Comparative evaluation of posttraumatic stress symptoms and negative life outcomes in pregnant women with and without hyperemesis gravidarum

Document Type : Original Article


1 Instructor, Department of Nursing, School of Nursing and Midwifery, Quchan Branch, Islamic Azad University, Quchan, Iran

2 Instructor, Department of midwifery, School of Nursing and Midwifery, Quchan Branch, Islamic Azad University, Quchan, Iran.


Introduction: Hyperemesis gravidarum is often accompanied by severe physical and mental stress. This type of vomiting can lead to complication and reducing the quality of life. This study was performed with aim to assess posttraumatic stress symptoms (PTSS) in pregnant women with and without Hyperemesis gravidarum.
Methods: This case-control study was performed on 350 pregnant women with Hyperemesis gravidarum and 350 pregnant women without Hyperemesis gravidarum who referred to the clinics and hospitals of Taamin Ejtemaee of Mashhad in 2014-2015. Data was collected through interview with mothers and completing the standard questionnaires of IES15 , PTSS10 and evaluation of negative life outcomes. Data were analyzed by SPSS software (version 20) and independent t-test, Chi-square, Fisher's exact test and U Mann-Whitney test. P<0.05 was considered significant.
Results: The mean PTSS scores in case and control groups were 138±4 and 28±3, respectively, that independent t-test showed that the difference was statistically significant (P <0.001). Also, significant difference was found between case and control groups in terms of negative life outcomes especially regarding financial issues, marital status, professional issues, as well as regarding psychological and physical well-being (P<0.05).
Conclusion: Pregnant women with Hyperemesis gravidarum are at more risk for developing PTSS and negative life outcomes compared to healthy pregnant women, so management and control of these patients seems to be necessary.


  1. Sadeghi N, Azizi S, Molaeinezhad M. Anxiety status in pregnant mothers at third trimester of pregnancy and its related factors in referrals to Bandar Abbas Hospitals in 2012. Iran J Obstet Gynecol Infertil 2014; 17(122):8-15. (Persian).
  2. Moshki M, Armanmehr V, Chervi K. The relationship between depression during pregnancy with social support and some demographic variables in pregnant women. Iran J Obstet Gynecol Infertil 2015; 18(142):12-20. (Persian).
  3. Abedian Z, Abbaszadeh N, Latifnezhad Roudsari R, Shakeri M. The effect of telephone support on the severity of nausea and vomiting in the first trimester of pregnancy in the primiparous women. Iran J Obstet Gynecol Infertil 2014; 17(118):18-29. (Persian).
  4. Wier LM, Levit K, Stranges E, Ryan K, Pfuntner A, Vandivort R, et al. Agency for healthcare research and quality; 2010. New York: HCUP facts and figures: statistics on hospital-based care in the United States; 2008.
  5. Verberg MF, Gillott DJ, Al-Fardan N, Grudzinskas JG. Hyperemesis gravidarum, a literature review. Hum Repord Update 2005; 11(5):527-39.
  6. Wood P, Murray A, Sinha B, Godley M, Goldsmith HJ. Wernicke's encephalopathy induced by hyperemesis gravidarum. Case reports. BJOG 1983; 90(6):583-6.
  7. Peeters A, Van de Wyangaert F, Van Lierde M, Sindic CJ, Laterre EC. Wernicke's encephalopathy and central pontine myelinolysis induced by hyperemesis gravidarum. Acta Nuerol Belg1993; 93(5):276-82.
  8. Adams RH, Gordon J, Combes B. Hyperemesis gravidarum. I. evidence of hepatic dysfunction. Obstet Gynecol 1968; 31(5):659-64.
  9. Hill JB, Yost NP, Wendel GD Jr. Acute renal failure in association with severe hyperemesis gravidarum. Obstet Gynecol 2002; 100(5 Pt 2):1119-21.
  10. Dodds L, Fell DB, Joseph KS, Allen VM, Butler B. Outcomes of pregnancies complicated by hyperemesis gravidarum. Obstet Gynecol 2006; 107(2 Pt 1):285-92.
  11. Bailit JL. Huperemesis gravidarum: epidemiologic findings from a large cohort. Am J Obstet Gynecol 2005; 193(3 Pt 1):811-4.
  12. KallenB. Hyperemesis during pregnancy and delivery outcome: a registry study. Eur J Obstet Gynecol Reprod Biol 1987; 26(4):291-302.
  13. Goodwin TM, Poursharif B, Korst LM, MacGibbon KW, Fejzo MS. Secular trends in the treatment of hyperemesis gravidarum. Am J Perinatol 2008; 25(3):141-7.
  14. Poursharif B, Korst LM, MacGibbon KW, Fejoz MS, Romero R, Goodwin TM. Elective pregnancy termination in a large cohort of women with hyperemesis gravidarum. Contraception 2007; 76(6):451-5.
  15. Fejzo MS, Poursharif B, Korst LM, Munch S, Romero R, Goodwin TM. Symptoms and pregnancy outcomes associated with extreme weight loss among women with hyperemesis gravidarum. J Womens Health 2009; 18(12):1981-7.
  16. Poursharif B, Korst LM, Fejoz MS, MacGibbon KW, RomeroR, Goodwin TM. The psychosocial burden of hyperemesis gravidarum. J Perinatol 2008; 28(3):176-81.
  17. Pirimoglu ZM, Guzelmeric K, Alpay B, Balcik O, Unal O, Turan MC. Psychological factors of hyperemesis gravidarum by using the SCL-90-R questionnaire. Clin Exp Obstet Gynecol 2010; 37(1):56-9.
  18. Tan PC, Vani S, Lim BK, Omar SZ. Anxiety and depression in hyperemesis gravidarum: prevalence, risk factors and correlation with clinical severity. Eur J Obstet Gynecol Reprod Biol 2010; 149(2):153-8.
  19. Meighan M, Wood AF. The impact of hyperemesis gravidarum on maternal role assumption. J Obstet Gynecol Neonatal Nurs 2005; 34(2):172-9.
  20. Mohaghegh MS, Momtazi S, Mosavinasab S, Arab A, Sabouri A. Post-traumatic stress disorder in male chemical injured war veterans compared to non-chemical war veterans. Med J Mashhad Univ Med Sci 2014; 56(6):361-8. (Persian).
  21. Jonsson A, Segesten K, Mattsson B. Post-traumatic stress among Swedish ambulance personnel. Emerg Med J 2003; 20(1):79-84.
  22. Munch S. A qualitative analysis of physician humanism: women's experiences with hyperemesis gravidarum. J Perinatol 2000; 20(8 Pt 1):540-7.
  23. van Pampus MG, Wolf H, Weijmar Schultz WC, Neeleman J, Aarnoudse JG. Posttraumatic stress disorder following preeclampsia and HELLP syndrome. J Psychosom Obstet Gynecol 2004; 25(3-4):183-7.
  24. Modares M, Molayee SM, Keyan FM, Afrasiyabi S. Prevalence of traumatic stress disorder after childbirth and related factors. Hayat 2010; 16(3-4):66-76. (Persian).
  25. Abedian Z, Soltani N, Mokhber N, Esmaily H. Comparing post-traumatic stress disorder (PTSD) in primiparous and multiparous women with preeclampsia. J Midwifery Reprod Health 2013; 1(1):13-8.
  26. Munch S, Korst LM, Hernandez GD, Romero R, Goodwin TM. Health-related quality of life in women with nausea and vomiting of pregnancy: the importance of psychosocial context. J Perinatol 2011; 31(1):10-20.
  27. Mirzamani M, Mohammadi MR, Besharati MA. Application of the PTSD symptoms scale (PSS) for Iranian PTSD Patients. Med J Islamic Republic Iran 2006; 19(3):345-8.
  28. Guodarzi MA. Validity and reability of micicipi posttraumatic stress disorders scales. J 62Sychol 2003; 26:8-12.
  29. Seng JS, Schrot JA, van De Ven C, Liberzon I. Service use data analysis of pre-pregnancy psychiatric and somatic diagnosis in women with hyperemesis gravidarum. J Psychosom Obstet Gynaecol 2007; 28(4):209-217.
  30. Simpson SW, Goodwim TM, Robins SB, Rizzo AA, Howers RA, Buckwalter DK, et al. Psychological factors and hyperemesis gravidarum. J Womens Health Gend Based Med 2001; 10(5):471-7.
  31. Zhang Y, Cantor RM, MacGibbon K, Romero R, Goodwim TM, Mullin PM, et al. Familial aggregation of hyperemesis gravidarum. Am J Obstet Gynecol 2011; 204(3):230.e1-7.

Vikanes A, Skjaerven R, Grjibovski AM, Gunnes N, Vangen S, Magnus P. Recurrence of hyperemesis gravidarum across generations: population based cohort study. BMJ 2010; 340:c2050