Symptomatology and Outcomes of Women withHyperemesis Gravidarum as Reported in a Large Registry
Lisa M. Korst, Borzouyeh Poursharif, Kimber W. MacGibbon, Marlena S. Fejzo, Roberto Romero, and T. Murphy Goodwin1University of Southern California, Obstetrics and Gynecology, Los Angeles, California,
2Hyperemesis Education and Research Foundation, Leesburg, Virginia, 3NICHD, NIH, DHHS, Perinatology Research Branch, Detroit, Michigan
Objective
Our objective is to report the breadth and severityof their symptomatology, and their maternal andfetal outcomes. This is the first report of a largenumber of affected women from an HG registry.
Introduction
Hyperemesis gravidarum (HG) is a severe formof nausea and vomiting of pregnancy (NVP),occurring in 1-2% of pregnant women. Ourunderstanding of the spectrum of symptoms andoutcomes derives largely from small series of HGpatients, giving an incomplete view of thiscondition.
Methods
The nonprofit Hyperemesis Education and Research(HER) Foundation administered an on-line surveyfrom 2003-2005, questioning women regarding theirsymptomatology, and maternal and fetal outcomes.
A control population was recruited largely from on-lineparenting groups. HG was defined as significantweight loss and debility secondary to nausea andvomiting during pregnancy, typically requiringmedications and/or IV fluids for treatment. Womenwith at least one gestation of at least 27 weeksduration, were the subject of this analysis, and datafrom early pregnancies that were lost were notincluded. As women reported on multiplepregnancies, data regarding the specificcharacteristics and outcomes of pregnancies wereaggregated at the level of the woman. Thus, if thecharacteristic of interest was found in any one of herpregnancies, that characteristic was noted, and theproportion of women who had at least one pregnancywith that characteristic was reported. Odds ratios(OR) were adjusted for the number of pregnancies >27 weeks per woman.
Results
The study population included 819 cases and 541controls. Of the 384 women with HG who reportedhaving more than one pregnancy, 95% reported arecurrence.
Women reported their most severe weight lossamong all their pregnancies:
o 16% lost < 5% of pre-pregnancy weighto 27% lost 5%-10% of pre-pregnancy weighto 46% lost 10-20% of pre-pregnancy weighto 10% lost > 20% of pre-pregnancy weight
Weight loss > 15% (N=214, 26%) was significantlyassociated:
During Pregnancy with:oExcess salivationoGall bladder and liver dysfunctionoHematemesisoMuscle painoRenal failureoRetinal hemorrhage
In the Postpartum Period with:oLonger recovery timeoGall bladder dysfunctionoInsomniaoMuscle painoNauseaoPTSD
Women with weight loss > 15% were nearly twiceas likely as other women with HG to continue tohave symptoms throughout pregnancy [63/214(29%) vs. 117/605 (19%), OR = 1.73, 95% CI(1.20-2.47), P = 0.003].
Results (cont):
Postpartum, cases were more likely than controlsto report bonding difficulties and negativefeelings toward the baby, and continued excessvomiting and weight management problems.
Summary
oHG is associated with a broader spectrum ofsymptoms during pregnancy than has beenpreviously reported.
oSome physical changes related to HG do notresolve with delivery.
oChildren of mothers with HG are more likely tobe reported as having behavioral, emotional, andlearning disorders.
oSevere HG, as indicated by greater weight loss,is associated with greater morbidity duringpregnancy and higher persistence of HG-associated symptoms postpartum.
Conclusions
Prenatal care practitioners should be aware ofthe broad spectrum of symptoms related to HGso that they can provide appropriateinterventions and support.
Effects of HG persisting postpartum, and effectsof HG on the offspring have not previously beenreported and should be investigated further.
P < 0.001
465 (86%)57 (11%)
2 (0%)8 (1%)9 (2%)
656 (80%)57 (7%)40 (5%)28 (3%)38 (5%)
ResidenceUSAUKAustraliaCanadaOther
P < 0.001
442 (82%)6 (1%)
13 (2%)47 (9%)33 (6%)
698 (85%)20 (2%)31 (4%)16 (2%)54 (7%)
Race/EthnicityWhiteBlackHispanicAsianOther
P < 0.00135 + 6
35 (19-62)32 + 5
32 (20-62)Maternal age (yrs)
N = 541N = 819Number of subjects
P valuesControlsCases
Patient Demographics
Selected Pregnancy Characteristicsamong Cases and Controls
05
10
1520
253035
40
Hyper
saliv
atio
n
Hemat
emes
is
Ora
l Bleed
ing
Hypote
nsion
Mem
oryLoss
Musc
lePai
n
Changed
Doctor
PPDig
estiv
ePro
blem
s
PPFood
Avers
ions
PPPTSD
Childwith
Behav
iora
l Disord
er
Childwith
Emotio
nalDis
order
Childwith
Learn
ing
Disord
er
Childwith
Senso
ryDis
order
Pre
va
len
ce
(%)
Cases Controls