Service use data analysis of pre-pregnancy psychiatric and somatic diagnoses in women with hyperemesis gravidarum

Abstract

Introduction. The purpose of this study was to redress weaknesses in past studies of a psychogenic etiology for hyperemesis gravidarum (HG) by (1) estimating from a known population what proportion of HG cases also have psychiatric diagnoses, (2) determining if psychiatric disorder preceded HG, and (3) re-considering whether non-pregnancy somatic conditions also precede HG.

Methods. We analyzed insurance data for all 11,016 members who gave birth to singletons in 2000–2004, 208 of whom had HG.

Results. Prevalence of HG was 1.8% overall, 3.8% with one psychiatric diagnosis, 5.8% with >1 psychiatric diagnosis. One in 10 HG cases had pre-pregnancy depression, anxiety, or substance abuse diagnoses. One in five HG cases had either a psychiatric or a somatic condition (e.g., chronic pelvic pain, dysmenorrhea) diagnosis prior to pregnancy. Pre-pregnancy psychiatric diagnosis doubled the adjusted odds of HG. Combined psychiatric and somatic diagnoses quadrupled the adjusted odds of HG.

Discussion. Vomiting is a non-specific sign that may have multiple etiologies. For 10–20% of HG sufferers, vomiting may be a physical comorbidity of a psychiatric condition occurring in the context of pregnancy. Psychobiological research with HG cases with past or current psychiatric diagnoses is needed to consider plausible mechanisms.

Keywords:

• Hyperemesis gravidarum
• psychophysiologic disorders
• psychosomatic medicine
• comorbidity
• depression
• posttraumatic stress
• pregnancy complications
• vomiting