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]