Archives of Women's Mental Health

, Volume 12, Issue 2, pp 61–67 | Cite as

Psychiatric consultation of patients with hyperemesis gravidarum

  • Deborah R. Kim
  • K. R. Connolly
  • Pilar Cristancho
  • Mark Zappone
  • Robert M. Weinrieb
Review Article


The request for a psychiatric examination of patients with hyperemesis gravidarum (HG) is a unique challenge for the psychiatric consultant. Unfortunately, there are little data in the psychosomatic medicine literature to guide diagnostic evaluations and treatment of patients with HG. In this article, we summarize the existing literature and propose a practical approach to such patients based on the literature and our clinical experience.


Hyperemesis gravidarum Psychiatric Depression Anxiety Psychosomatic Nausea Vomiting Pregnancy Consultation Treatment 


  1. American College of Obstetrics and Gynecology (2004) ACOG (american college of obstetrics and gynecology) practice bulletin: Nausea and vomiting of pregnancy. Obstet Gynecol 103(4):803–814Google Scholar
  2. Bahna SL, Bjerkedal T (1974) The course and outcome of pregnancy in women with neuroses. Acta Obstet Gynecol Scand 53(2):129–133PubMedCrossRefGoogle Scholar
  3. Broussard CN, Richter JE (1998) Nausea and vomiting of pregnancy. Gastroenterol Clin North Am 27(1):123–151PubMedCrossRefGoogle Scholar
  4. Depue RH, Bernstein L, Ross RK, Judd HL, Henderson BE (1987) Hyperemesis gravidarum in relation to estradiol levels, pregnancy outcome, and other maternal factors: A seroepidemiologic study. Am J Obstet Gynecol 156(5):1137–1141PubMedGoogle Scholar
  5. el-Mallakh RS, Liebowitz NR, Hale MS (1990) Hyperemesis gravidarum as conversion disorder. J Nerv Ment Dis 178(10):655–659PubMedCrossRefGoogle Scholar
  6. Fairweather DV (1968) Nausea and vomiting in pregnancy. Am J Obstet Gynecol 102(1):135–175PubMedGoogle Scholar
  7. Fejzo MS, Ingles SA, Wilson M, Wang W, MacGibbon K, Romero R et al (2008) High prevalence of severe nausea and vomiting of pregnancy and hyperemesis gravidarum among relatives of affected individuals. Eur J Obstet Gynecol Reprod Biol 141(1):13–17PubMedCrossRefGoogle Scholar
  8. Fell DB, Dodds L, Joseph KS, Allen VM, Butler B (2006) Risk factors for hyperemesis gravidarum requiring hospital admission during pregnancy. Obstet Gynecol 107(2 Pt 1):277–284PubMedGoogle Scholar
  9. Goodwin TM, Montoro M, Mestman JH, Pekary AE, Hershman JM (1992) The role of chorionic gonadotropin in transient hyperthyroidism of hyperemesis gravidarum. J Clin Endocrinol Metab 75(5):1333–1337PubMedCrossRefGoogle Scholar
  10. Guclu S, Gol M, Dogan E, Saygili U (2005) Mirtazapine use in resistant hyperemesis gravidarum: Report of three cases and review of the literature. Arch Gynecol Obstet 272(4):298–300PubMedCrossRefGoogle Scholar
  11. HARVEY WA, SHERFEY MJ (1954) Vomiting in pregnancy; a psychiatric study. Psychosom Med 16(1):1–9PubMedGoogle Scholar
  12. Heazell A, Thorneycroft J, Walton V, Etherington I (2006) Acupressure for the in-patient treatment of nausea and vomiting in early pregnancy: A randomized control trial. Am J Obstet Gynecol 194(3):815–820PubMedCrossRefGoogle Scholar
  13. Hod M, Orvieto R, Kaplan B, Friedman S, Ovadia J (1994) Hyperemesis gravidarum. A review. J Reprod Med 39(8):605–612PubMedGoogle Scholar
  14. Iatrakis GM, Sakellaropoulos GG, Kourkoubas AH, Kabounia SE (1988) Vomiting and nausea in the first 12 weeks of pregnancy. Psychother Psychosom 49(1):22–24PubMedCrossRefGoogle Scholar
  15. Jewell, D., & Young, G. (2002). Interventions for nausea and vomiting in early pregnancy. Cochrane Database of Systematic Reviews (Online), (1)(1), CD000145.Google Scholar
  16. Josefsson A, Angelsioo L, Berg G, Ekstrom CM, Gunnervik C, Nordin C et al (2002) Obstetric, somatic, and demographic risk factors for postpartum depressive symptoms. Obstet Gynecol 99(2):223–228PubMedCrossRefGoogle Scholar
  17. Koren G, Boskovic R, Hard M, Maltepe C, Navioz Y, Einarson A (2002) Motherisk-PUQE (pregnancy-unique quantification of emesis and nausea) scoring system for nausea and vomiting of pregnancy. Am J Obstet Gynecol 186(5 Suppl Understanding):S228–31PubMedCrossRefGoogle Scholar
  18. Lacasse A, Rey E, Ferreira E, Morin C, Berard A (2008) Validity of a modified pregnancy-unique quantification of emesis and nausea (PUQE) scoring index to assess severity of nausea and vomiting of pregnancy. Am J Obstet Gynecol 198(1):71.e1–71.e7CrossRefGoogle Scholar
  19. Majerus PW, Guze SB, Delong WB, Robins E (1960) Psychologic factors and psychiatric disease in hyperemesis gravidarum: A follow-up study of 69 vomiters and 66 controls. Am J Psychiatry 117:421–428PubMedGoogle Scholar
  20. Martin IC (1974) Confused and confusing-hyperemsis gravidarum. Nursing Times 70(13):473–474PubMedGoogle Scholar
  21. Mazzotta P, Stewart D, Atanackovic G, Koren G, Magee LA (2000) Psychosocial morbidity among women with nausea and vomiting of pregnancy: Prevalence and association with anti-emetic therapy. J Psychosom Obstet Gynaecol 21(3):129–136PubMedCrossRefGoogle Scholar
  22. Meighan M, Wood AF (2005) The impact of hyperemesis gravidarum on maternal role assumption. Journal of Obstetric, Gynecologic, and Neonatal Nursing : JOGNN / NAACOG 34(2):172–179CrossRefGoogle Scholar
  23. Munch S (2000) A qualitative analysis of physician humanism: Women’s experiences with hyperemesis gravidarum. Journal of Perinatology : Official Journal of the California Perinatal Association 20(8 Pt 1):540–547Google Scholar
  24. Munch S (2002b) Chicken or the egg? the biological-psychological controversy surrounding hyperemesis gravidarum. Social Science & Medicine (1982) 55(7):1267–1278Google Scholar
  25. Munch S (2002a) Women’s experiences with a pregnancy complication: Causal explanations of hyperemesis gravidarum. Soc Work Health Care 36(1):59–76PubMedCrossRefGoogle Scholar
  26. Munch S, Schmitz MF (2006) Hyperemesis gravidarum and patient satisfaction: A path model of patients’ perceptions of the patient-physician relationship. J Psychosom Obstet Gynaecol 27(1):49–57PubMedCrossRefGoogle Scholar
  27. Poursharif B, Korst LM, Fejzo MS, MacGibbon KW, Romero R, Goodwin TM (2008) The psychosocial burden of hyperemesis gravidarum. Journal of Perinatology : Official Journal of the California Perinatal Association 28(3):176–181Google Scholar
  28. Poursharif B, Korst LM, Macgibbon KW, Fejzo MS, Romero R, Goodwin TM (2007) Elective pregnancy termination in a large cohort of women with hyperemesis gravidarum. Contraception 76(6):451–455PubMedCrossRefGoogle Scholar
  29. Rohde A, Dembinski J, Dorn C (2003) Mirtazapine (remergil) for treatment resistant hyperemesis gravidarum: Rescue of a twin pregnancy. Arch Gynecol Obstet 268(3):219–221PubMedCrossRefGoogle Scholar
  30. Safari HR, Fassett MJ, Souter IC, Alsulyman OM, Goodwin TM (1998) The efficacy of methylprednisolone in the treatment of hyperemesis gravidarum: A randomized, double-blind, controlled study. Am J Obstet Gynecol 179(4):921–924PubMedCrossRefGoogle Scholar
  31. Schiff MA, Reed SD, Daling JR (2004) The sex ratio of pregnancies complicated by hospitalisation for hyperemesis gravidarum. BJOG : An International Journal of Obstetrics and Gynaecology 111(1):27–30CrossRefGoogle Scholar
  32. Seng JS, Oakley DJ, Sampselle CM, Killion C, Graham-Bermann S, Liberzon I (2001) Posttraumatic stress disorder and pregnancy complications. Obstet Gynecol 97(1):17–22PubMedCrossRefGoogle Scholar
  33. Simpson SW, Goodwin TM, Robins SB, Rizzo AA, Howes RA, Buckwalter DK et al (2001) Psychological factors and hyperemesis gravidarum. Journal of Women’s Health & Gender-Based Medicine 10(5):471–477CrossRefGoogle Scholar
  34. Slavney PR (1999) Diagnosing demoralization in consultation psychiatry. Psychosomatics 40(4):325–329PubMedGoogle Scholar
  35. Soltani H, Taylor GM (2003) Changing attitudes and perceptions to hyperemesis gravidarum. RCM Midwives : The Official Journal of the Royal College of Midwives 6(12):520–524Google Scholar
  36. Swallow BL, Lindow SW, Masson EA, Hay DM (2004) Psychological health in early pregnancy: Relationship with nausea and vomiting. Journal of Obstetrics and Gynaecology : The Journal of the Institute of Obstetrics and Gynaecology 24(1):28–32Google Scholar
  37. Tsang IS, Katz VL, Wells SD (1996) Maternal and fetal outcomes in hyperemesis gravidarum. International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics 55(3):231–235Google Scholar
  38. Tsoi PT, Chin RK, Chang AM (1988) Psychogenic factors in hyperemesis gravidarum. Asia-Oceania Journal of Obstetrics and Gynaecology / AOFOG 14(4):457–460PubMedGoogle Scholar
  39. Vasconcelos MS, Sampaio AS, Hounie AG, Akkerman F, Curi M, Lopes AC et al (2007) Prenatal, perinatal, and postnatal risk factors in obsessive-compulsive disorder. Biol Psychiatry 61(3):301–307PubMedCrossRefGoogle Scholar
  40. Verberg MF, Gillott DJ, Al-Fardan N, Grudzinskas JG (2005) Hyperemesis gravidarum, a literature review. Human Reproduction Update 11(5):527–539PubMedCrossRefGoogle Scholar
  41. Vutyavanich T, Kraisarin T, Ruangsri R (2001) Ginger for nausea and vomiting in pregnancy: Randomized, double-masked, placebo-controlled trial. Obstet Gynecol 97(4):577–582PubMedCrossRefGoogle Scholar
  42. Yoshimura M, Hershman JM (1995) Thyrotropic action of human chorionic gonadotropin. Thyroid : Official Journal of the American Thyroid Association 5(5):425–434Google Scholar
  43. Yost NP, McIntire DD, Wians FH Jr, Ramin SM, Balko JA, Leveno KJ (2003) A randomized, placebo-controlled trial of corticosteroids for hyperemesis due to pregnancy. Obstet Gynecol 102(6):1250–1254PubMedCrossRefGoogle Scholar
  44. Zechnich R, Hammer T (1982) Brief psychotherapy for hyepremesis gravidarum. Am Fam Physician 26(5):179–181PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Deborah R. Kim
    • 1
  • K. R. Connolly
    • 1
  • Pilar Cristancho
    • 1
  • Mark Zappone
    • 2
  • Robert M. Weinrieb
    • 1
  1. 1.Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.School of NursingUniversity of PennsylvaniaPhiladelphiaUSA

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