Hyperemesis Gravidarum: A Current Review

Abstract

Hyperemesis gravidarum or pernicious vomiting of pregnancy affects between 0.3% and 2% of all pregnant patients. The objective of this paper is to review current literature pertaining to epidemiology, etiology, symptomatology, complications, treatment, and perinatal outcome of patients with hyperemesis gravidarum. We performed a MEDLINE search of the English literature from 1966 through January 2000 utilizing the keywords: hyperemesis gravidarum, nausea and vomiting, and pregnancy. Current data pertaining to epidemiology, etiology, clinical manifestations, differential diagnosis, complications, various treatment modalities, subsequent perinatal outcome and recent developments are presented. Review of the literature supports that hyperemesis gravidarum is a multifactorial disease in which pregnancy-induced hormonal changes associated with concurrent gastrointestinal dysmotility and possible Helicobacter pylori infection function as contributing factors. Therapeutic key elements are mainly supportive in conjunction with antiemetic medication. It appears perinatal outcome is unaffected.

Hyperemesis gravidarum and subsequent breast cancer risk

“…Thus, opposing effects on breast cancer risk by the different hormones seem unlikely. Hyperemesis has also been linked to reproductive history, twinning and to an altered sex ratio of the offspring (Askling et al, 1999;Eliakim et al, 2000), all of which could possibly affect breast cancer risk (Kelsey et al, 1993;Hsieh et al, 1999). All these factors were accounted for in our study, and adjustments had no marked impact on the estimates.…”

“…As women with hyperemesis are exposed to high levels of hCG, they provide one of the few human populations in which to study effects of this hormone. Apart from increases in serum hCG, hyperemesis has also been linked to raised levels of circulating oestrogens, particularly oestradiol (Eliakim et al, 2000). Given that oestradiol would increase breast cancer risk, this could theoretically conceal a true protective effect of hCG.…”

Is there any effect of demographic features on development of hyperemesis gravidarum in the Turkish population?

“…HG affects 0.5%-2% of pregnant women (1)(2)(3)(4). It usually begins 4-7 weeks after the last menstrual period and resolves in 90% of women by the 20th week of gestation (12).…”

“…It occurs in about 0.5% to 2% of pregnant women and is the most common cause of admission to the hospital in early pregnancy (1)(2)(3)(4).…”

Familial aggregation of hyperemesis gravidarum

“…An increased incidence of HG has been reported with multiple gestations, gestational trophoblastic disease, fetal chromosomal abnormalities and central nervous system malformations, and for mothers of female offspring [8,29]. While smoking during pregnancy was recently reported to decrease the risk of hyperemesis, smoking by the partner was reported to increase the risk [4,8].…”