HYPEREMESIS GRAVIDARUM: A CURRENT REVIEW

Rami Eliakim; Ovadia Abulafia; David M. Sherer

doi:10.1055/s-2000-9424

American Journal of Perinatology, Table of Contents

Am J Perinatol 2000; Volume 17(Number 04): 207-218
DOI: 10.1055/s-2000-9424

HYPEREMESIS GRAVIDARUM: A CURRENT REVIEW

Rami Eliakim¹ , Ovadia Abulafia² , David M. Sherer³

¹Division of Gastroenterology, Rambam Medical Center, Technion School of Medicine, Haifa, Israel
²Department of Obstetrics & Gynecology, State University of New York, Health and Science Center at Brooklyn, Brooklyn, New York
³Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynocology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York

Abstract

ABSTRACT

Hyperemesis gravidarum or pernicious vomiting of pregnancy affects between 0.3% and 2% of all pregnant patients. The objective of this paper is to review current literature pertaining to epidemiology, etiology, symptomatology, complications, treatment, and perinatal outcome of patients with hyperemesis gravidarum. We performed a MEDLINE search of the English literature from 1966 through January 2000 utilizing the keywords: hyperemesis gravidarum, nausea and vomiting, and pregnancy. Current data pertaining to epidemiology, etiology, clinical manifestations, differential diagnosis, complications, various treatment modalities, subsequent perinatal outcome and recent developments are presented. Review of the literature supports that hyperemesis gravidarum is a multifactorial disease in which pregnancy-induced hormonal changes associated with concurrent gastrointestinal dysmotility and possible Helicobacter pylori infection function as contributing factors. Therapeutic key elements are mainly supportive in conjunction with antiemetic medication. It appears perinatal outcome is unaffected.

KEYWORD

Hyperemesis gravidarum - pernicious vomiting - nausea - pregnancy

Full Text

References

REFERENCES

1 Broussard C N, Richter J E. Nausea and vomiting of pregnancy. Gastroenterol Clin North Am . 1998; 27 123-151
2 Gadsby R, Barnie-Adshead A M, Jagger C. A prospective study of nausea and vomiting during pregnancy. Br J Gen Pract . 1993; 43 245-248
3 Fairweather D V. Nausea and vomiting in pregnancy. Am J Obstet Gynecol . 1968; 102 135-137
4 Cruikshank D P, Wigton T R, Hays P M. Maternal physiology in pregnancy. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics Normal and Problem Pregnancies 3rd ed. New York: Churchill Livingstone, Inc 1996: 91-109
5 Kallen B. Hyperemesis during pregnancy and delivery outcome: a registry study. Eur J Obstet Gynecol Reprod Biol . 1987; 26 292-302
6 Bashiri A, Newmann L, Maymon E, Katz M. Hyperemesis gravidarum: epidemiologic features, complications and outcome. Eur J Obstet Gynecol Reprod Biol . 1995; 63 135-138
7 Pokras R. Vital and Health Statistics: Detailed Diagnoses and Procedures, National hospital Discharge Survey. DHHS Pub. No. (PHS) 87-1751 Series 13, No 90 Rockville, MD: US Department of Health and Human Services; 1985
8 Commission on Professional and Hospital Activities. Length of Stay by Diagnosis, Northeastern Region Ann Arbour, MI: CPH Publications 1986: 150
9 Klebanoff M A, Koslowe P A, Kaslow R, Rhodes G G. Epidemiology of vomiting in early pregnancy. Obstet Gynecol . 1985; 66 612-616
10 Price A, Davies R, Heller S R, Milford-Ward A, Weetman A P. Asian women are at risk of gestational thyrotoxicosis. J Clin Endocrinol Metab . 1996; 81 1160-1163
11 Jordan V, MacDonald J, Crichton S, Stone P, Ford H. The incidence of hyperemesis gravidarum is increased among Pacific Islanders living in Wellington. NZ Med J . 1995; 108 342-344
12 Depue R H, Bernstein L, Ross R K, Judd H L, Henderson B E. Hyperemesis gravidarum in relation to estradiol levels, pregnancy outcome, and other maternal factors: a seroepidemiology study. Am J Obstet Gynecol . 1987; 156 1137-1141
13 Abell T L, Riel C A. Hyperemsis gravidarum. Gastroenterol Clin North Am . 1992; 21 835-849
14 Soules M R, Hughes C L, Garcia J A. Nausea and vomiting in pregnancy: role of human chorionic gonadotropin and 17 hydroxyprogesterone. Obstet Gynecol . 1980; 55 696-700
15 Goodwin T M, Hershman J M, Cole L. Increased concentration of the free beta-subunit of human chorionic gonadotropin in hyperemesis gravidarum. Acta Obstet Gynecol Scand . 1994; 73 770-772
16 Kimura M, Amino N, Tamaki H, Ito E, Mitsuda N, Miyai K, Tanizawa O. Gestational thyrotoxicosis and hyperemesis gravidarum: role of hCG with higher stimulating activity. Clin Endocrinol . 1993; 38 345-350
17 Jordan V, Grebe S KG, Cooke R R. Acidic forms of chorionic gonadotropin in European and Samoan women are associated with hyperemesis gravidarum and may be thyrotropic. Clin Endocrinol . 1999; 50 619-627
18 Kennedy R L, Darne J, Davies R, Price A. Thyrotoxicosis and hyperemesis gravidarum associated with a serum activity which stimulates human thyroid cells in vitro. Clin Endocrinol . 1992; 36 83-89
19 Mestman J H. Hyperthyroidism in pregnancy. Endocrin Metab Clin North Am . 1998; 27 127-149
20 Boullion R, Naesens M, van Assche F A. Thyroid function in patients with hyperemesis gravidarum. Am J Obstet Gynecol . 1982; 143 922-926
21 Bober S A, McGill A C, Tunbridge W MG. The thyroid function in hyperemesis gravidarum. Acta Endocrinol . 1986; 111 404-410
22 Valbo A, Jerve F. A study of thyroid hormones in women suffering from vomiting in pregnancy. Acta Eur Fertil . 1987; 18 381-383
23 Wilson R, McKillop J H, MacLean M. Thyroid function test are rarely abnormal in patients with severe hyperemesis gravidarum. Clin Endocrinol . 1992; 37 331-334
24 Goodwin T M, Montoro M, Mestman J H. Transient hyperthyroidism and hyperemesis gravidarum: clinical aspects. Am J Obstet Gynecol . 1992; 167 649-652
25 Goodwin T M, Montoro M, Mestman J H, Pekary A E, Hershman J M. The role of chorionic gonadotropin in transient hyperthyroidism of hyperemesis gravidarum. J Clin Endocrinol Metab . 1992; 75 1333-1337
26 Sullivan C A, Johnson C A, Roach H, Martin R W, Stewart D K, Morrison J C. A pilot study of intravenous ondansteron for hyperemesis gravidarum. Am J Obstet Gynecol . 1996; 174 1565-1568
27 Hasler W L. Serotonin receptor physiology: relation to emesis. Dig Dis Sci . 1999; 44 108S-118S
28 Guikontes E, Spantideas A, Diakadis J. Ondansterone and hyperemesis gravidarum. Lancet . 1992; 340 1223
29 World M J. Ondansterone and hyperemesis gravidarum. Lancet . 1993; 341 185
30 Borgeat A, Fathi M, Valiton A. Hyperemesis gravidarum: is serotonin implicated. Am J Obstet Gynecol . 1997; 176 476-477
31 Van Thiel D H, Gravaler J S, Joshi S N. Heartburn of pregnancy. Gastroenterol . 1977; 72 666-668
32 Koch K l, Stern R M, Vasey M, Otti J J, Creasy G W, Dwyer A. Gastric dysrhythmias and nausea of pregnancy. Digestive Diseases and Sciences . 1990; 35 961-968
33 Riezzo G, Pezzolla F, Darconza G, Giorgio I. Gastric myoelectrical activity in the first trimester of pregnancy: a cutaneous electrogastrographic study. Am J Gastroenterol . 1992; 87 702-707
34 Maes B D, Spitz B, Ghoos Y F, Hiele M I, Evenepoel P, Rutgeerts. Gastric emptying in hyperemesis gravidarum and non-dyspeptic pregnancy. Aliment Pharmacol Ther . 1999; 13 237-243
35 Michaletz-Onody P A. Peptic ulcer disease in pregnancy. Gastroenterol Clin North Am . 1992; 21 817-826
36 Frigo P, Lang C, Reisenberger K, Hirschl A M. Hyperemesis gravidarum associated with Helicobacter pylori Seropositivity. Obstet Gynecol . 1998; 91 615-617
37 El Younis C M, Abulafia O, Sherer D M. Rapid response of severe hyperemesis gravidarum to oral erythromycin. Am J Perinatol . 1998; 15 533-534
38 Jacoby E B, Porter K B. Helicobacter Pylori infection and persistent hyperemesis gravidarum. Am J Perinatol . 1999; 16 85-88
39 Morali J A, Braverman D Z. Abnormal liver enzymes and ketonuria in hyperemesis gravidarum: a retrospective review of eighty patients. J Clin Gastroenterol . 1990; 12 303-305
40 Wallstedt A, Riely C A, Shaver D. Prevalence and characteristics of liver dysfunction in hyperemesis gravidarum. Clin Res . 1990; 38 970-972
41 Larrey D, Rueff B, Feldman G, Degott C, Danan G, Benhamou J P. Recurrent jaundice caused by recurrent hyperemesis gravidarum. Gut . 1984; 25 1414-1415
42 Orazi G, Dufour P H, Puech F. Jaundice induced by hyperemesis gravidarum. Int J Gynecol Obstet . 1998; 61 181-183
43 Signorello L B, Harlow B L, Wang S, Erick M A. Saturated fat intake and the risk of severe hyperemesis gravidarum. Epidemiology . 1998; 9 636-640
44 Minagawa M, Narita J, Tada T. Mechanisms underlying immunologic states during pregnancy: possible association of the sympathetic nervous system. Cell Immunol . 1999; 196 1-13
45 Reinken L, Gant H. Vitamin B₆ nutrition in women with hyperemesis gravidarum during the first trimester of pregnancy. Clin Chim Acta . 1974; 55 101-102
46 Tabbakh G E, Darwish E, Sebaie F E. Study of serum copper and zinc in serum of patients with hyperemesis gravidarum. Int J Gynecol Obstet . 1989; 29 207-212
47 Lao T T, Chin R KH, Mak Y T, Panesar N S. Plasma zinc concentration and thyroid function in hyperemetic pregnancies. Acta Obstet Gynecol Scand . 1988; 67 599-604
48 Chin R KH, Lao T T, Swaminathan R, Mak Y T. A longitudinal study of changes in erythrocyte zinc concentration in hyperemesis gravidarum. Gynecol Obstet Invest . 1990; 29 22-25
49 Guze B, DeLong W B, Majerus P W. Association of clinical psychiatric disease with hyperemesis gravidarum. N Engl J Med . 1957; 261 136-138
50 Katon W J, Ries R K, Bokan L A. Hyperemesis gravidarum: a biopsychological perspective. Int J Psychiatry Med . 1980; 10 151-162
51 Iancu I, Kotler M, Spivak B, Radvan M, Weizman A. Psychiatric aspects of hyperemesis gravidarum. Psychother Psychosome . 1994; 61 143-149
52 Stewart D E. Reproductive functions in eating disorders. Ann Med . 1992; 24 287-291
53 Lingham R, McCluskey S. Eating disorders associated with hyperemesis gravidarum. J Psychosomatic Res . 1996; 40 231-234
54 Johnson D R, Douglas D, Hauswald M, Tandberg D. Dehydration and orthostatic vital signs in women with hyperemesis gravidarum. Acad Emerg Med . 1995; 2 692-697
55 Hod M, Orvieto R, Kaplan B, Friedman S, Ovadia J. Hyperemesis gravidarum: a review. J Reprod Med . 1994; 39 605-612
56 Goodwin T M. Hyperemesis gravidarum. Clin Obstet Gynecol . 1998; 41 597-605
57 Robertson C, Millar H. Hyperamylasemia in bulimia nervosa and hyperemesis gravidarum. Int J Eat Disorder . 1999; 26 223-227
58 Omer S M, al Kawi M Z, al Watban J, Bohelga S, McLean D R, Miller G. Acute Wernicke's encephalopathy associated with hyperemesis gravidarum: magnetic resonance imaging findings. J Neuroimaging . 1995; 5 251-253
59 Rotman P, Hassin D, Mouallem M, Barkai G, Farfel Z. Wernicke's encephalopathy in hyperemesis gravidarum: association with abnormal liver function. Isr J Med Sci . 1994; 30 225-228
60 Gardian G, Voros E, Jardanhazy T, Ungurean A, Vecsei L. Wernicke's encephalopathy induced by hyperemesis gravidarum. Acta Neurol Scand . 1999; 99 196-198
61 Rees J H, Ginsberg L, Schapira H V. Two pregnant women with vomiting and fits. Am J Obstet Gynecol . 1997; 177 1539-1540
62 Ohkoshi N, Ishii A, Shoji S. Wernicke's encephalopathy induced by hyperemesis gravidarum, associated with bilateral caudate lesions on computed tomography and magnetic resonance imaging. Eur Neurol . 1994; 34 177-180
63 Peeters A, van de wyngaert F, Van Lierde M, Sindic C J, Laterre E C. Wernicke's encephalopathy and central pontine myelinolysis induced by hyperemesis gravidarum. Acta Neurol Belg . 1993; 93 276-282
64 Bergin P S, Harvey P. Wernicke's encephalopathy and central pontine myelinolysis associated with hyperemesis gravidarum. Br Med J . 1992; 305 517-518
65 Castillo R A, Ray R A, Yaghmai F. Central pontine myelinolysis and pregnancy. Obstet Gynecol . 1989; 73 459-461
66 Fraser D. Central pontine myelinolysis as a result of treatment of hyperemesis gravidarum: case report. Br J Obstet Gynaecol . 1988; 95 621-623
67 Arieff A I. Hyponatremia, convulsions, respiratory arrest and permanent brain damage after elective surgery in healthy women. N Engl J Med . 1986; 314 1529-1534
68 Kanayama N, Khatun S, Belayet H M. Vasospasms of cerebral arteries in hyperemesis gravidarum. Gynecol Obstet Invest . 1998; 46 139-141
69 Schwartz M, Rossoff L. Pneumomediastinum and bilateral pneumothoraces in a patient with hyperemesis gravidarum. Chest . 1994; 106 1904-1906
70 Gorbach J S, Counselmann F L, Mendelson M H. Spontaneous pneumomediastinum secondary to hyperemesis gravidarum. J Emerg Med . 1997; 15 639-643
71 Chirino O, Kovac R, Bale D, Blythe J G. Barogenic rupture of the esophagus associated with hyperemesis gravidarum. Obstet Gynecol . 1978; 52 51S-53S
72 Fukada Y, Ohta S, Mizuno K, Hoshi K. Rhabdomyolysis secondary to hyperemesis gravidarum. Acta Obstet Gynecol Scand . 1999; 78 71-73
73 Robinson J N, Banerjee R, Thiet M P. Coagulopathy secondary to vitamin K deficiency in hyperemesis gravidarum. Obstet Gynecol . 1998; 92 673-675
74 van Stuijvenberg M E, Schabort I, Labadarios D, Nel J T. The nutritional status and treatment of patients with hyperemesis gravidarum. Am J Obstet Gynecol . 1995; 172 1585-1591
75 Greenspoon J S, Rosen D J, Ault M. Use of the peripherally inserted central catheter for parenteral nutrition during pregnancy. Obstet Gynecol . 1993; 81 831-834
76 Sahakian V, Rouse D, Sipes S. Vitamin B₆ is effective therapy for nausea and vomiting of pregnancy: a randomized double blind placebo controlled study. Obstet Gynecol . 1991; 78 33-36
77 Nageotte M P, Briggs G G, Towers C V, Asrat T. Droperidol and diphenhydramine in the management of hyperemesis gravidarum. Am J Obstet Gynecol . 1996; 174 1801-1805
78 Leathem A. Safety and efficacy of antiemetics used to treat nausea and vomiting of pregnancy. Clin Pharm . 1986; 5 660-668
79 Desmond P V, Watson K JR. Metoclorpramide: a review. Med J Aust . 1986; 144 366-369
80 Safari H R, Alsulyman O M, Gherman R B, Goodwin T M. Experience with oral methylprednisolone in the treatment of refractory hyperemesis gravidarum. Am J Obstet Gynecol . 1998; 178 1054-1058
81 Safari H R, Fassett M J, Souter I C, Alsulyman O M, Goodwin T M. The efficacy of methylprednisolone in the treatment of hyperemesis gravidarum: a randomized, double blind, controlled study. Am J Obstet Gynecol . 1998; 179 921-924
82 Fisher-Rasmussen W, Kjaer S, Dahl C, Asping U. Ginger treatment of hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol . 1990; 38 19-24
83 Hsu J J, Clark-Glena R, Nelson D K, Kim C H. Nasogastric enteral feeding in the management of hyperemesis gravidarum. Obstet Gynecol . 1996; 88 343-346
84 Erick M. Nutrition via jejunostomy in refractory hyperemesis gravidarum: a case report. J Am Diet Assoc . 1997; 97 1154-1156
85 Godil A, Chen Y K. Percutaneous endoscopic gastrostomy for nutrition support in pregnancy associated with hyperemesis gravidarum and anorexia nervosa. J Parenter Enter Nutr . 1998; 22 238-241
86 Zibell-Frisk D, Jen K L, Rick J. Use of parenteral nutrition to maintain adequate nutritional status in hyperemesis gravidarum. J Perinatol . 1990; 10 390-395
87 Naef R W, Chauhan S P, Roach H, Roberts W E, Travis K H, Morrison J C. Treatment for hyperemesis gravidarum in the home: an alternative to hospitalization. J Perinatol . 1995; 15 289-292
88 Gross S, Librach C, Cecutti A. Maternal weight loss associated with hyperemesis gravidarum: a predictor of fetal outcome. Am J Obstet Gynecol . 1989; 160 906-909
89 Godsey R K, Newman R B. Hyperemesis gravidarum: a comparison of single and multiple admissions. J Reprod Med . 1991; 36 287-290
90 Hallak M, Tsalamandris K, Drombrowski M P, Isada N B, Pryde P G, Evans M I. Hyperemesis gravidarum: effects on fetal outcome. J Reprod Med . 1996; 41 871-874
91 Tsang I S, Katz V L, Wells S D. Maternal and fetal outcomes in hyperemesis gravidarum. Int J Gynecol Obstet . 1996; 55 231-23