Nausea and vomiting of pregnancy and hyperemesis gravidarum

Abstract

Nausea and vomiting of pregnancy (NVP) is a common condition that affects as many as 70% of pregnant women. Although no consensus definition is available for hyperemesis gravidarum (HG), it is typically viewed as the severe form of NVP and has been reported to occur in 0.3–10.8% of pregnant women. HG can be associated with poor maternal, fetal and child outcomes. The majority of women with NVP can be managed with dietary and lifestyle changes, but more than one-third of patients experience clinically relevant symptoms that may require fluid and vitamin supplementation and/or antiemetic therapy such as, for example, combined doxylamine/pyridoxine, which is not teratogenic and may be effective in treating NVP. Ondansetron is commonly used to treat HG, but studies are urgently needed to determine whether it is safer and more effective than using first-line antiemetics. Thiamine (vitamin B1) should be introduced following protocols to prevent refeeding syndrome and Wernicke encephalopathy. Recent advances in the genetic study of NVP and HG suggest a placental component to the aetiology by implicating common variants in genes encoding placental proteins (namely GDF15 and IGFBP7) and hormone receptors (namely GFRAL and PGR). New studies on aetiology, diagnosis, management and treatment are under way. In the next decade, progress in these areas may improve maternal quality of life and limit the adverse outcomes associated with HG.

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Fig. 1: Possible model for the role of GDF15 in pregnancies affected by HG.
Fig. 2: The management of women with NVP and HG.

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Acknowledgements

The authors thank K. W. MacGibbon, Director of the Hyperemesis Education and Research Foundation, for providing resources for this manuscript. T.J.R. acknowledges funding from the European Union, the Dutch Heart Foundation, the Dutch Organization for Scientific Research, the Medical Research Council UK, and the Foreest Institute.

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Contributions

Introduction (M.S.F.); Epidemiology (P.M.M.); Mechanisms/pathophysiology (M.S.F. and T.J.R.); Diagnosis, screening and prevention (I.J.G. and R.C.P.); Management (J.T., K.S. and P.M.M.); Quality of life (Å.V.); Outlook (M.S.F.); Overview of the Primer (M.S.F.).

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Correspondence to Marlena S. Fejzo.

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Competing interests

M.S.F. has received funding from the Hyperemesis Education and Research (HER) Foundation and is on their Board of Directors. She is a co-inventor of the HG Care application, which is available for free download in the Apple store. She is currently funded, in part, by the Eppley Foundation for Research. P.M.M. is on the Board of Directors of the HER Foundation and has a speaking agreement with Duchesnay, USA. The remaining authors declare no competing interests.

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Nature Reviews Disease Primers thanks M. O’Hara, S. O’Rahilly, M. Shehmar, C. Williamson and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Related links

Hyperemesis Australia: hyperemesisaustralia.org.au

Hyperemesis Finland: hyperemeesi.fi

Hyperemesis France: associationhg.fr

Hyperemesis DE: hyperemesis.de

Hyperemesis Ireland: hyperemesis.ie

Zwangerschapsmisselijkheid en hyperemesis gravidarum (ZEHG): zehg.nl/wordpress

Hyperemesis Norway: hyperemesis-norge.com

Pregnancy Sickness Support: pregnancysicknesssupport.org.uk

Hyperemesis Education and Research Foundation: hyperemesis.org; helpher.org

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Fejzo, M.S., Trovik, J., Grooten, I.J. et al. Nausea and vomiting of pregnancy and hyperemesis gravidarum. Nat Rev Dis Primers 5, 62 (2019). https://doi.org/10.1038/s41572-019-0110-3

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