Hyperemesis Gravidarum

It is estimated that 0.3-3.0% of pregnant women have hyperemesis gravidarum. Diagnostic criteria include intractable vomiting, disturbance of nutritional status, weight loss of at least 5%, ketosis, and acetonuria. Hyperemesis gravidarum can result in neurologic disturbances, liver damage, retinal hemorrhage, and renal damage.

Hyperemesis gravidarum is different than the “morning sickness” that is not unusual among pregnant women. Symptoms are not time-specific and occur throughout the day (vs. being worse, for example, in the morning). Women are often unable to perform activities of daily living, and hyperemesis gravidarum interferes with sleep. Ketones are often present, dehydration and electrolyte imbalances are common, and urine is scant, dark, and malodorous.

The etiology of hyperemesis gravidarum is not known, however theories include the influence of adrenal dysfunction, hormonal changes, and human chorionic gonadotropin (hCG) levels. Olfactory triggers have also been documented; these are thought to be a result of enhanced chemoreception with increased estrogen levels. (ACOG, 2018)

Treatment is “symptomatic,” and usually includes rehydration therapy and avoidance of “trigger smells,” (both food and non-food); antiemetics (medications that help with vomiting), hyperalimentation, and hospitalization are often necessary.