Severe pregnancy sickness doubles postpartum depression risk

By Dr. Liji Thomas, MDReviewed by Lauren HardakerFeb 5 2026

Women experiencing severe nausea and vomiting in early pregnancy may face a higher risk of postpartum depression, highlighting the need for earlier screening and targeted maternal mental health support.

Study: The association between nausea and vomiting of pregnancy and postpartum depression symptoms: a longitudinal study. Image credit: gpointstudio/Shutterstock.com

A recent paper from Wuhan, China, examined detection rates of pregnancies affected by nausea and vomiting and postpartum depression in a hospital-based cohort in that region, and looked for associations by degree of severity of the former. The paper appeared in Scientific Reports.

Understanding how early pregnancy symptoms affect postpartum wellbeing

Nausea and vomiting of pregnancy (NVP) is estimated to affect up to 90 % of pregnancies, usually subsiding after the first trimester. However, severe NVP may persist throughout the pregnancy.

Clinical features cover the spectrum from mild nausea to hyperemesis gravidarum (HG), a relatively uncommon but disabling form of NVP affecting 0.3-2 % of pregnancies. Especially at higher frequencies, NVP reduces the quality of life during pregnancy.

Postpartum depression symptoms (PPDS) are among the most common medical sequelae of pregnancy, affecting 17 % to 19 % of pregnancies. It causes emotional distress, disrupts normal social and mental functioning, and reduces the quality of life. It is also linked to worse emotional and cognitive development in the offspring.

Factors that increase PPDS risk may present intervention targets. NVP has been associated with PPDS, though the evidence is inconclusive, and mostly applies to HG. The Swedish BASIC cohort study found that prolonged NVP (lasting >17 weeks) is linked to a higher risk of PPDS at six weeks. The Japanese JECS study also showed that NVP severity correlated with PPDS incidence at one month.

However, these studies relied on restricted samples and had methodological limitations, reducing their generalizability. The current study covered pregnant women receiving care at a major urban hospital in Wuhan, drawing on a large data source. Although participants were recruited from a single hospital, they may not fully represent all pregnant women in the region or those receiving care in different healthcare settings.

Pregnancy symptoms and depression

The study involved 3,061 pregnant women who attended the Women and Children’s Hospital of Wuhan throughout pregnancy and the postpartum period, between October 2016 and October 2019. NVP was self-reported using a single question focused on whether participants experienced vomiting during pregnancy, with severity classified partly by treatment or hospitalization requirements, meaning the measure primarily captured vomiting severity and may not fully reflect the overall burden of nausea symptoms. PPDS was identified using the Edinburgh Postnatal Depression Scale (EPDS).

Using binary logistic regression, the researchers modeled the risk of PPDS with varying degrees of severity of NVP.

Severe pregnancy sickness strongly tied to postpartum depression

The average age of the participants was 30 years, with the mean EPDS score being 8.61. The body mass index (BMI) before conception was normal in most women (67 %), and 70 % were in their first pregnancy.

NVP affected 64 % of pregnancies, mostly mild (42 %) and moderate (20 %), with severe NVP occurring in only ~2 %.

PPDS affected 16 % of postpartum women. At one and six months postpartum, depressive symptoms were detected in ~17 % and ~14 % of women, respectively, among participants with available follow-up EPDS data (2,362 women at 1 month and 1,896 at 6 months postpartum). These figures are broadly consistent with existing literature.

Women with severe NVP were more likely to have PPDS at both postpartum time points. When potential confounders such as maternal age and other model-specific covariates were accounted for, the risk was 2.4-fold and 2.7-fold, respectively.

These figures are broadly in line with some prior studies, though earlier research has shown inconsistent findings across populations and NVP severity levels. In Wuhan City, an EPDS score of 13 or higher is used as the screening threshold for PPDS. This led to similar reported PPDS detection rates at one month. The authors note that domestic Chinese studies reporting EPDS-screened PPDS at six months postpartum have been limited or not described in the literature they reviewed.

In contrast to the earlier studies, only severe NVP was linked to a higher PPDS risk at one or six months postpartum. This may reflect ethnic and cultural differences in China compared with other countries. Also, the relatively small proportion of severe NVP cases and the overall sample size may have limited the ability to detect smaller associations with milder NVP, as the authors suggest.

The study has limited validity and generalizability because NVP severity was assessed with a single self-reported question, which may have led to misclassification, whereas PPDS was assessed with a screening tool rather than a clinical diagnosis. Additionally, the sample was drawn from a single urban hospital, which may not reflect populations in rural areas or different healthcare settings.

Findings support targeted maternal mental health screening strategies

“Severe NVP in the first trimester is associated with an increased risk of depression at 1 and 6 months postpartum.” In view of the correlation with PPDS, the study authors advise that women in the first trimester be monitored for NVP and receive personalized care. This might help identify women at elevated risk of PPDS and support earlier monitoring and supportive interventions where needed.

However, future work in a larger and diverse population, with objective measures of exposures and outcomes, is essential to validate and extend these observations.