(1044) Early-pregnancy psychological health indices and the incidence of nausea and vomiting in later gestation.

Moderate or severe nausea and vomiting of pregnancy (NVP) that occurs beyond the first trimester has been associated with maternal distress and poor postpartum mental health. Factors that increase risk of NVP in mid-late gestation are unknown. We aimed to determine if maternal anxiety or depression in early pregnancy are associated with moderate/severe NVP later in pregnancy.


Study Design:

This is a secondary analysis of nulliparas from the NuMoM2b cohort which included assessments at three study visits across gestation; “V1” at 12.5±2.7 weeks, “V2” at 19.4±2.5 weeks, and “V3” at 28.0±3.2 weeks. Participants completed the Edinburgh Postnatal Depression Scale (n=9669) & Trait Anxiety Index (n=8548) at V1 and were classified as having no, mild, or moderate/severe anxiety or depression based on established cut-points. NVP was assessed at each study visit by the Pregnancy-Unique Quantification of Emesis (PUQE). Scores ranged 3-15 and classified as minimal/mild (PUQE score < 7) or moderate/severe (PUQE score ≥7) NVP. Separate binary logistic regression models were used to test the association between anxiety or depression in V1 with the odds of moderate/severe NVP in V2 and V3, adjusting for covariates (maternal age, smoking status, early-pregnancy body mass index).


Results:

In V1, moderate/severe anxiety and depression complicated 22.6 and 5.5% of pregnancies, respectively. Moderate/severe NVP complicated 3.0% of pregnancies in V2 and 1.8% in V3. The distribution of moderate/severe NVP at each visit differed significantly according to degree of anxiety or depression (Table 1). In the adjusted analysis, moderate/severe anxiety in V1 was not associated with NVP in V2 or V3 compared to those with no anxiety symptoms. However, moderate/severe depression in V1 was associated with a significantly greater odds of moderate/severe NVP in V2 (OR=4.80, 95% CI=2.08 to 11.05) and in V3 (OR=6.55, 95% CI=2.22 to 19.029), compared to those with no depressive symptoms.


Conclusion:

Depression in early pregnancy was associated with the incidence of moderate/severe NVP in mid and late pregnancy.