Volume 10, Issue 2 (2025)
SJMR 2025, 10(2): 87-94 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Rezakhan M. Investigation of the Relationship between Stress, Anxiety, and Depression with Hyperemesis Gravidarum (HG). SJMR 2025; 10 (2) : 6
URL: http://saremjrm.com/article-1-369-en.html
URL: http://saremjrm.com/article-1-369-en.html
Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women’s Hospital, Iran University of Medical Sciences, Tehran, Iran. & Sarem Cell Research Center (SCRC), Sarem Women’s Hospital, Tehran, Iran.
Abstract: (325 Views)
Introduction: Nausea and vomiting are among the most common complications of pregnancy (also called Hyperemesis Gravidarum, HG), affecting multiple aspects of maternal health, while their exact etiology remains unclear. During pregnancy, women become more vulnerable to life stressors, and some researchers have attributed nausea and vomiting to psychological factors. Identifying the determinants of nausea and vomiting may help develop effective strategies for alleviating these symptoms. The present study aimed to examine the relationship between the incidence and severity of pregnancy-related nausea and vomiting with anxiety and depression among pregnant women at Sarem Specialized Hospital in Tehran.
Materials and Methods: This descriptive-correlational study was conducted from 2023 to 2024 on 67 pregnant women (6–16 weeks of gestation) presenting with hyperemesis gravidarum at Sarem Specialized Hospital. Nausea and vomiting were assessed using the Pregnancy-Unique Quantification of Emesis (PUQE) index, anxiety was measured by the Spielberger State-Trait Anxiety Inventory, and depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS). Data were analyzed with SPSS version 22.
Results: The findings demonstrated significant positive correlations between the scores of nausea, vomiting, retching, and the total PUQE score with stress, anxiety, and depression. Women with higher levels of nausea, vomiting, and retching had correspondingly higher scores of stress, state and trait anxiety, and depression, and vice versa. The prevalence of nausea and vomiting among the study participants was 92%. Furthermore, a significant direct relationship was observed between the incidence and severity of nausea and vomiting and the levels of anxiety and depression (P<0.05).
Conclusion: Nausea, vomiting, and retching during pregnancy were significantly associated with stress, anxiety, and depression. Therefore, it is recommended that psychological well-being be given greater consideration in the care of pregnant women.
Materials and Methods: This descriptive-correlational study was conducted from 2023 to 2024 on 67 pregnant women (6–16 weeks of gestation) presenting with hyperemesis gravidarum at Sarem Specialized Hospital. Nausea and vomiting were assessed using the Pregnancy-Unique Quantification of Emesis (PUQE) index, anxiety was measured by the Spielberger State-Trait Anxiety Inventory, and depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS). Data were analyzed with SPSS version 22.
Results: The findings demonstrated significant positive correlations between the scores of nausea, vomiting, retching, and the total PUQE score with stress, anxiety, and depression. Women with higher levels of nausea, vomiting, and retching had correspondingly higher scores of stress, state and trait anxiety, and depression, and vice versa. The prevalence of nausea and vomiting among the study participants was 92%. Furthermore, a significant direct relationship was observed between the incidence and severity of nausea and vomiting and the levels of anxiety and depression (P<0.05).
Conclusion: Nausea, vomiting, and retching during pregnancy were significantly associated with stress, anxiety, and depression. Therefore, it is recommended that psychological well-being be given greater consideration in the care of pregnant women.
Article number: 6
Keywords: Nausea, Vomiting, Hyperemesis Gravidarum (HG), Pregnancy, Anxiety, Depression, Psychological Factors, Trait Anxiety.
Article Type: Original Research |
Subject:
Pregnancy Care
Received: 2025/08/11 | Accepted: 2025/09/1 | Published: 2025/09/8
Received: 2025/08/11 | Accepted: 2025/09/1 | Published: 2025/09/8
References
1. 1. Clark, S.M., E. Dutta, and G.D.V. Hankins, The outpatient management and special considerations of nausea and vomiting in pregnancy. Seminars in Perinatology, 2014. 38(8): p. 496-502. [DOI:10.1053/j.semperi.2014.08.014] [PMID]
2. Payne, B., et al., Nausea and vomiting in pregnancy: a cross-sectional study of community pharmacists in the UK. International Journal of Pharmacy Practice, 2025. 33(1): p. 45-51. [DOI:10.1093/ijpp/riae057] [PMID]
3. Shidhaye, R., et al., 'I am happy because I am pregnant, but becoming a mother is not easy,'the experience of pregnancy and antenatal depression and perception of yoga in rural pregnant women in Maharashtra, a qualitative study. SSM-Mental Health, 2025: p. 100487. [DOI:10.1016/j.ssmmh.2025.100487]
4. Popa, S.L., et al., Life‑threatening complications of hyperemesis gravidarum. Exp Ther Med, 2021. 21(6): p. 642. [DOI:10.3892/etm.2021.10074] [PMID] []
5. Martin, R.P., J. Wisenbaker, and M.O. Huttunen, Nausea during pregnancy: relation to early childhood temperament and behavior problems at twelve years. J Abnorm Child Psychol, 1999. 27(4): p. 323-9. [DOI:10.1023/A:1022662726587] [PMID]
6. Lee, N.M. and S. Saha, Nausea and vomiting of pregnancy. Gastroenterol Clin North Am, 2011. 40(2): p. 309-34, vii. [DOI:10.1016/j.gtc.2011.03.009] [PMID] []
7. Wang, H., et al., Severe nausea and vomiting in pregnancy: psychiatric and cognitive problems and brain structure in children. BMC Med, 2020. 18(1): p. 228. [DOI:10.1186/s12916-020-01701-y] [PMID] []
8. Fairweather, D.V., Nause and vomiting in pregnancy. American journal of obstetrics and gynecology, 1968. 102(1): p. 135-175. [DOI:10.1016/0002-9378(68)90445-6] [PMID]
9. Tan, A., S. Lowe, and A. Henry, Nausea and vomiting of pregnancy: effects on quality of life and day‐to‐day function. Australian and New Zealand Journal of Obstetrics and Gynaecology, 2018. 58(3): p. 278-290. [DOI:10.1111/ajo.12714] [PMID]
10. Matthews, A., et al., Interventions for nausea and vomiting in early pregnancy. Cochrane Database of Systematic Reviews, 2015(9). [DOI:10.1002/14651858.CD007575.pub4]
11. Bozzo, P., et al., Nausea and vomiting of pregnancy (NVP) and depression: cause or effect? Clinical and Investigative Medicine, 2011. 34(4): p. E245-E248. [DOI:10.25011/cim.v34i4.15367] [PMID]
12. Koren, G., et al., Motherisk-PUQE (pregnancy-unique quantification of emesis and nausea) scoring system for nausea and vomiting of pregnancy. American journal of obstetrics and gynecology, 2002. 186(5): p. S228-S231. [DOI:10.1067/mob.2002.123054] [PMID]
13. Soltani, A., et al., Frequency and severity of nausea and vomiting in pregnancy and the related factors among pregnant women. Iran Journal of Nursing, 2007. 19(48): p. 95-102.
14. Spielberger, C., et al., Manual for the State-Trait Anxiety Inventory (Form Y1 - Y2). Vol. IV. 1983. [DOI:10.1037/t06496-000]
15. Tavasoli, A., M. Alipour, and N. Bigdeli, Comparison of ondansetron and the combination of dexametasone-metocholopromide on post operative nausea and vomiting. Internal Medicine Today, 2011. 17(1): p. 5-11.
16. Cox, J.L., J.M. Holden, and R. Sagovsky, Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry, 1987. 150: p. 782-6. [DOI:10.1192/bjp.150.6.782] [PMID]
17. Bergink, V., et al., Validation of the Edinburgh Depression Scale during pregnancy. J Psychosom Res, 2011. 70(4): p. 385-9. [DOI:10.1016/j.jpsychores.2010.07.008] [PMID]
18. Bazarganipour, F., et al., The Frequency and Severity of Nausea and Vomiting during Pregnancy and its Association with Psychosocial Health. Journal of Midwifery and Reproductive Health, 2015. 3(3): p. 401-407.
19. Andersson, L., et al., Implications of antenatal depression and anxiety for obstetric outcome. Obstet Gynecol, 2004. 104(3): p. 467-76. [DOI:10.1097/01.AOG.0000135277.04565.e9] [PMID]
20. Tan, P.C., et al., Anxiety and depression in hyperemesis gravidarum: prevalence, risk factors and correlation with clinical severity. Eur J Obstet Gynecol Reprod Biol, 2010. 149(2): p. 153-8. [DOI:10.1016/j.ejogrb.2009.12.031] [PMID]
21. Kitamura, T., et al., Psychosocial study of depression in early pregnancy. Br J Psychiatry, 1996. 168(6): p. 732-8. [DOI:10.1192/bjp.168.6.732] [PMID]
22. Bozzo, P., et al., The incidence of nausea and vomiting of pregnancy (NVP): a comparison between depressed women treated with antidepressants and non-depressed women. Clin Invest Med, 2006. 29(6): p. 347-50.
23. Meng, W., et al., Relationship between prenatal anxiety, depression, pregnancy stress and their social determinants. BMC Psychol, 2025. 13(1): p. 905. [DOI:10.1186/s40359-025-03237-3] [PMID] []
24. Zhong, W., et al., Mechanisms of Nausea and Vomiting: Current Knowledge and Recent Advances in Intracellular Emetic Signaling Systems. Int J Mol Sci, 2021. 22(11). [DOI:10.3390/ijms22115797] [PMID] []
25. Herrell, H.E., Nausea and vomiting of pregnancy. Am Fam Physician, 2014. 89(12): p. 965-70.
26. Broussard, C.N. and J.E. Richter, Nausea and vomiting of pregnancy. Gastroenterol Clin North Am, 1998. 27(1): p. 123-51. [DOI:10.1016/S0889-8553(05)70350-2] [PMID]
27. Bazzano, M., et al., Use of nutraceuticals in the stallion: Effects on semen quality and preservation. Reprod Domest Anim, 2021. 56(7): p. 951-957. [DOI:10.1111/rda.13934] [PMID] []
28. Beyazit, F. and B. Sahin, Effect of Nausea and Vomiting on Anxiety and Depression Levels in Early Pregnancy. Eurasian J Med, 2018. 50(2): p. 111-115. [DOI:10.5152/eurasianjmed.2018.170320] [PMID] []
29. Rondanelli, M., et al., A Food Pyramid and Nutritional Strategies for Managing Nausea and Vomiting During Pregnancy: A Systematic Review. Foods, 2025. 14(3): p. 373. [DOI:10.3390/foods14030373] [PMID] []
30. Kris-Etherton, P.M., et al., Nutrition and behavioral health disorders: depression and anxiety. Nutr Rev, 2021. 79(3): p. 247-260. [DOI:10.1093/nutrit/nuaa025] [PMID] []
31. Chou, F.H., et al., Relationships between nausea and vomiting, perceived stress, social support, pregnancy planning, and psychosocial adaptation in a sample of mothers: a questionnaire survey. Int J Nurs Stud, 2008. 45(8): p. 1185-91. [DOI:10.1016/j.ijnurstu.2007.08.004] [PMID]
32. Wang, H., et al., Severe nausea and vomiting in pregnancy: psychiatric and cognitive problems and brain structure in children. BMC Medicine, 2020. 18(1): p. 228. [DOI:10.1186/s12916-020-01701-y] [PMID] []
33. Ghanei Gheshlagh, R., et al., The relationship between preoperative anxiety and postoperative nausea and vomiting. Medical Sciences Journal of Islamic Azad University, 2014. 23(4): p. 269-274.
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
