Incidence and risk factors of hyperemesis gravidarum: A national register‐based study in Finland, 2005‐2017

Abstract

IntroductionHyperemesis gravidarum is the most common reason for hospitalization in early pregnancy in pregnancies resulting in delivery. Several associative factors indicate that the etiology is likely to be multifactorial. To assess this, we used a unique procedure to compare hyperemetic pregnancies with non‐hyperemetic pregnancies both in different women and in the same women's different pregnancies.Material and methodsData about all pregnancies resulting in delivery in Finland in 2005‐2017 were retrieved from healthcare registers. Women who had a diagnosis of hyperemesis gravidarum in any pregnancy in the Finnish Hospital Discharge Register were chosen as cases (n = 9315) and other women (n = 428 150) as the reference group. The incidence of hyperemesis gravidarum was calculated and associations between hyperemesis and maternal, environmental and pregnancy‐related factors were analyzed in a novel setting by comparing case women's pregnancies diagnosed with hyperemesis to (1) reference group women's pregnancies and (2) case women's non‐hyperemetic pregnancies.ResultsOf the 437 465 women who had at least one pregnancy resulting in delivery during the study period, 9315 women had at least one hyperemetic pregnancy. The total number of pregnancies resulting in delivery was 741 387 and 9549 of those were diagnosed with hyperemesis gravidarum; thus the incidence of hyperemesis gravidarum was 1.3%. In comparison (1), case women's hyperemetic pregnancies vs reference group's pregnancies, younger maternal age, higher gravidity, underweight and overweight were associated with increased risk of hyperemesis; in contrast, in comparison (2), case women's hyperemetic pregnancies vs their non‐hyperemetic pregnancies, higher age and obesity were associated with higher risk of hyperemesis, whereas the risk was lower as gravidity and parity increased. In both comparisons, smoking was associated with lower risk, whereas higher municipality population, assisted reproductive technology, multiple gestation and female sex of the fetus were associated with increased risk of hyperemesis.ConclusionsOur novel study setting provided new insights about risk factors: hyperemetic pregnancies differ both from pregnancies of women who had never been diagnosed with hyperemesis and from hyperemetic women's non‐hyperemetic pregnancies. The incidence of hyperemesis gravidarum in Finland was comparable to that in other countries.

The Contribution of Registered Dietitians in the Management of Hyperemesis Gravidarum in the United Kingdom

“…Hyperemesis Gravidarum (HG) is a more severe condition at the extreme end of the pregnancy sickness spectrum. It is estimated to affect 1.5% of pregnant women in the United Kingdom (UK) [2], with rates of 0.8-3.3% reported in other populations [3][4][5][6]. There is no agreed definition of HG, which makes diagnosis, management and research challenging; but HG is typically reported as involving persistent and intractable nausea and vomiting with the triad of more than 5% pre-pregnancy weight loss, dehydration and electrolyte imbalance [7].…”

The role of hematological parameters in the diagnosis of hyperemesis gravidarum

“…Up to 90% of pregnant women experience nausea in the early period. It has been reported that nausea during pregnancy is caused by an increase in the level of human chorionic gonadotropin hormone (HCG) [1][2][3]. Hyperemesis gravidarum is a clinical manifestation characterized by increased severity and duration of nausea and vomiting.…”

“…Nutritional disorders, dehydration, electrolyte disorders, weight loss, and ketonuria can also be added to the picture, which may worsen the clinical course of the pregnant woman. Hyperemesis gravidarum, which can develop in almost 2% of pregnant women, may be at a level that may require hospitalization in some patients [1][2][3][4][5]. A wide variety of factors play a role in the development of hyperemesis gravidarum.…”

“…A wide variety of factors play a role in the development of hyperemesis gravidarum. These include increased beta-HCG level, steroids, multiple pregnancy, increased body mass index, and a history of hyperemesis gravidarum, but the exact cause of the hyperemesis has not been elucidated [3][4][5]. Serious complications can also be developed in some pregnant women with hyperemesis gravidarum such as Wernicke encephalopathy and thromboembolism, preterm birth, low birth weight, retarded growth, some congenital anomalies, and fetal death.…”

“…Serious complications can also be developed in some pregnant women with hyperemesis gravidarum such as Wernicke encephalopathy and thromboembolism, preterm birth, low birth weight, retarded growth, some congenital anomalies, and fetal death. Therefore, it is necessary to closely monitor the hyperemesis gravidarum, and it is important to provide supportive treatment to these pregnant women quickly [3][4][5][6][7]. In chronic inflammation, proliferation is observed in the megakaryocytic series, which leads to the emergence of relative thrombocytosis.…”