank all participating women in both the MOTHER and follow-up study.

Ethics approval

The MOTHER trial was approved by the Research Ethics Committee of the Amsterdam University Medical Centers (UMC), location AMC, on 3 April 2013. The MOTHER study was also registered at www.trialregister.nl by NTR4197. According to the Medical Research Involving Human Subjects Act, ethical approval for the follow-up study was not necessary (reference number W20_066 #20.094).

Author contributions

IJG, TJR, and RCP conceived and conducted the MOTHER study. KN and RCP conceived and conducted the follow-up study. LMvdM helped develop the online survey tool. JMJB, CR-S, HAB, DPvdH, WMH, AH, GK, SK, JOEHvL, JL, FvdM, DP, M-JP, PJP, LvRF, RJR, HCJS, TV, BWM, MHK, IJG, and RCP recruited participants for the original MOTHER study and collected data. KN performed the statistical analyses, under supervision of RCP and RvE, and drafted the manuscript. CD is a patient representative and gave perspective on the interpretation of the results. All authors (LvdM, CD, JMJB, CR-S, RvE, HAB, DPvdH, WMH, AH, GK, SK, JOEHvL, JL, FvdM, DP, M-JP, PJP, LvRF, RJR, HCJS, TV, BWM, MHK, IJG, RCP, and MvO) critically reviewed and approved the final draft of the manuscript.

Disclosure statement

Dr B.W. Mol reports grants from NHMRC outside the submitted work. Dr R.C. Painter reports grants from Amsterdam Reproduction and Development, during the conduct of the study, and she is the clinical and scientific advisor to the Dutch patient organization for Hyperemesis Gravidarum. She was also the chair of the organizing committee for the 3rd International Collaboration on Hyperemesis Gravidarum conference, Amsterdam, October 2019. Drs K. Nijsten and all other authors report no conflict of interests. ICMJE disclosure of interest forms are submitted as supporting information.

Data availability statement

The data that support the findings of this study are available from the principle investigator ([email protected]) upon reasonable request.

Additional information

Funding

The MOTHER study was supported by a research grant from the North West Hospital Group, Alkmaar, The Netherlands under grant number 2013T085. The follow-up study was supported by the Amsterdam Reproduction and Development (AR&D) Research Institute, Amsterdam UMC, The Netherlands under project number 23346. Neither funders had any role in the planning, execution or interpretation of this study.