HyperemesisGravidarumAssociatedWithSeriousMorbidity

Norra MacReady
Authors and Disclosures
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May 10, 2007 (San Diego) Hyperemesis gravidarum (HG), extreme nausea and vomiting during pregnancy
resulting in the loss of at least 5% of woman's prepregnancy body weight, can be a source of serious morbidity
during and after the pregnancy and is an important cause of pregnancy termination, researchers said at the 55th
annual clinical meeting of the American College of Obstetricians and Gynecologists.
In an online survey of 505 women with HG, 125 (25%) reported having terminated at least one pregnancy
because of it. Sixty-three patients (12.5%) had undergone 5 abortions or more, and 27 women (5.3%) strongly
considered termination because of their symptoms. Borzouyeh Poursharif, MD, and colleagues also presented
the findings of another survey of 819 women, showing that most of those patients had lost at least 10% of their
body weight, with a significant minority of patients saying their symptoms lasted throughout the pregnancy.
Weight loss of 15% or more was associated with the most serious adverse effects during and after pregnancy.
The data were gathered from online surveys conducted by the Hyperemesis Research and Education
Foundation, a support and education group for HG sufferers and their caregivers. The information on pregnancy
termination came from questionnaires posted from 2002 to 2003, and the data on weight loss and associated
conditions were collected from a survey posted from 2003 to 2005.
Pregnancy Termination Due to HG
Compared with patients who did not terminate their pregnancies, those who did so were more likely to cite a
negative attitude by their healthcare provider ( P < .0001) and fear of a future pregnancy ( P = .046) as
associated factors. However, women who did not terminate their pregnancies experienced more family
dysfunction ( P = .0295), career problems ( P = .0036), eating problems ( P = .0067), and limitations on physical
activity ( P < .0001) as a result of their HG. In some cases, these problems persisted after delivery, the authors
said in a poster presentation.
Effect on Overall Health
In the second survey, 73% of the respondents said they lost 5% to 20% of their prepregnancy weight due to HG,
and 10% lost more than 20% of their prepregnancy weight. Women who lost more than 15% of their
prepregnancy weight were more likely than those who lost less to be treated with intravenous fluids,
hyperalimentation, or ondansetron ( P < .0001 for all interventions). They were more than 3 times as likely to
receive inpatient treatment and more than twice as likely to change physicians during the course of their
pregnancies.
Women who lost more than 15% of their weight also were 5 times more likely to develop renal failure ( P = .
0108) and retinal hemorrhage ( P = .0001), and they were significantly more likely to experience other serious
health consequences, including liver dysfunction ( P = .0009) and neurologic changes ( P < .0001).
Estimates of the incidence of HG range from 0.3% to 2% of all pregnancies, said Dr. Poursharif, a visiting
research fellow in the Division of Maternal-Fetal Medicine at the University of Southern California in Los
Angeles. HG is the most common cause of hospitalization during the first half of pregnancy, and the second
most common cause of hospitalization during pregnancy overall. In their presentation, Dr. Poursharif and
colleagues noted that HG's physical and psychological effects may be underestimated. The fact that women
who terminated their pregnancies were actually less likely to encounter social and familial consequences than
those who carried theirpregnancies to term "reflects the burden of HG on women's lives," they write.
Many women fear that the fetus suffers from the incessant nausea and vomiting and the weight loss, "but this is
not proven yet," Dr. Poursharif told Medscape.
If anything, "we know that [HG] doesn't harm the fetus if the woman is hydrated and given appropriate
replacements," said Julie B. Schmidt, MD, division chief of obstetrics and gynecology at Cook County Hospital
in Chicago. Dr. Schmidt, who was not involved in these studies, agreed that this condition can have a profound
effect on a patient's work, relationships, and family life. But when women with HG terminate their pregnancies
over concerns for the fetus, "you have to wonder who is counseling them," she said.
Obstet Gynecol. 2007;109(4[suppl]):119S, 120S.
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