Hyperemesis Gravidarum

Hyperemesis Gravidarum is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Hyperemesis gravidarum is persistent vomiting in a pregnant woman that interferes with fluid and electrolyte balance as well as nutrition:
    • Usually associated with the first 8 to 20 weeks of pregnancy
    • Believed to have biomedical and behavioral aspects
    • Associated with high estrogen and human chorionic gonadotropin (hCG) levels
    • Symptoms usually begin ~2 weeks after first missed period.
  • System(s) affected: endocrine/metabolic; gastrointestinal; reproductive
  • Synonym(s): morning sickness

Pregnancy Considerations
Common condition during pregnancy, typically in the 1st and 2nd trimesters but may persist into the 3rd trimester

Epidemiology

Incidence
Hyperemesis gravidarum occurs in 1–2% of pregnancies.

Prevalence
Hyperemesis gravidarum is the most common cause of hospitalization in the first half of pregnancy and the second most common cause of hospitalization of pregnant women.

Etiology and Pathophysiology

  • Unknown
  • Possible psychological factors
  • Hyperthyroidism
  • Hyperparathyroidism
  • Gestational hormones
  • Liver dysfunction
  • Autonomic nervous system dysfunction
  • CNS neoplasm
  • Addison disease

Risk Factors

  • Obesity
  • Nulliparity
  • Multiple gestations
  • Gestational trophoblastic disease
  • Gonadotropin production stimulated
  • Altered GI function
  • Hyperthyroidism
  • Hyperparathyroidism
  • Liver dysfunction
  • Female fetus
  • Helicobacter pylori infection

General Prevention

Anticipatory guidance in 1st and 2nd trimesters regarding dietary habits in hopes of avoiding dehydration and nutritional depletion

Pregnancy Considerations
  • 2% of pregnancies have electrolyte disturbances.
  • 50% of pregnancies have at least some GI disturbance.

Commonly Associated Conditions

Hyperthyroidism

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