Severe Morning Sickness Linked to Depression

Summary: Almost 50% of women who experience hyperemesis gravidarum, or extreme morning sickness, develop depression while pregnant. 30% report symptoms of postnatal depression.

Source: Imperial College London

Severe morning sickness, known as hyperemesis gravidarum (HG), is a debilitating condition that affects around 1-2 percent of pregnant women in the UK. Far more serious than ‘normal’ morning sickness, it is one of the most common reasons for hospitalization during pregnancy and can continue right up until birth. Women can be bed-bound for weeks on end, suffer dehydration and weight loss and are often unable to work or care for other children they have.

The study, by researchers from Imperial College London and Imperial College Healthcare NHS Trust, found that nearly half of women with HG suffered antenatal depression and nearly 30 percent had postnatal depression. In women without the condition, just six percent experienced antenatal depression and seven percent suffered postnatal depression. The findings are published today in BMJ Open.

Dr. Nicola Mitchell-Jones, specialist registrar in obstetrics and gynecology and lead author of the study, believes the psychological impact of the condition is not taken seriously enough by both healthcare professionals and the wider public.

“Our study shows that women with HG are around eight times more likely to suffer antenatal depression and four times more likely to have postnatal depression,” she says. “Some women in the study even had thoughts of self-harm whilst suffering HG. These figures are shocking and should be reflected in the treatment women receive. We need to do much more than simply treat the physical symptoms of HG; assessment for mental health support should also be routine for any woman with the condition.”

The study recruited 214 women across three London hospitals—Chelsea and Westminster Hospital NHS Foundation Trust, Queen Charlotte’s and Chelsea Hospital and St Mary’s Hospital (both part of Imperial College Healthcare NHS Trust)—in the first trimester of pregnancy.

Half were recruited on admission to hospital with symptoms of HG. A similar size control group, without significant nausea or vomiting, were recruited through a midwifery-led antenatal clinic. None of the study participants had been treated for mental health conditions in the last year. The women were assessed for their psychological wellbeing in the first trimester of pregnancy and six weeks after the birth.

Of the women with HG, 49 percent experienced depression during pregnancy compared to just six percent in the control group. Just seven percent of the control group had postnatal depression, compared to 29 percent in the group with HG. Half of the women with HG were forced to take four or more weeks off work during or after pregnancy.

Although the study found no direct link between HG and maternal-infant bonding, other research has shown that depression can have a negative effect on this bond. Sadly, eight women with HG recruited to the study terminated their pregnancies, despite originally expressing a desire to keep the baby.

“Although we can’t say that HG was the main reason for those decisions, it may certainly have played a role which is heart-breaking,” said Dr. Mitchell-Jones, who herself suffered from HG during her first pregnancy in 2018.

This shows a pregnant woman
Of the women with HG, 49 percent experienced depression during pregnancy compared to just six percent in the control group. Image is in the public domain.

“I was in and out of hospital, spent nearly six months in bed—but I was lucky enough to have a supportive employer and family,” she recalled. “Many women can’t afford that amount of time off work or are stay-at-home mums with young children to care for. Too often their partners, relatives or work colleagues are not providing the support they need because they fail to understand the severity of what these women are going through. We need to educate them, as well as healthcare professionals.”

Dr. Mitchell-Jones hopes that her findings can help to improve understanding of HG and change clinical guidelines on how women with the condition are treated, to include a psychological screening and referral to specialist mental health where required.

About this pregnancy and depression research news

Source: Imperial College London
Contact: Press Office – Imperial College London
Image: The image is in the public domain

Original Research: Open access.
Association between hyperemesis gravidarum and psychological symptoms, psychosocial outcomes and infant bonding: a two-point prospective case–control multicentre survey study in an inner city setting” by Nicola Mitchell-Jones et al. BMJ Open


Association between hyperemesis gravidarum and psychological symptoms, psychosocial outcomes and infant bonding: a two-point prospective case–control multicentre survey study in an inner city setting

To assess if there is any association between hyperemesis gravidarum (HG), psychological morbidity and infant bonding and to quantify any psychosocial consequences of HG.

Two-point prospective case–control, multicentre survey study with antenatal and postnatal data collection.

Three London hospitals.

Pregnant women at ≤12 completed weeks gestation recruited consecutively over 2 years. Women with HG were recruited at the time of admission; controls recruited from a low risk antenatal clinic. 106 women were recruited to the case group and 108 to the control. Response rates at antenatal data collection were 87% and 85% in the case and control groups, respectively. Postnatally, the response rate was 90% in both groups.

Primary and secondary outcome measures 
Primary outcomes were psychological morbidity in the antenatal and postnatal periods, infant bonding in the postnatal period and psychosocial implications of HG. Secondary outcomes were the effects of severity and longevity of HG and assessment of correlation between Edinburgh Postnatal Depression Scale scores and maternal-to-infant bonding scores.

Antenatally, 49% of cases had probable depression compared with 6% of controls (OR 14.4 (5.29 to 39.44)). Postnatally, 29% of cases had probable depression versus 7% of controls (OR 5.2 (1.65 to 17.21)). There was no direct association between HG and infant bonding. 53% of women in the HG group reported needing four or more weeks of sick leave compared with 2% in the control group (OR 60.5 (95% CI 8.4 to 2535.6)).

Long-lasting psychological morbidity associated with HG was evident. Significantly more women in the case group sought help for mental health symptoms in the antenatal period, however very few were diagnosed with or treated for depression in pregnancy or referred to specialist perinatal mental health services. HG did not directly affect infant bonding. Women in the case group required long periods off work, highlighting the socioeconomic impact of HG.

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