OBG MANAGEMENT:In the past, haven’t a number of psychodynamic causes been proposed for NVP?
GOODWIN: Yes. These included speculation that the woman was subconsciously rejecting the pregnancy, “hysterical,” maternally dependent or too independent, or denying her femininity. Fortunately, these ideas have been discredited.
Severe NVP does have psychological effects, however. Simpson et al20 found that women with hyperemesis gravidarum were more likely to experience anxiety, depression, somatization, psychoticism, and symptoms of obsessive-compulsive disorder. After delivery, however, they returned to normal and were no more likely than other nonpregnant women to experience these conditions.
NVP is not more likely to occur during an unwanted pregnancy. The rates are about the same as for desired gestations.
OBG MANAGEMENT:Is NVP ever the result of a psychologic condition?
GOODWIN: Very rarely, although a behavioral component may be involved—eg, vomiting as a conditioned response. However, this does not mean that the patient has a disease or is responsible for her own condition.
That kind of thinking is one reason women hesitate to raise the subject.
Dr. Goodwin reports no financial relationships relevant to this article.
