Hyperemesis gravidarum

Hyperemesis gravidarum
SpecialtyObstetrics
Gastroenterology
SymptomsNausea and vomiting such that weight loss and dehydration occur[1]
DurationOften gets better but may last entire pregnancy[2]
CausesUnknown.[3] New research (late 2023) indicates an elevated level of one specific hormone.
Risk factorsFirst pregnancy, multiple pregnancy, obesity, prior or family history of hyperemesis gravidarum, trophoblastic disorder
Diagnostic methodBased on symptoms[3]
Differential diagnosisUrinary tract infection, high thyroid levels[4]
TreatmentDrinking fluids, bland diet, intravenous fluids[2]
MedicationPyridoxine, metoclopramide[4]
Frequency~1% of pregnant women[5]

Hyperemesis gravidarum (HG) is a pregnancy complication that is characterized by severe nausea, vomiting, weight loss, and possibly dehydration.[1] Feeling faint may also occur.[2] It is considered a more severe form of morning sickness.[2] Symptoms often get better after the 20th week of pregnancy but may last the entire pregnancy duration.[6][7][8][9][2]

The exact causes of hyperemesis gravidarum are unknown.[3] Risk factors include the first pregnancy, multiple pregnancy, obesity, prior or family history of HG, and trophoblastic disorder. A December 2023 study published in Nature indicated a link between HG and abnormally high levels of the hormone GDF15, as well as increased sensitivity to that specific hormone.[10]

Diagnosis is usually made based on the observed signs and symptoms.[3] HG has been technically defined as more than three episodes of vomiting per day such that weight loss of 5% or three kilograms has occurred and ketones are present in the urine.[3] Other potential causes of the symptoms should be excluded, including urinary tract infection, and an overactive thyroid.[4]

Treatment includes drinking fluids and a bland diet.[2] Recommendations may include electrolyte-replacement drinks, thiamine, and a higher protein diet.[3][11] Some people require intravenous fluids.[2] With respect to medications, pyridoxine or metoclopramide are preferred.[4] Prochlorperazine, dimenhydrinate, ondansetron (sold under the brand-name Zofran) or corticosteroids may be used if these are not effective.[3][4] Hospitalization may be required due to the severe symptoms associated.[9][3] Psychotherapy may improve outcomes.[3] Evidence for acupressure is poor.[3]

While vomiting in pregnancy has been described as early as 2,000 BCE, the first clear medical description of HG was in 1852, by Paul Antoine Dubois.[12] HG is estimated to affect 0.3–2.0% of pregnant women, although some sources say the figure can be as high as 3%.[6][9][5] While previously known as a common cause of death in pregnancy, with proper treatment this is now very rare.[13][14] Those affected have a lower risk of miscarriage but a higher risk of premature birth.[15] Some pregnant women choose to have an abortion due to HG symptoms.[11]

  1. ^ a b "Management of hyperemesis gravidarum". Drug and Therapeutics Bulletin. 51 (11): 126–129. November 2013. doi:10.1136/dtb.2013.11.0215. PMID 24227770. S2CID 20885167.
  2. ^ a b c d e f g "Pregnancy". Office on Women's Health. 27 September 2010. Archived from the original on 10 December 2015. Retrieved 5 December 2015.
  3. ^ a b c d e f g h i j Jueckstock JK, Kaestner R, Mylonas I (July 2010). "Managing hyperemesis gravidarum: a multimodal challenge". BMC Medicine. 8: 46. doi:10.1186/1741-7015-8-46. PMC 2913953. PMID 20633258.
  4. ^ a b c d e Sheehan P (September 2007). "Hyperemesis gravidarum--assessment and management" (PDF). Australian Family Physician. 36 (9): 698–701. PMID 17885701. Archived (PDF) from the original on 6 June 2014.
  5. ^ a b Goodwin TM (September 2008). "Hyperemesis gravidarum". Obstetrics and Gynecology Clinics of North America. 35 (3): 401–17, viii. doi:10.1016/j.ogc.2008.04.002. PMID 18760227.
  6. ^ a b Zimmerman CF, Ilstad-Minnihan AB, Bruggeman BS, Bruggeman BJ, Dayton KJ, Joseph N, et al. (2 January 2022). "Thyroid Storm Caused by Hyperemesis Gravidarum". AACE Clinical Case Reports. 8 (3): 124–127. doi:10.1016/j.aace.2021.12.005. PMC 9123575. PMID 35602873.
  7. ^ Tan JY, Loh KC, Yeo GS, Chee YC (June 2002). "Transient hyperthyroidism of hyperemesis gravidarum". BJOG. 109 (6): 683–688. doi:10.1111/j.1471-0528.2002.01223.x. PMID 12118648. S2CID 34693980.
  8. ^ Goodwin TM, Montoro M, Mestman JH (September 1992). "Transient hyperthyroidism and hyperemesis gravidarum: clinical aspects". American Journal of Obstetrics and Gynecology. 167 (3): 648–652. doi:10.1016/s0002-9378(11)91565-8. PMID 1382389.
  9. ^ a b c McParlin C, O'Donnell A, Robson SC, Beyer F, Moloney E, Bryant A, et al. (October 2016). "Treatments for Hyperemesis Gravidarum and Nausea and Vomiting in Pregnancy: A Systematic Review". JAMA. 316 (13): 1392–1401. doi:10.1001/jama.2016.14337. PMID 27701665. S2CID 205074563. Archived from the original on 26 July 2023. Retrieved 31 May 2022.
  10. ^ Wong C (13 December 2023). "Extreme morning sickness? Scientists finally pinpoint a possible cause". Nature. doi:10.1038/d41586-023-03982-8. PMID 38102380. S2CID 266311523.
  11. ^ a b Gabbe SG (2012). Obstetrics : normal and problem pregnancies (6th ed.). Elsevier/Saunders. p. 117. ISBN 978-1-4377-1935-2. Archived from the original on 26 July 2023. Retrieved 19 September 2020.
  12. ^ Davis CJ (1986). Nausea and Vomiting : Mechanisms and Treatment. Springer. p. 152. ISBN 978-3-642-70479-6. Archived from the original on 26 July 2023. Retrieved 19 September 2020.
  13. ^ Kumar G (2011). Early Pregnancy Issues for the MRCOG and Beyond. Cambridge University Press. p. Chapter 6. ISBN 978-1-107-71799-2. Archived from the original on 26 July 2023. Retrieved 19 September 2020.
  14. ^ DeLegge MH (2007). Handbook of home nutrition support. Sudbury, Mass.: Jones and Bartlett. p. 320. ISBN 978-0-7637-4769-5. Archived from the original on 26 July 2023. Retrieved 19 September 2020.
  15. ^ Ferri FF (2012). Ferri's clinical advisor 2013 5 books in 1 (1st ed.). Elsevier Mosby. p. 538. ISBN 978-0-323-08373-7.
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