Hyperemesis Gravidarum

Original Editor - Rishika Babburu

Top Contributors - Rishika Babburu, Kim Jackson and Vidya Acharya  

Introduction[edit | edit source]

Nausea and occasional vomiting are common in early pregnancy (NVP) . It affects 50%-80% of pregnant women during the first half of gestation.[1] When vomiting is severe or protracted, it is often referred to as hyperemesis gravidarum (HG). It is generally referred to as “morning sickness,” for many women symptoms persist over the whole day.HG may effect 0.3–2% of pregnancies and it is defined by dehydration, ketonuria, and more than 5% body weight loss.[2]

Aetiology[edit | edit source]

  • Hormone Changes[3]: There may be a connection between higher hCG and higher estrogen concentrations and hyperemesis. hCG levels and estrogen peaks during the first trimester, corresponding to the typical onset of hyperemesis symptoms.
  • Genetics: Genetics could play a role in causing Hyperemesis Gravidarum.If the mother or sister of the pregnant woman has a history of HG, then it may play a role in causing the same condition for her.[4]
  • Changes in the Gastrointestinal System[3]: one school of thought is that the relaxation of the lower esophageal sphincter during pregnancy due to the elevations in estrogen and progesterone may cause an increased incidence of gastroesophageal reflux disease (GERD) symptoms like nausea in pregnancy. However, research reports conflicting results regarding the association between GERD and emesis.
  • Eating of spicy foods and inadequate water intake could be one of the causes for frequent vomiting.
  • Intake of saturated fat: Pregnant women who consume more saturated fats such as frequent unhealthy snacks could suffer from HG.
  • In some cases pregnant women who have no intake of ginger are likely to develop hyperemesis gravidarum.[5]
  • Inadequate intake of vitamin B: Insufficient intake of vitamin B through diet can also lead to increased nausea and vomitings.[6]

Clinical signs[edit | edit source]

  • Symptoms may include a broad spectrum of severity ranging from occasional nausea to intractable vomiting.
  • Nausea and vomiting begins in the first trimester around six to nine weeks’ gestation and settle by about 12 weeks.
  • Few women have symptoms after 20 weeks of gestation.
  • Oliguria/ decreased urine output..
  • Epigastric pain.

Differential diagnosis[edit | edit source]

  • Gastrointestinal disorders
  • Gastrooesophageal reflux disease
  • Pancreatitis
  • Pepticulcer disease
  • Bowel Obstruction
  • Endocrine and metabolic disorders
  • Ovarian torsion
  • Migraines
  • Vestibular Disease
  • Eating disprders such as anorexia nervosa ,bulimia
  • Genitourinary and renal disorders are to name a few conditions in differential diagnosis.[7]

Treatment[edit | edit source]

  • Women who suffer from HG are often counselled on self limited course of symptoms and are advised to avoid foods, odours and activities that may trigger nausea or vomiting.
  • Proper diet consisting of nutritional food, inclusion of ginger and adequate fluid intake is advised.
  • Hospital admission is indicated when there is significant weight loss, electrolyte abnoramlities or persistant vomitings after rehydration .Symptoms may improve in a day or two following inpatient treatment.
  • Antihistamines (H1 antagonists), including doxylamine is used in combination with pyridoxine, meclizine, dimenhydrinate, and diphenhydramine.They are to be administered strictly under medical supervision.[7]
  • Physical activity in pregnancy may help relieve symptoms to some extent.


References[edit | edit source]

  1. Gadsby R, Barnie-Adshead AM, Jagger C. A prospective study of nausea and vomiting during pregnancy. Br J Gen Pract. 1993 Jun;43(371):245-8. Erratum in: Br J Gen Pract 1993 Aug;43(373):325. PMID: 8373648; PMCID: PMC1372422.
  2. Hod M, Orvieto R, Kaplan B, Friedman S, Ovadia J. Hyperemesis gravidarum. A review. The Journal of reproductive medicine. 1994 Aug 1;39(8):605-12.
  3. 3.0 3.1 Jennings LK, Krywko DM. Hyperemesis gravidarum.
  4. Fejzo MS, Ingles SA, Wilson M, Wang W, MacGibbon K, Romero R, Goodwin TM. High prevalence of severe nausea and vomiting of pregnancy and hyperemesis gravidarum among relatives of affected individuals. Eur J Obstet Gynecol Reprod Biol. 2008 Nov;141(1):13-7. doi: 10.1016/j.ejogrb.2008.07.003. Epub 2008 Aug 26. PMID: 18752885; PMCID: PMC2660884.
  5. https://www.researchgate.net/publication/230621165_Treatment_of_Hyperemesis_Gravidarum
  6. Ashebir G, Nigussie H, Glagn M, Beyene K, Getie A (2022) Determinants of hyperemesis gravidarum among pregnant women attending health care service in public hospitals of Southern Ethiopia. PLoS ONE 17(4): e0266054. https://doi.org/10.1371/journal.pone.0266054
  7. 7.0 7.1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7037589/
  8. Hyperemesis Gravidarum - Obstetrics for Medical Students. Available from:https://www.youtube.com/watch?v=OGdHimyPq2g