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Pregnancy, Hyperemesis Gravidarum

Authors: Susan Renee Wilcox, MDAuthor Information and Disclosures

Editors: Assaad J Sayah, MD; Francisco Talavera, PharmD, PhD; Mark Zwanger, MD, MBA; John Halamka, MD; Pamela Dyne, MDEditor Information

Last Updated: July 18, 2006

Synonyms and related keywords ›

Introduction

Background: Nausea and vomiting are common in pregnancy, occurring in 70-85% of all gravid women. Hyperemesis gravidarum is a severe and intractable form of nausea and vomiting in pregnancy. It is a diagnosis of exclusion and may result in weight loss; nutritional deficiencies; and abnormalities in fluids, electrolyte levels, and acid-base balance. The peak incidence is at 8-12 weeks of pregnancy, and symptoms usually resolve by week 20 in all but 10% of patients. Uncomplicated nausea and vomiting of pregnancy is generally associated with a lower rate of miscarriage, but hyperemesis gravidarum may affect the health and well-being of both the pregnant woman and the fetus.

Pathophysiology: The etiology of nausea and vomiting of pregnancy is unknown. Many have postulated that nausea and vomiting are protective in pregnancy to reduce exposures to potentially teratogenic materials. Some theories hold that elevated human chorionic gonadotropin (hCG) or estradiol levels could be causative, due to correlations in numerous studies between levels and symptoms, but this has not been demonstrated conclusively. Psychological theories of the etiology are falling out of favor, and the American College of Obstetrics and Gynecology warns that attributing vomiting to psychological disorders has likely impeded progress in understanding the true etiology of hyperemesis gravidarum.

Frequency:

  • In the US: Hyperemesis gravidarum occurs in 0.5-2% of pregnancies, with the variation in incidence arising from different diagnostic criteria and ethnic variations. Studies have found an admission rate of 0.8% for hyperemesis gravidarum and an average of 1.3 hospital admissions per hyperemesis patient, with an average hospital stay of 2.6-4 days.

Mortality/Morbidity: With mild-to-moderate vomiting, the patient and the fetus are unlikely to experience any increased morbidity or mortality. Before the advent of intravenous hydration, hyperemesis was a major cause of maternal death. Currently, mortality is exceedingly rare, but maternal morbidities may include Wernicke encephalopathy from vitamin B-1 deficiency, Mallory-Weiss tears, esophageal rupture, pneumothorax, and acute tubular necrosis. Hyperemesis is the second leading cause of hospitalization in pregnancy, second only to preterm labor. Additionally, many women experience significant psychosocial morbidity, occasionally interfering with assumption of the maternal role and rarely leading to termination of the pregnancy.

Race: Hyperemesis patients are more likely to be nonwhite.

Age: Patients younger than 30 years are more likely to experience hyperemesis.

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Synonyms And Related Keywords

hyperemesis gravidarum, nausea and vomiting in pregnancy, pernicious vomiting in pregnancy, uncontrollable vomiting in pregnancy, severe nausea and vomiting in pregnancy, morning sickness, miscarriage

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Author Information and Disclosures

Author: Susan Renee Wilcox, MD, Resident, Department of Emergency Medicine, Harvard Medical School

Coauthor(s): Alison Edelman, MD, Assistant Professor, Department of Obstetrics and Gynecology, Oregon Health Sciences University; Judith R Logan, MD, MS, Assistant Professor, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University

Susan Renee Wilcox, MD, is a member of the following medical societies: Phi Beta Kappa

Editor Information

Editor(s): Assaad J Sayah, MD, Chief, Department of Emergency Medicine, Cambridge Health Alliance; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Mark Zwanger, MD, MBA, Assistant Professor, Department of Emergency Medicine, Thomas Jefferson University; John Halamka, MD, Chief Information Officer, CareGroup Healthcare System, Assistant Professor of Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Assistant Professor of Medicine, Harvard Medical School; and Pamela Dyne, MD, Program Director, Associate Professor, Department of Medicine, Division of Emergency Medicine, University of California at Los Angeles School of Medicine

 
 
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