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


CONCLUSIONS
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.
Seng
Julia S
JS
Institute for Research on Women and Gender, Department of Obstetrics and Gynecology, School of Nursing, University of Michigan, Ann Arbor, MI 48109-1290, USA. jseng@umich.edu
Schrot
Jacquelyn A
JA
van De Ven
Cosmas
C
Liberzon
Israel
I
D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D016022:Case-Control Studies; D015897:Comorbidity; D003627:Data Interpretation, Statistical; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D006939:Hyperemesis Gravidarum / Q000453:epidemiology* / Q000523:psychology*; D007348:Insurance, Health; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D016017:Odds Ratio; D011247:Pregnancy; D015995:Prevalence; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology