Anxiety, depression and marital satisfaction in women with hyperemesis gravidarum: A comparative cross-sectional study in Hospital Tengku Ampuan Rahimah, Klang, Malaysia.

INTRODUCTION: Hyperemesis Gravidarum (HG) is a severe form of vomiting that occurs among pregnant mothers. Due to the nature of HG, pregnant mothers may feel fatigued and burdened by it and questions have been raised about the emergence of psychiatric illness during this period of vulnerability. METHODS: A comparative cross-sectional study using Hospital Anxiety and Depression Scale (HADS), M.I.N.I (MINI International Neuropsychiatric Interview) and ENRICH- EMS (Evaluation and Nurturing Relationship Issues, Communication and Happiness - Marital Satisfaction Scale) were performed in a group of 112 pregnant women. RESULTS: There were no differences in the prevalence rate of any anxiety disorder among the patient with HG vs comparative group (9% vs 3%, P > 0.05) and depressive disorder in women with HG vs comparative group (16% vs 8%, P > 0.05) respectively. There were associations between HG and gravida, past history of miscarriage, and gestational diabetes (P < 0.05). After adjustment, only past history of gestational diabetes was associated with HG as a protective factor (AOR 0.034 95% CI 0.002-0.181; P = 0.0014). We found that women in the HG group tended to score statistically significantly higher than the comparison group for depressive symptoms in the HADS Depression subscale (P = 0.041). DISCUSSION: We found no convincing association between HG and anxiety disorder, depressive disorder, and marital satisfaction, but women with HG statistically significantly reported more depressive symptoms than women who were not diagnosed with HG. Psychiatric evaluation should be considered for women with HG.

The impact of endometrial thickness (EMT) on the day of human chorionic gonadotropin (hCG) administration on pregnancy outcomes: a 5-year retrospective cohort analysis in Malaysia.

BACKGROUND: Chances of pregnancy in relation to endometrial thickness (EMT) remain elusive albeit some literatures suggest poorer pregnancy outcomes below the threshold of 6-7 mm, notwithstanding others perceive detrimental effect at thicker EMT. We aim to examine the implication of EMT on pregnancy outcomes using a cut-off of 8 mm and further explore for any effect of 'thick' EMT in our patient population. METHODS: This was a retrospective cohort study performed for 162 women to assess the associations between EMT on the human chorionic ganadotropin (hCG) trigger day and pregnancy outcomes in infertile patients undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) and autologous fresh embryo transfer (ET) in controlled ovarian stimulation (COS) cycles under an assisted reproductive technology (ART) shared-care programme between public and private institutions from January 2012 through December 2016.The associations between pregnancy outcomes [Total Pregnancy Rate (TPR), Biochemical Pregnancy Rate (BPR), Clinical Pregnancy Rate (CPR), Ongoing Pregnancy Rate (OPR)/ Live Birth Delivery Rate (LBDR), Miscarriage Rate (MR) and Implantation Rate (IR)] and EMT (< 8 or ≥ 8 mm) on the hCG trigger day were evaluated. Besides, the associations between pregnancies outcomes with EMT ≥ 14 mm and ≥ 8 to < 14 mm were further assessed. RESULTS: We found that the ≥8 mm group had a higher TPR (55.4% vs 21.4%; p = 0.015) and CPR (52.0% vs 21.4%; p = 0.029). However, the BPR, MR, OPR/ LBDR and IR were not associated with the EMT (p > 0.05). All pregnancy outcomes were comparable for ≥14 mm and ≥ 8 to < 14 mm subgroups. CONCLUSIONS: Our findings suggest that EMT < 8 mm on hCG trigger day could adversely affect TPR and CPR in infertile patients undergoing IVF/ICSI-ET. Besides, we also disprove the notion of reduced chances of pregnancy with EMT ≥ 14 mm. The findings are based on completed cycles which each has demonstrated a triple-line endometrial pattern on the hCG trigger day with fresh autologous ET consisted of high-quality morphological gradings. However, our findings are still preliminary to suggest decision for ET transfer, cycle cancellation or adjunctive therapies. Further studies with larger sample size from this geographical region are required to verify the findings.