Global InformationHyperemesis gravidarum information
| Hyperemesis gravidarum | |
|---|---|
| Specialty | Obstetrics Gastroenterology |
| Symptoms | Nausea and vomiting such that weight loss and dehydration occur[1] |
| Duration | Often gets better but may last entire pregnancy[2] |
| Causes | Unknown.[3] New research (late 2023) indicates an elevated level of one specific hormone. |
| Risk factors | First pregnancy, multiple pregnancy, obesity, prior or family history of hyperemesis gravidarum, trophoblastic disorder |
| Diagnostic method | Based on symptoms[3] |
| Differential diagnosis | Urinary tract infection, high thyroid levels[4] |
| Treatment | Drinking fluids, bland diet, intravenous fluids[2] |
| Medication | Pyridoxine, 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 more severe than 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]
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ 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.
- ^ Ferri FF (2012). Ferri's clinical advisor 2013 5 books in 1 (1st ed.). Elsevier Mosby. p. 538. ISBN 978-0-323-08373-7.