Experiences of psychological burden and care in women with hyperemesis gravidarum and nausea and vomiting in pregnancy: a mixed-methods systematic review.

BACKGROUND: Hyperemesis gravidarum (HG) affects 0.3-2% of pregnancies, while nausea and vomiting in pregnancy (NVP) affects up to 70-80% worldwide. Although physical complications are well recognised, the psychological burden and role of care experiences are less clearly defined. AIM: To synthesise evidence on psychological morbidity in HG and NVP, alongside women's experiences of care. METHODS: Mixed-methods systematic review of peer reviewed studies (2010-2025). CINAHL, Embase, MEDLINE, and PsycINFO were searched in line with PRISMA. Study quality was appraised using Joanna Briggs Institute tools. Quantitative data was synthesised narratively, qualitative data thematically, and findings integrated using a convergent segregated approach. RESULTS: Results: Sixty four international studies were included, comprising 56 quantitative studies, six qualitative studies and two mixed-methods studies. Depression and anxiety were the most frequently assessed outcomes and were generally higher in HG compared with controls, with some persistence beyond pregnancy. Greater symptom severity in HG and NVP was associated with higher depression and anxiety. Large cohort studies reported increased risks of anxiety and depression, including postnatal and longer term risk. Additional outcomes included stress, psychological distress, post-traumatic stress symptoms, suicidal ideation, and reduced mental health related quality of life. Qualitative studies identified four themes: psychological burden and trauma, invalidation and unmet care needs, disruption to daily life, identity and relationships, and support and coping. Women reported dismissal and lack of validation, while valuing specialist services and psychological support. Integrated findings indicated psychological morbidity was associated with both symptom severity and care experiences. CONCLUSION: HG and severe NVP are associated with substantial psychological burden that extends beyond symptom scores alone. Integrating quantitative and qualitative evidence highlights the importance of considering both psychological outcomes and women's experiences of care when assessing the impact of these conditions.