Description

• Although morning sickness is common during pregnancy, HG is a rare condition.
• Intractable 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
  • Associated with high estrogen and human chorionic gonadotropin (hCG) levels
  • Symptoms usually begin ~2 weeks after first missed period, peak around the 12th week, and resolve by the 20th week
• System(s) affected: endocrine/metabolic, gastrointestinal, reproductive

Epidemiology

• Generally affects young women, primiparous, non-smokers, and nonwhite people
• Other risk factors: prior history of hyperemesis, pre-existing diabetes, hyperthyroid disorder, psychiatric illness, asthma, and GI disorders

Incidence
HG occurs in 0.5–2% of pregnancies.

Prevalence
The most common cause of hospitalization in the first half of pregnancy; the second most common cause of hospitalization of all pregnant women

Etiology and Pathophysiology

Etiology is unknown; proposed influences include the following:

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

Genetics
Increased risk if maternal family history of HG

Risk Factors

Nulliparity; multiple gestations; history of migraines; history of motion sickness; black or Asian women; gestational trophoblastic disease; fetus with trisomy 21; female fetus; possible association with Helicobacter pylori infection

General Prevention

Guidance regarding dietary habits to avoid dehydration and nutritional depletion

• Small, frequent meals
• Avoid an overly empty or full stomach.
• Avoid greasy, spicy, and fatty foods.
• Eat bland, low-fiber, high-protein snacks.