Relationship between anxiety and hyperemesis gravidarum in pregnant women from Trujillo, Peru: A prospective cohort study
DOI:
https://doi.org/10.64716/4a3zw930Palabras clave:
Anxiety, Hyperemesis gravidarum, Pregnancy, Cohort studies, Maternal healthResumen
Background: Hyperemesis gravidarum (HG) is a severe pregnancy-related condition that may substantially affect maternal physical and psychological well-being. Anxiety frequently coexists with HG, although evidence regarding whether anxiety precedes its occurrence remains limited, particularly in Peruvian populations. Objective: To evaluate the association between anxiety and HG among pregnant women in Trujillo, Peru. Methods: A prospective cohort study was conducted among 216 pregnant women receiving antenatal care at public healthcare facilities in Trujillo, Peru, between August and September 2025. Anxiety was assessed at enrollment using the validated Spanish version of the 20-item Zung Self-Rating Anxiety Scale, with scores ≥45 indicating anxiety. Women with HG diagnosed at enrollment were excluded, and participants were subsequently followed for incident HG through 20 weeks of gestation. HG was identified from physician-recorded diagnoses supported by persistent nausea and vomiting with clinically relevant features. Crude risk ratios (RRs) and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were estimated. Results: HG occurred in 56 of 108 women with anxiety (51.9%) and 20 of 108 women without anxiety (18.5%). Anxiety was associated with a higher crude risk of HG (RR, 2.80; 95% CI, 1.81–4.33; p < 0.001) and remained significantly associated after multivariable adjustment (aOR, 5.51; 95% CI, 2.66–11.38; p < 0.001). Conclusions: Anxiety was associated with a higher occurrence of HG in this prospective cohort. These findings support consideration of anxiety assessment as part of comprehensive antenatal care; however, they do not establish a causal relationship.
Descargas
Referencias
Elmas B, Vatansever M, Civan Kahve A, Salman Özgü B, Asut G, Çakmak IB, et al. Evaluation of psychological resilience and anxiety levels of patients with hyperemesis gravidarum diagnosis and comparison with healthy pregnant women. Turk J Obstet Gynecol. 2021;18(2):115–123. https://doi.org/10.4274/tjod.galenos.2021.05994
Vinnars MT, Forslund M, Claesson IM, Hedman AM, Peira N, Olofsson H, et al. Treatments for hyperemesis gravidarum: a systematic review. Acta Obstet Gynecol Scand. 2024;103(1):13–29. https://doi.org/10.1111/aogs.14706
Ángeles-Olaza GJ, García-Borjas CN, Arce-Huamaní MÁ. Factores de riesgo de hiperémesis gravídica en el Instituto Materno Perinatal peruano. Rev Peru Ginecol Obstet. 2024;70(3):e2659. https://doi.org/10.31403/rpgo.v70i2659
Răchită AIC, Strete GE, Sălcudean A, Ghiga DV, Rădulescu F, Călinescu M, et al. Prevalence and risk factors of depression and anxiety among women in the last trimester of pregnancy: a cross-sectional study. Medicina (Kaunas). 2023;59(6):1009. https://doi.org/10.3390/medicina59061009
Jansen LAW, Shaw V, Grooten IJ, Koot MH, Dean CR, Painter RC. Diagnosis and treatment of hyperemesis gravidarum. CMAJ. 2024;196(14):E477–E485. https://doi.org/10.1503/cmaj.221502
Fell DB, Dodds L, Joseph KS, Allen VM, Butler B. Risk factors for hyperemesis gravidarum requiring hospital admission during pregnancy. Obstet Gynecol. 2006;107(2 Pt 1):277–284. https://doi.org/10.1097/01.AOG.0000195059.82029.74
Fiaschi L, Nelson-Piercy C, Tata LJ. Hospital admission for hyperemesis gravidarum: a nationwide study of occurrence, reoccurrence and risk factors among 8.2 million pregnancies. Hum Reprod. 2016;31(8):1675–1684. https://doi.org/10.1093/humrep/dew128
Nijsten K, Dean C, van der Minnen LM, Bais JMJ, Ris-Stalpers C, van Eekelen R, et al. Recurrence, postponing pregnancy, and termination rates after hyperemesis gravidarum: follow-up of the MOTHER study. Acta Obstet Gynecol Scand. 2021;100(9):1636–1643. https://doi.org/10.1111/aogs.14197
Penninx BWJH, Pine DS, Holmes EA, Reif A. Anxiety disorders. Lancet. 2021;397(10277):914–927. https://doi.org/10.1016/S0140-6736(21)00359-7
Nijsten K, van der Minnen LM, Dean C, Bais JMJ, Ris-Stalpers C, van Eekelen R, et al. Depression, anxiety, and post-traumatic stress disorder symptoms after hyperemesis gravidarum: a prospective cohort study. J Matern Fetal Neonatal Med. 2022;35(25):10055–10063. https://doi.org/10.1080/14767058.2022.2089550
Hernández-Pozo MR, Macías-Martínez D, Calleja-Bello N, Cerezo-Reséndiz S, del Valle Chauvet C. Propiedades psicométricas del inventario Zung del estado de ansiedad con mexicanos. Psychologia. 2008;2(2):19–46. Disponible en: https://www.redalyc.org/articulo.oa?id=297225162009
Asociación Médica Mundial. Declaración de Helsinki de la AMM: principios éticos para la investigación médica con participantes humanos [Internet]. Ferney-Voltaire: Asociación Médica Mundial; 2024 [citado 19 de marzo de 2025]. Disponible en: https://www.wma.net/es/policies-post/declaracion-de-helsinki-de-la-amm-principios-eticos-para-las-investigaciones-medicas-en-seres-humanos/
El-Skaan RGA, Abdelrahman RM, Hassan AMA. Retrospective analysis of hyperemesis gravidarum and its psychological impact during hospital admission. J Obstet Gynaecol India. 2023;73(Suppl 1):19–24. https://doi.org/10.1007/s13224-023-01787-3
Seid AM, Mehari EA, Bekalu AF, Sema FD, Limenh LW, Geremew DT, et al. Prevalence of hyperemesis gravidarum and associated factors among pregnant women at comprehensive specialized hospitals in northwest Ethiopia: multicenter cross-sectional study. SAGE Open Med. 2024;12:20503121241257163. https://doi.org/10.1177/20503121241257163
Gökbulut N, Aksoy Derya Y. Effects of foot-massage in pregnant women with hyperemesis gravidarum on severity of nausea-vomiting and anxiety. J Reprod Infant Psychol. 2025;43(4):859–878. https://doi.org/10.1080/02646838.2023.2291412
Yıldız P, Dereli ML. The role of maternal serum ischemia-modified albumin in the prediction of hyperemesis gravidarum: a prospective cohort study. Biomarkers. 2025;30(3):226–231. https://doi.org/10.1080/1354750X.2025.2465972
Beyene GA, Ayele ND, Kasahun AW. Prevalence and determinants of hyperemesis gravidarum among pregnant women in Ethiopia: a systematic review and meta-analysis. PLoS One. 2024;19(12):e0314783. https://doi.org/10.1371/journal.pone.0314783
Descargas
Declaración de disponibilidad de datos
The de-identified data supporting the findings of this study are available from the corresponding author upon reasonable academic request. The dataset has not been deposited in a public repository because it contains clinical information obtained from pregnant participants and its dissemination requires appropriate safeguards to preserve confidentiality and privacy. Any request for access will therefore be considered in accordance with applicable ethical and data-protection requirements.
Número
Sección
Licencia
Derechos de autor 2026 Jackelin Pricila Cusi-Ortiz de Orué, Johnny Fernando Quiñones-Jauregui, Maria Dolores Mondejár-Barrios (Autor/a)
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
Los autores conservan los derechos de autor y conceden a TUMI Health Sciences Research el derecho de primera publicación. Los artículos se publican bajo la Licencia Internacional Creative Commons Atribución 4.0 (CC BY 4.0).
