Critical appraisal of case–control studies of risk factors or etiology of Hyperemesis gravidarum

Investigation of the relationship between salivary cortisol, dehydroepiandrosterone sulfate, anxiety, and depression in patients with hyperemesis gravidarum

BACKGROUND

The aim of this study was to determine the relationship of the salivary levels of dehydroepiandrosterone sulfate (DHEA-S) and cortisol with factors related to depression and anxiety in patients with hyperemesis gravidarum (HG).

METHODS

Forty patients with a diagnosis of HG were selected for the study and matched with 40 control patients according to body mass index, parity, and age. Symptoms of depression and anxiety were investigated using the Beck Depression Inventory and Beck Anxiety Inventory for Adults, respectively. Saliva samples were collected in the morning and at night and subjected to enzyme-linked immunosorbent assay for the determination of DHEA-S and cortisol levels.

RESULTS

We observed a positive correlation between increased levels of depression and anxiety and increased salivary levels of cortisol and DHEA-S in patients with HG.

CONCLUSIONS

Salivary cortisol and DHEA-S levels, as well as mood disorders, should be monitored in patients with HG, although further large, prospective studies are needed to confirm our results.

Do immigration and acculturation have an impact on hyperemesis gravidarum? Results of a study in Berlin/Germany

QUESTION

How large is the number of immigrant women being treated for hyperemesis gravidarum (HG) among the in-patients in a University hospital in Germany? Does migration have an impact on the psychosocial state of HG patients? Does acculturation have an impact on psychosocial distress in HG patients?

METHODS

The following methods were used: retrospective evaluation of all in-patients with HG from 1/1997 to 11/2009, inquiry of a consecutively surveyed group (from 2007 to 2009) of HG in-patients with a questionnaire set: socio-demographic data, questionnaire on psychic distress (SCL-90-R) questionnaire on migration/acculturation, and comparison of German patients and patients with immigration backgrounds as well as among immigrant groups.

RESULTS

During the 13-year study period, there were 4.5 times more immigrants treated for HG than native German patients. Compared to the age standardized resident population, the number of women with immigration backgrounds is over-proportionally high. The HG patients scored high in the SCL-90-R scale "somatization" without showing a higher level of psychic distress than the native patients.

CONCLUSIONS

Experience of migration is an etiological cofactor for HG. The grade of acculturation does not have a significant influence on the psychic well-being of HG patients.

Assessment of anxiety and depression levels of pregnant women with hyperemesis gravidarum in a case-control study

OBJECTIVE

The aim of this study was to determine the depression and anxiety levels of pregnant women with hyperemesis gravidarum by using the Beck depression and anxiety inventory scoring system in a Turkish population.

MATERIAL AND METHODS

To ascertain this relationship, a case-control study was conducted involving 86 pregnant women in their first trimester of pregnancy. Forty-one subjects had hyperemesis gravidarum, and 45 were healthy pregnant women who served as control subjects. The groups were adjusted for age, parity, and body mass index. All included women were subjected to baseline laboratory investigations including serum TSH and total hCG levels.

RESULTS

There were no statistically significant differences between the groups with respect to the demographic and obstetric parameters and baseline laboratory investigations except the mean serum potassium level, which was significantly lower in patients with hyperemesis gravidarum than in the control group (p=0.039). Patients with hyperemesis gravidarum had significantly higher depression and anxiety scores than control cases (p=0.0001 and p=0.049, respectively).

CONCLUSION

Our results suggest that increased anxiety and depression levels may be involved in the pathogenesis of hyperemesis gravidarum and extra psychological support may be necessary during the treatment and follow-up of these patients.