Hyperemesis Gravidarum: A Review of Recent Literature

Abstract

Background: In the United States, hyperemesis gravidarum is the most common cause of hospitalization during the first half of pregnancy and is second only to preterm labor for hospitalizations in pregnancy overall. In approximately 0.3-3% of pregnancies, hyperemesis gravidarum is prevalent and this percentage varies on account of different diagnostic criteria and ethnic variation in study populations. Despite extensive research in this field, the mechanism of the disease is largely unknown. Although cases of mortality are rare, hyperemesis gravidarum has been associated with both maternal and fetal morbidity. The current mainstay of treatment relies heavily on supportive measures until improvement of symptoms as part of the natural course of hyperemesis gravidarum, which occurs with progression of gestational age. However, studies have reported that severe, refractory disease manifestations have led to serious adverse outcomes and to termination of pregnancies. Summary: Despite extensive research in the field, the pathogenesis of hyperemesis gravidarum remains unknown. Recent literature points to a genetic predisposition in addition to previously studied factors such as infectious, psychiatric, and hormonal contributions. Maternal morbidity is common and includes psychological effects, financial burden, clinical complications from nutritional deficiencies, gastrointestinal trauma, and in rare cases, neurological damage. The effect of hyperemesis gravidarum on neonatal health is still debated in literature with conflicting results regarding outcomes of birth weight and prematurity. Available therapy options remain largely unchanged in the past several decades and focus on parenteral antiemetic medications, electrolyte repletion, and nutritional support. Most studies of therapeutic options do not consist of randomized control studies and cross-study analysis is difficult due to considerable variation of diagnostic criteria. Key Messages: Hyperemesis gravidarum carries a significant burden on maternal health and US health care. Most published research on pathogenesis is observational and suggests multifactorial associations with hyperemesis gravidarum. Precise, strictly defined criteria for clinical diagnosis are likely to benefit meta-analyses of further research studies regarding pathogenesis as well as therapeutic options.

Hyperemesis Gravidarum

“…Variations exist in the reported incidence of NVP and HG across different study populations . While this may be due to genetic or epigenetic factors, differences in incidence rates may also be due to the lack of uniformity in the diagnostic criteria used to identify cases across studies …”

“…11 While this may be due to genetic or epigenetic factors, differences in incidence rates may also be due to the lack of uniformity in the diagnostic criteria used to identify cases across studies. 12 While NVP is 1 of the most common indications for hospitalization throughout pregnancy, HG is the most common cause of hospitalization in the first half of pregnancy, accounting for >59,000 hospitalizations annually. 13,14 Apart from requiring hospitalization, HG leads to extra physician visits and emergency room visits throughout pregnancy.…”

Surgical Management of Underlying Biliary Disease in Refractory Hyperemesis Gravidarum

“…Its most severe form, HEG only affects 3% of pregnancies. Despite its overall low incidence, HEG is the single most common cause of hospitalization during the first half of pregnancy [1,5]. Although no definitive mechanism of action is universally accepted, several factors are agreed to play a role in the pathogenesis of HEG.…”

“…Hyperemesis gravidarum (HEG) is the most common cause of hospitalization during the first half of pregnancy. It affects approximately 0.3-3% of all pregnancies [1]. There is no one accepted definition or diagnostic criteria for HEG.…”

Maternal and fetal outcomes in pregnant women with hyperemesis gravidarum

“…6 HG is the most common cause of hospitalization during the first half of pregnancy and is second only to preterm labor for hospitalizations in overall pregnancy in USA. 7 The prevalence of HG may varies from 0.3% to 3% of pregnancies depending on ethnic variation in study populations. 7 Pregnant women of Western Europe had the lowest prevalence (0.8%) of HG, whereas those of India and Sri Lanka had the highest prevalence (3.2%) of HG.…”