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Hyperemesis Gravidarum (HG)

Hyperemesis Gravidarum is a debilitating and potentially life-threatening condition of pregnancy. It is characterized by persistent and severe nausea and vomiting leading to weight loss, dehydration and malnutrition. It occurs before 22 weeks gestation and must be diagnosed by a health professional to eliminate other causes.

Diagnosis of HG:

The diagnostic criteria for HG often varies amongst health professionals and leading researchers. A suitable differentiation between morning sickness and hyperemesis has been little researched so far. As a result, HG is currently recognised as a continuation and worsening of morning sickness symptoms - leading to the need for medical intervention. Hyperemesis affects approximately 0.3-3.6% of pregnancies and 1-3% of these diagnosed cases require treatment through hospitalization.

Causes of HG:

Current scientific research suggests placental and appetite hormones (GDF15, GFRAL and PGR) as playing the largest role in the aetiology of hyperemesis. Additional theories include vitamin deficiencies and elevated thyroxine levels amongst other metabolic changes. However, many of these existing theories are founded by the understanding these deficiencies co-exist with sufferers of HG. Therefore, it is not known if metabolic disturbances are a result or cause of hyperemesis.

Treatment:

HG can cause significant adverse outcomes on women’s emotional, physical and mental state. Treatment of HG can include pharmacological intervention and restoration of lost fluids to prevent further dehydration.

This typically involves:

  • admission to hospital
  • diagnosis of HG and elimination of other conditions
  • intravenous fluid administration
  • antiemetic drugs (drugs to relieve the symptoms of nausea)
  • Smaller meals slowly reintroduced

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References
Fejzo, M., Poursharif, B., Korst, L., Munch, S., MacGibbon, K., Romero, R. and Goodwin, T., 2009. Symptoms and Pregnancy Outcomes Associated with Extreme Weight Loss among Women with Hyperemesis Gravidarum. Journal of Women's Health, 18(12), pp.1981-1987.
Fejzo, M., Sazonova, O., Sathirapongsasuti, J., Hallgrímsdóttir, I., Vacic, V., MacGibbon, K., Schoenberg, F., Mancuso, N., Slamon, D. and Mullin, P., 2018. Placenta and appetite genes GDF15 and IGFBP7 are associated with hyperemesis gravidarum. Nature Communications, 9(1).
Fejzo, M., Trovik, J., Grooten, I., Sridharan, K., Roseboom, T., Vikanes, Å., Painter, R. and Mullin, P., 2019. Nausea and vomiting of pregnancy and hyperemesis gravidarum. Nature Reviews Disease Primers, 5(1).
NORD (National Organization for Rare Disorders). 2020. Hyperemesis Gravidarum - NORD (National Organization for Rare Disorders). [online] Available at: <https://rarediseases.org/rare-diseases/hyperemesis-gravidarum/> [Accessed 2 April 2021].
Veenendaal, M., van Abeelen, A., Painter, R., van der Post, J. and Roseboom, T., 2011. Consequences of hyperemesis gravidarum for offspring: a systematic review and meta-analysis. BJOG: An International Journal of Obstetrics & Gynaecology, 118(11), pp.1302-1313.

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