Hyperemesis gravidarum strongly linked to depression

There is a link between hyperemesis gravidarum and depression, according to a recent study published in The Lancet Psychiatry.¹

A 5-fold increase in the odds of having experienced depression before pregnancy was reported in pregnant women with severe nausea. According to investigators, this highlights shared biological mechanisms between these characteristics, indicating a need for systematic psychiatric screening during and after pregnancy.¹

“Our research shows that severe nausea in pregnancy is not only a physically stressful condition, but also a significant mental health risk factor,” said Eeva Terävä-Utti, doctoral researcher from the University of Turku.¹

Assessing pregnancy-related nausea

To evaluate the links between hyperemesis gravidarum with both pre-pregnancy and new-onset post-pregnancy depression, investigators conducted a nationwide register-based controlled study.² The trial was conducted from January 1, 2004, to December 31, 2017, in Finland.

The Finnish Hospital Discharge Register was assessed for hyperemesis gravidarum and psychiatric diagnoses data, while the Finnish Medical Birth Register was assessed for delivery data. Participants included pregnant women with livebirth during the study period, while exclusion criteria included abortion, ectopic pregnancy, and stillbirth.²

Hyperemesis gravidarum in an initial pregnancy that delivered between January 1, 2005, and December 31, 2017, were indicated cases. This was defined based on ICD-10 codes, alongside the primary outcome of depression recorded in registers during the study period. Covariates included socioeconomic status, body mass index, age, smoking, and other psychiatric diagnoses.²

Risk increases observed

There were 4265 hyperemesis gravidarum cases and 302,663 non-hyperemesis gravidarum controls included in the final analysis. A pre-pregnancy diagnosis of depression was reported in 8.8% and 1% of these patients, respectively, and the mean ages were 26.6 and 27.9 years, respectively.²

Overall, an adjusted odds ratio (aOR) of 5.2 was reported for a pre-pregnancy diagnosis of depression among patients with vs without hyperemesis gravidarum, highlighting a significant increase in risk. New onset depression was reported in 4.9% of the hyperemesis gravidarum group vs 1% of the non-hyperemesis gravidarum group, indicating an aOR of 3.6.²

Most women were diagnosed with depression more than a year after delivery, with rates of 81% in hyperemesis gravidarum patients vs 86% in non-hyperemesis gravidarum patients. However, diagnoses occurred earlier in the former group, at 3.3 vs 4.5 years, respectively.²

Increased awareness needed

These results indicated underlying biological mechanisms shared between hyperemesis gravidarum and depression, leading to a long-term mental health burden in hyperemesis gravidarum patients. Investigators concluded there is a need for systematic psychiatric screening during and after pregnancy.²

“The results emphasize the need for improved collaboration between psychiatry, gynecology, and primary care,” said Terävä-Utti.¹ “Our aim is also to raise awareness and improve access to support for these patients.”

The need for improved mental health screening postpartum has also been highlighted by Laxmi Gannu, MS, senior manager of real world evidence at Sage Therapeutics, in an interview with Contemporary OB/GYN.³ In the discussion, Gannu discussed findings from a study about practices regarding postpartum depression (PPD) screening and treatment.

Opportunities to improve care

According to Gannu, 90% of providers had a screening protocol implemented into their practice, but only 80% consistently followed these protocols. Additionally, depression scores measured from baseline remained below the clinically meaningful threshold even in patients receiving treatment for moderate to severe PPD.³

“Optimizing the health care provider education, adherence to the guidelines and protocols, and enhancing the care coordination with the follow-up—I think these all will improve the patient outcomes,” said Gannu.³

References

1. Finnish study reveals association between severe nausea during pregnancy and depression. University of Turku. November 14, 2025. Accessed December 5, 2025. https://www.eurekalert.org/news-releases/1106105
2. Terävä-Utti E, Nurmi M, Laitinen L, Rissanen T, Järvenpää T, Polo-Kantola P. Association between hyperemesis gravidarum and depression: a national register-based controlled study in Finland. The Lancet Psychiatry, 2025;12(11):841-851. doi:10.1016/S2215-0366(25)00271-8
3. Gannu L. Laxmi Gannu, MS, notes PPD screening gaps and adverse outcomes. Contemporary OB/GYN. May 17, 2025. Accessed December 4, 2025. https://www.contemporaryobgyn.net/view/laxmi-gannu-md-notes-ppd-screening-gaps-and-adverse-outcomes.