What percentage of women experience hyperemesis gravidarum (Hyperemesis Gravidarum) during pregnancy?

From the Guidelines

Hyperemesis gravidarum affects approximately 0.3% to 2% of pregnant women. This severe form of pregnancy-related nausea and vomiting is much more intense than typical morning sickness, often requiring medical intervention 1. While morning sickness affects about 70-80% of pregnant women and typically resolves by the second trimester, hyperemesis gravidarum can persist throughout pregnancy and lead to dehydration, weight loss, and electrolyte imbalances. The condition is thought to be related to elevated levels of pregnancy hormones, particularly human chorionic gonadotropin (hCG) and estrogen, though genetic factors and H. pylori infection may also play roles.

Some key points to consider in the management of hyperemesis gravidarum include:

• Treatment with antiemetics such as ondansetron, promethazine, or metoclopramide, along with IV fluids for rehydration in severe cases 1
• Thiamine supplementation to prevent Wernicke’s encephalopathy 1
• Hospitalization may be necessary in some cases, and total parenteral nutrition may be required if oral intake is inadequate
• The condition typically resolves after delivery but can have significant physical and psychological impacts during pregnancy

It's worth noting that hyperemesis gravidarum is not usually associated with any major adverse maternal or fetal outcomes, although low birth weight and premature delivery have been associated 1. Recurrence is high with subsequent pregnancies, although there is no association with chronic liver disease.

In terms of evaluation, a comprehensive history taking and physical examination are essential, including any previous pregnancies and pre-existing conditions 1. The evaluation should focus on signs of dehydration and any other potential complications.

Overall, the management of hyperemesis gravidarum should prioritize supportive care, including rehydration, anti-emetic therapy, and thiamine supplementation, with the goal of minimizing morbidity, mortality, and improving quality of life for affected women 1.

From the Research

Prevalence of Hyperemesis Gravidarum

• The estimated percentage of pregnant women affected by hyperemesis gravidarum (HG) varies across studies:
  • 1-2% of pregnant women 2
  • 0.3-3% of pregnancies 3
  • 0.3-1.0% of pregnant women 4
  • 1%-3% of pregnancies worldwide 5
• These variations may be due to different diagnostic criteria and ethnic variation in study populations 3

Key Findings

• Hyperemesis gravidarum is a condition at the extreme end of the pregnancy sickness spectrum, causing malnutrition, dehydration, electrolyte imbalance, and unintended weight loss 2
• HG can persist throughout pregnancy and have negative effects on maternal, physical, and psychological wellbeing, as well as fetal growth 2, 3
• Current treatment options include symptomatic treatment with anti-emetic pharmacological treatment, rehydration if needed, and psychological support 5
• There is a lack of high-quality evidence on treatment for HG, and future research should focus on understanding the cause, developing effective treatment, and limiting the burden of disease on patients and healthcare systems 5