Women’s perspectives on the management and consequences of hyperemesis gravidarum – a descriptive interview study

Abstract

Objective: Hyperemesis gravidarum (HG) affects 0.3–3% of pregnant women and is a leading cause of hospitalization in early pregnancy. The aim of the study was to investigate women’s treatment and management of HG, as well as the consequences of HG on women’s daily life. Design and setting: A cross-sectional study based on a structured telephone interview and an online questionnaire. Participants were recruited by social media and by the Norwegian patient’s organization for HG. Subjects: Norwegian women that experienced HG. Main outcome measure: Women’s perspectives on management and consequences of HG. Results: The study included 107 women. Maternal morbidity was profound; about 3/4 of participants were hospitalized due to HG, and the majority showed clinical signs of dehydration (79%), ketonuria (75%), and >5% weight loss (84%). Antiemetics were used by >90% and frequently prescribed “as needed”. Metoclopramide (71%) and meclozine (51%) were most commonly used. Participants described HG as having severe psychosocial consequences and profound impact on daily activities. Almost two out of five reported thoughts of elective abortion, and 8 women had at least one elective pregnancy termination due to HG. Overall, 20 women (19%) changed GPs due to dissatisfaction with HG management. Conclusion: Despite the high psychosocial burden and major impact on daily activities, many women with HG reported a lack of support from healthcare professionals and suboptimal management. Greater awareness and knowledge among healthcare professionals is needed to improve care for women with HG. Key Points There is a paucity of studies on management and the consequences of HG on women’s daily lives and psychosocial burden. We found that: • Many women described HG as one of their worst life experiences with profound morbidity. • Many women reported suboptimal management of HG and lack of support from healthcare professionals. • Greater understanding of patient perspectives among healthcare professionals is important to improve care and management for HG patients.

Comparative Analysis of Maternal and Fetal Outcomes of Pregnancies Complicated and Not Complicated with Hyperemesis Gravidarum Necessitating Hospitalization

“…While adverse pregnancy outcomes of HG are conflicting and the current study findings revealed no association of the condition with an increased risk of fetal or maternal outcomes compared to the control pregnancies, it should be noted that HG has been associated with a significant psychosocial burden in women together with an adverse impact on daily activities 22 in addition to increased risk of low quality of life negatively affecting the acceptance of pregnancy and the role of motherhood 23 . This seems notable given the reported lack of support from healthcare professionals and suboptimal management of women with HG 22 .…”

The effect of a pharmacist consultation on pregnant women’s quality of life with a special focus on nausea and vomiting: an intervention study

“…The term "morning sickness" may also be misleading because the symptoms often are present throughout the day. Although the symptoms usually resolve spontaneously by gestational week 16, from 5 to 10% of women experience prolonged symptoms, sometimes throughout the entire pregnancy [6]. Early recognition of NVP and initiation of optimal management are essential and may prevent further complications, such as dehydration, ketonuria, excessive weight loss, malnutrition, and in worst cases, the diagnosis of hyperemesis gravidarum [7].…”

An Atypical Case of a Common Pregnancy Issue: Appendicitis-Like Hyperemesis Gravidarum

“…Hyperemesis gravidarum (HG) is a severe subtype of nausea and vomiting in pregnancy (NVP) that is estimated to affect 0.3–2% of pregnancies [ 1 , 2 ]. It is a common reason for admission to the hospital in the first trimester of pregnancy [ 2 ].…”

“…Hyperemesis gravidarum (HG) is a severe subtype of nausea and vomiting in pregnancy (NVP) that is estimated to affect 0.3–2% of pregnancies [ 1 , 2 ]. It is a common reason for admission to the hospital in the first trimester of pregnancy [ 2 ]. HG typically begins in the first trimester of pregnancy, likely due to increasing amounts of hormones, and usually ends in the second trimester, although some cases have lasted the entire duration of pregnancy [ 3 ].…”

“…Complications of the disorder include electrolyte imbalances and, rarely, fetal demise [ 3 ]. Management includes fluid repletion and antiemetic drugs such as first-generation antihistamines, but there is no specific treatment or preventative measure [ 1 , 2 ]. Because HG is a diagnosis of exclusion, organic causes of gastrointestinal, genitourinary, metabolic, neurologic, psychologic, and pharmacologic sources must be considered during work-up [ 4 ].…”