Z Geburtshilfe Neonatol. 2000 Jul-Aug; 204(4): 128-34.

[Nausea and vomiting in early pregnancy/hyperemesis gravidarum. Current status of psychosomatic factors]

Leeners B, Sauer I, Rath W.

Universit�tsfrauenklinik der RWTH Aachen.

BACKGROUND: Although Hyperemesis gravidarum (HG) is still a disease of unknown aetiology psychosocial aspects are involved in the genesis of this disease. MATERIALS AND METHODS: Based on experiences in our department and on actual literature psychosocial aspects and therapeutic approaches of HG are presented. RESULTS: Predisposing factors of HG are stress, inadequate information about pregnancy or delivery and problems in the marital relationship. Feelings of ambivalence towards pregnancy, a distorted perception of reality, the unconscious refusing of a wanted child and the worry about a relation between nutrition of the foetus and the HG have influence on the development of the HG. The role of the social context, especially the mother, of expectations towards vomiting and of secondary gain in the genesis and the evaluation of HG is explained. Therapeutical approaches beside the known somatic therapies are acupuncture, the electric stimulation of the N. vestibularis and different methods of psychotherapy, which can include the partner or other persons from the social context. In some cases an intensified therapy under in-patient conditions can improve therapeutic results. DISCUSSION: Psychosocial factors are involved not only in the genesis of HG, but also in the duration and intensity of symptoms as well as in the resistance especially, towards isolated somatic therapeutical approaches. CONCLUSIONS: When psychosocial factors are taken into account in the search for a cause and the treatment of HG results of treatment are more successful and persist over a longer time.