title: A prospective cohort study investigating associations between hyperemesis gravidarum and cognitive, behavioural and emotional well-being in pregnancy.
abstract: OBJECTIVE
  To investigate the association between hyperemesis gravidarum and altered cognitive, behavioural and emotional well-being in pregnancy.
  
  
  METHODS
  The study cohort consisted of 3423 nulliparous women recruited in the Screening for Pregnancy Endpoints (SCOPE) study performed in Auckland, New Zealand; Adelaide, Australia; Cork, Ireland; Manchester and London, United Kingdom between November 2004 and August 2008. Women were interviewed at 15±1 weeks' gestation and at 20±1weeks' gestation. Women with a diagnosis of hyperemesis gravidarum (HG) were compared with women who did not have a diagnosis of HG. Main outcome measures included the Short form State- Trait Anxiety Inventory (STAI) score (range 6-24), Perceived Stress Scale score (PSS, range 0-30), Edinburgh Postnatal Depression Scale (EPDS) score (range 0-30 or categories a-c) and behavioural responses to pregnancy score (limiting/resting [range 0-20] and all-or-nothing [range 0-28]).
  
  
  RESULTS
  During the study period 164 women suffered from HG prior to their 15 week interview. Women with HG had significantly higher mean STAI, PSS, EPDS and limiting response to pregnancy scores compared to women without HG. These differences were observed at both 15±1 and 20±1 weeks' of gestation. The magnitude of these differences was greater in women with severe HG compared to all women with HG. Women with severe HG had an increased risk of having a spontaneous preterm birth compared with women without HG (adjusted OR 2.6 [95% C.I. 1.2, 5.7]).
  
  
  CONCLUSIONS
  This is the first large prospective study on women with HG. Women with HG, particularly severe HG, are at increased risk of cognitive, behavioural and emotional dysfunction in pregnancy. Women with severe HG had a higher rate of spontaneous preterm birth compared to women without HG. Further research is required to determine whether the provision of emotional support for women with HG is beneficial.
authors: Department of Obstetrics and Gynecology, The Anu Research Centre, Cork University Maternity Hospital, University College Cork, Cork, Ireland. Fergus.mccarthy@ucc.ie
authors: Fergus P
authors: FP
authors: McCarthy
authors: Ali S
authors: AS
authors: Khashan
authors: Robyn A
authors: RA
authors: North
authors: Rona
authors: R
authors: Moss-Morris
authors: Philip N
authors: PN
authors: Baker
authors: Gus
authors: G
authors: Dekker
authors: Lucilla
authors: L
authors: Poston
authors: Louise C
authors: LC
authors: Kenny
mesh_terms: D000328:Adult; D001519:Behavior / Q000502:physiology*; D003071:Cognition / Q000502:physiology*; D004644:Emotions / Q000502:physiology*; D005260:Female; D005865:Gestational Age; D006801:Humans; D006939:Hyperemesis Gravidarum / Q000503:physiopathology* / Q000523:psychology; D007231:Infant, Newborn; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult