Search
hyperemesis gravidarum
Epidemiology:
- 15% chance of recurrence with subsequent pregnancy [2]
- 3 times more common in daughters of affected mothers [4]
Pathology:
1) generally self-limited
2) fetal production of GDF15, & maternal sensitivity to GDF15, contribute risk of hyperemesis gravidarum [5]
3) increased circulating levels of chorionic gonadotropin
4) liver disorder
Clinical manifestations:
- severe vomiting
Laboratory:
1) serum transaminases < 500 IU/L (50%) [1]
2) serum bilirubin < 4 mg/dL
3) basic metabolic panel: electrolyte abnormalities [1]
3) increased serum total T4
4) low serum TSH
5) blunted TSH response to TRH
Management:
1) clinical hydration
- intravenous fluids as needed [1]
2) antiemetics [1], metoclopramide
3) pyridoxine (vit B6) 10-25 mg TID-QID
4) add doxylamine 12.5 mg with each dose of pyridoxine as needed
5) accupressure [3]
Related
morning sickness (nausea & vomiting of pregnancy)
vomiting
General
liver disease during pregnancy
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, 16.
American College of Physicians, Philadelphia 1998, 2012
- Trogstad LI, Stoltenberg C, Magnus P, Skjaerven R, Irgens LM.
Recurrence risk in hyperemesis gravidarum.
BJOG. 2005 Dec;112(12):1641-5.
PMID: 16305568
- Prescriber's Letter 13(12): 2006
Detail-Document#: 221210
Gastrointestinal drug use during pregnancy
(subscription needed) http://www.prescribersletter.com
- Vikanes A et al
Recurrence of hyperemesis gravidarum across generations:
population based cohort study
BMJ 2010;340:c2050
PMID: 21030362
http://www.bmj.com/cgi/content/full/340/apr29_1/c2050
- Nelson-Piercy C (Editorial)
Recurrence of hyperemesis across generations
BMJ 2010;340:c2178
PMID: 21030363
http://www.bmj.com/cgi/content/extract/340/apr29_1/c2178
- Fejo M, Rocha N, Cimino I et al
GDF15 linked to maternal risk of nausea and vomiting during pregnancy.
Nature. 2-23. Dec 13.
PMID: 38092039
https://www.nature.com/articles/s41586-023-06921-9