Severe nausea and vomiting (hyperemesis gravidarum): psychological impact and current management

This thesis comprises three studies with the combined aim of improving care for women with hyperemesis gravidarum (HG), a severe form of nausea and vomiting of pregnancy (NVP). The first component of the thesis was a randomised control trial (RCT) of inpatient versus outpatient management of HG. The aim was to determine whether outpatient (ambulatory) management (whereby women could stay at home with family between treatment episodes) was of equal efficacy to standard inpatient management. The methodology of the trial was adapted due to strong patient preferences within the study group. The RCT with patient preference arm found that ambulatory care was as effective as inpatient management of HG. The second and third components of the thesis focused on the psychological and psychosocial aspects of HG. A systematic review and meta-analysis assessing the relationship between HG and psychological symptoms was undertaken in which 12 case-control papers were meta-analysed. A very large effect between HG and depression and a large effect between HG and anxiety were found. A two-point case control study was then undertaken to assess psychological symptoms, hospital experience, infant bonding and psychosocial experiences in women with HG compared to two control groups (one asymptomatic and the other admitted to hospital for other symptoms). Women completed survey assessments both during and after pregnancy. The study found that HG significantly increased the risk of major depressive disorder during and after pregnancy, women with HG had more negative experiences of hospital care and significantly more psychosocial sequelae were reported during pregnancy. Infant bonding was not directly affected. In conclusion, the work of this thesis has provided strong evidence which can be utilised to improve care for women suffering from HG, beyond the current standard supportive medical care of physical symptomsOpen Acces