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.
This is a preview of subscription content, access via your institution
Access Nature and 54 other Nature Portfolio journals
Get Nature+, our best-value online-access subscription
$29.99 / 30 days
cancel any time
Subscribe to this journal
Receive 1 digital issues and online access to articles
$99.00 per year
only $99.00 per issue
Rent or buy this article
Prices vary by article type
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
Jarvis, S. & Nelson-Piercy, C. Management of nausea and vomiting in pregnancy. BMJ 342, d3606 (2011).
Gazmararian, J. A. et al. Hospitalizations during pregnancy among managed care enrollees. Obstet. Gynecol. 100, 94–100 (2002).
Bacon, C. The vomiting of pregnancy. Am. J. Med. Sci. 115, 690–689 (1898).
Fairweather, D. V. Nausea and vomiting in pregnancy. Am. J. Obstet. Gynecol. 102, 135–175 (1968).
Koot, M. H. et al. Variation in hyperemesis gravidarum definition and outcome reporting in randomised clinical trials: a systematic review. BJOG 125, 1514–1521 (2018).
Fejzo, M. S., MacGibbon, K. W., Mullin, P. M. Why are women still dying from nausea and vomiting of pregnancy? Gynecol. Obstet. Case Rep. 2 (2016). This study reviews recent maternal deaths secondary to HG reported in the UK, Ireland, the USA, Tunisia and Oman, and provides guidelines to prevent these serious complications in the future.
Verberg, M. F., Gillott, D. J., Al-Fardan, N. & Grudzinskas, J. G. Hyperemesis gravidarum, a literature review. Hum. Reprod. Update 11, 527–539 (2005).
Mullin, P. M. et al. Risk factors, treatments, and outcomes associated with prolonged hyperemesis gravidarum. J. Matern. Fetal Neonatal Med. 25, 632–636 (2012).
Christodoulou-Smith, J. et al. Posttraumatic stress symptoms following pregnancy complicated by hyperemesis gravidarum. J. Matern. Fetal Neonatal Med. 24, 1307–1311 (2011).
Fejzo, M. S. et al. Symptoms and pregnancy outcomes associated with extreme weight loss among women with hyperemesis gravidarum. J. Womens Health 18, 1981–1987 (2009).
Walch, A., Duke, M., Auty, T. & Wong, A. Profound hypokalaemia resulting in maternal cardiac arrest: a catastrophic complication of hyperemesis gravidarum? Case Rep. Obstet. Gynecol. 2018, 4687587 (2018).
Kondo, T. et al. Hyperemesis gravidarum followed by refeeding syndrome causes electrolyte abnormalities induced rhabdomyolysis and diabetes insipidus. Endocr. J. 66, 253–258 (2019).
Robinson, J. N., Banerjee, R. & Thiet, M. P. Coagulopathy secondary to vitamin K deficiency in hyperemesis gravidarum. Obstet. Gynecol. 92, 673–675 (1998).
Fiaschi, L., Nelson-Piercy, C., Gibson, J., Szatkowski, L. & Tata, L. J. Adverse maternal and birth outcomes in women admitted to hospital for hyperemesis gravidarum: a population-based cohort study. Paediatr. Perinat. Epidemiol. 32, 40–51 (2018). A recent and large population-based study elucidating HG complications for mother and baby.
Tian, R., MacGibbon, K., Martin, B., Mullin, P. & Fejzo, M. Analysis of pre- and post-pregnancy issues in women with hyperemesis gravidarum. Auton. Neurosci. 202, 73–78 (2017).
Ramskold, L. A. & Asaria, R. H. Valsalva retinopathy secondary to hyperemesis gravidarum. Eur. J. Obstet. Gynecol. Reprod. Biol. 162, 118–119 (2012).
Bolin, M., Akerud, H., Cnattingius, S., Stephansson, O. & Wikstrom, A. K. Hyperemesis gravidarum and risks of placental dysfunction disorders: a population-based cohort study. BJOG 120, 541–547 (2013).
Sherman, P. W. & Flaxman, S. M. Nausea and vomiting of pregnancy in an evolutionary perspective. Am. J. Obstet. Gynecol. 186, S190–S197 (2002).
Fessler, D. M. Reproductive immunosupression and diet. An evolutionary perspective on pregnancy sickness and meat consumption. Curr. Anthropol. 43, 19–61 (2002).
Huxley, R. R. Nausea and vomiting in early pregnancy: its role in placental development. Obstet. Gynecol. 95, 779–782 (2000).
Lacroix, R., Eason, E. & Melzack, R. Nausea and vomiting during pregnancy: a prospective study of its frequency, intensity, and patterns of change. Am. J. Obstet. Gynecol. 182, 931–937 (2000).
Gadsby, R., Barnie-Adshead, A. M. & Jagger, C. A prospective study of nausea and vomiting during pregnancy. Br. J. Gen. Pract. 43, 245–248 (1993).
Einarson, T. R., Piwko, C. & Koren, G. Quantifying the global rates of nausea and vomiting of pregnancy: a meta analysis. J. Popul. Ther. Clin. Pharmacol. 20, e171–e183 (2013).
Fiaschi, L., Nelson-Piercy, C. & Tata, L. J. Hospital admission for hyperemesis gravidarum: a nationwide study of occurrence, reoccurrence and risk factors among 8.2 million pregnancies. Hum. Reprod. 31, 1675–1684 (2016).
Trogstad, L. I., Stoltenberg, C., Magnus, P., Skjaerven, R. & Irgens, L. M. Recurrence risk in hyperemesis gravidarum. BJOG 112, 1641–1645 (2005).
Nurmi, M., Rautava, P., Gissler, M., Vahlberg, T. & Polo-Kantola, P. Recurrence patterns of hyperemesis gravidarum. Am. J. Obstet. Gynecol. 219, 469.e1–469.e10 (2018).
Vandraas, K. et al. Hyperemesis gravidarum and birth outcomes-a population-based cohort study of 2.2 million births in the Norwegian Birth Registry. BJOG 120, 1654–1660 (2013).
Roseboom, T. J., Ravelli, A. C., van der Post, J. A. & Painter, R. C. Maternal characteristics largely explain poor pregnancy outcome after hyperemesis gravidarum. Eur. J. Obstet. Gynecol. Reprod. Biol. 156, 56–59 (2011).
O’Brien, B. & Zhou, Q. Variables related to nausea and vomiting during pregnancy. Birth 22, 93–100 (1995).
Klebanoff, M. A., Koslowe, P. A., Kaslow, R. & Rhoads, G. G. Epidemiology of vomiting in early pregnancy. Obstet. Gynecol. 66, 612–616 (1985).
Weigel, M. M. & Weigel, R. M. The association of reproductive history, demographic factors, and alcohol and tobacco consumption with the risk of developing nausea and vomiting in early pregnancy. Am. J. Epidemiol. 127, 562–570 (1988).
Louik, C., Hernandez-Diaz, S., Werler, M. M. & Mitchell, A. A. Nausea and vomiting in pregnancy: maternal characteristics and risk factors. Paediatr. Perinat. Epidemiol. 20, 270–278 (2006).
Lacasse, A., Rey, E., Ferreira, E., Morin, C. & Bérard, A. Epidemiology of nausea and vomiting of pregnancy: prevalence, severity, determinants, and the importance of race/ethnicity. BMC Pregnancy Childbirth 9, 26 (2009).
Källén, B. Hyperemesis during pregnancy and delivery outcome: a registry study. Eur. J. Obstet. Gynecol. Reprod. Biol. 26, 291–302 (1987).
Zhang, J. & Cai, W. W. Severe vomiting during pregnancy: antenatal correlates and fetal outcomes. Epidemiology 2, 454–457 (1991).
Bailit, J. L. Hyperemesis gravidarium: epidemiologic findings from a large cohort. Am. J. Obstet. Gynecol. 193, 811–814 (2005).
Dodds, L., Fell, D. B., Joseph, K. S., Allen, V. M. & Butler, B. Outcomes of pregnancies complicated by hyperemesis gravidarum. Obstet. Gynecol. 107, 285–292 (2006). One of the first studies to describe insufficient maternal weight gain as a risk factor for developing small for gestational age and preterm delivery.
Grjibovski, A. M., Vikanes, A., Stoltenberg, C. & Magnus, P. Consanguinity and the risk of hyperemesis gravidarum in Norway. Acta Obstet. Gynecol. Scand. 87, 20–25 (2008).
Vikanes, A., Grjibovski, A. M., Vangen, S. & Magnus, P. Variations in prevalence of hyperemesis gravidarum by country of birth: a study of 900,074 pregnancies in Norway, 1967-2005. Scand. J. Public Health 36, 135–142 (2008).
Konikoff, T., Avraham, T., Ophir, E. & Bornstein, J. Hyperemesis gravidarum in northern Israel: a retrospective epidemiological study. Isr. J. Health Policy Res. 5, 39 (2016).
Fiaschi, L., Nelson-Piercy, C., Deb, S., King, R. & Tata, L. J. Clinical management of nausea and vomiting in pregnancy and hyperemesis gravidarum across primary and secondary care: a population based study. BJOG 126, 1201–1211 (2019).
Jordan, V., MacDonald, J., Crichton, S., Stone, P. & Ford, H. The incidence of hyperemesis gravidarum is increased among Pacific Islanders living in Wellington. NZ Med. J. 108, 342–344 (1995).
Tan, P. C., Jacob, R., Quek, K. F. & Omar, S. Z. The fetal sex ratio and metabolic, biochemical, haematological and clinical indicators of severity of hyperemesis gravidarum. BJOG 113, 733–737 (2006).
Matsuo, K., Ushioda, N., Nagamatsu, M. & Kimura, T. Hyperemesis gravidarum in Eastern Asian population. Gynecol. Obstet. Invest. 64, 213–216 (2007).
Piwko, C., Koren, G., Babashov, V., Vicente, C. & Einarson, T. R. Economic burden of nausea and vomiting of pregnancy in the USA. J. Popul. Ther. Clin. Pharmacol. 20, e149–e160 (2013). A study determining the economic burden imposed by NVP.
Gadsby, R., Rawson, V., Dziadulewicz, E., Rousseau, B. & Collings, H. Nausea and vomiting of pregnancy and resource implications: the NVP Impact Study. Br. J. Gen. Pract. 69, e217–e223 (2019).
Ramzan, A., Fejzo, M. & Mullin, P. Hyperemesis gravidarum-related hospitalizations and emergency room visits: characterizations and trends, 2000-2009. Am. J. Obstet. Gynecol. 206, S246–S247 (2012).
Sharp, B. R., Sharp, K. M., Patterson, B. & Dooley-Hash, S. Treatment of nausea and vomiting in pregnancy: factors associated with ED revisits. West J. Emerg. Med. 17, 585–590 (2016).
Piwko, C., Ungar, W. J., Einarson, T. R., Wolpin, J. & Koren, G. The weekly cost of nausea and vomiting of pregnancy for women calling the Toronto Motherisk Program. Curr. Med. Res. Opin. 23, 833–840 (2007).
von Dadelszen, P. in Nausea Vomiting Pregnancy: State of the Art 2000 Vol. 1 (ed. G. Koren) 5–9 (Motherisk, 2000).
Kemp, W. N. Hyperemesis gravidarum treated as a temporary adrenal cortex insufficiency. Can. Med. Assoc. J. 28, 389–391 (1933).
Bustos, M., Venkataramanan, R. & Caritis, S. Nausea and vomiting of pregnancy - what’s new? Auton. Neurosci. 202, 62–72 (2017).
Vikanes, A. et al. Recurrence of hyperemesis gravidarum across generations: population based cohort study. BMJ 340, c2050 (2010).
Zhang, Y. et al. Familial aggregation of hyperemesis gravidarum. Am. J. Obstet. Gynecol. 204, 230.e1–7 (2011).
Colodro-Conde, L. et al. Nausea and vomiting during pregnancy is highly heritable. Behav. Genet. 46, 481–491 (2016).
Niemeijer, M. N. et al. Diagnostic markers for hyperemesis gravidarum: a systematic review and metaanalysis. Am. J. Obstet. Gynecol. 211, 150.e1-15 (2014).
Korevaar, T. I. et al. Reference ranges and determinants of total hCG levels during pregnancy: the Generation R Study. Eur. J. Epidemiol. 30, 1057–1066 (2015).
Dypvik, J., Pereira, A. L., Tanbo, T. G. & Eskild, A. Maternal human chorionic gonadotrophin concentrations in very early pregnancy and risk of hyperemesis gravidarum: a retrospective cohort study of 4372 pregnancies after in vitro fertilization. Eur. J. Obstet. Gynecol. Reprod. Biol. 221, 12–16 (2018).
Fejzo, M. S. et al. Placenta and appetite genes GDF15 and IGFBP7 are associated with hyperemesis gravidarum. Nat. Commun. 9, 1178 (2018). The first GWAS of NVP and HG provided novel insight into the aetiology by revealing the placenta and appetite hormone gene GDF15 are the greatest risk factors for both NVP and HG.
Patel, S. et al. GDF15 provides an endocrine signal of nutritional stress in mice and humans. Cell Metab. 29, 707–718.e8 (2019).
Xiong, Y. et al. Long-acting MIC-1/GDF15 molecules to treat obesity: evidence from mice to monkeys. Sci. Transl Med. 9, eaan8732 (2017).
Sanger, G. J., Broad, J. & Andrews, P. L. The relationship between gastric motility and nausea: gastric prokinetic agents as treatments. Eur. J. Pharmacol. 715, 10–14 (2013).
Moore, A. G. et al. The transforming growth factor-ss superfamily cytokine macrophage inhibitory cytokine-1 is present in high concentrations in the serum of pregnant women. J. Clin. Endocrinol. Metab. 85, 4781–4788 (2000).
Marjono, A. B. et al. Macrophage inhibitory cytokine-1 in gestational tissues and maternal serum in normal and pre-eclamptic pregnancy. Placenta 24, 100–106 (2003).
Derbent, A. U. et al. First trimester maternal serum PAPP-A and free β-HCG levels in hyperemesis gravidarum. Prenat. Diagn. 31, 450–453 (2011).
Kaitu’u-Lino, T. J. et al. Plasma MIC-1 and PAPP-a levels are decreased among women presenting to an early pregnancy assessment unit, have fetal viability confirmed but later miscarry. PLOS ONE 8, e72437 (2013).
Lerner, L. et al. MAP3K11/GDF15 axis is a critical driver of cancer cachexia. J. Cachexia Sarcopenia Muscle 7, 467–482 (2016).
Sadeghi, M. et al. Cancer cachexia: diagnosis, assessment, and treatment. Crit. Rev. Oncol. Hematol. 127, 91–104 (2018).
Fejzo, M. S., Arzy, D., Tian, R., MacGibbon, K. W. & Mullin, P. M. Evidence GDF15 plays a role in familial and recurrent hyperemesis gravidarum. Geburtshilfe Frauenheilkd. 78, 866–870 (2018).
Petry, C. J. et al. Associations of vomiting and antiemetic use in pregnancy with levels of circulating GDF15 early in the second trimester: a nested case-control study. Wellcome Open Res. 3, 123 (2018). The first study to show an association between serum levels of GDF15 and vomiting during the second trimester and between GDF15 and maternal antiemetic use, supporting the genetic findings and providing evidence for a novel therapeutic target for treating NVP and HG.
Fejzo, M. S. et al. Analysis of GDF15 and IGFBP7 in hyperemesis gravidarum support causality. Geburtshilfe Frauenheilkd. 79, 382–388 (2019).
Oh, Y. et al. Synthesis and characterization of insulin-like growth factor-binding protein (IGFBP)-7. Recombinant human mac25 protein specifically binds IGF-I and -II. J. Biol. Chem. 271, 30322–30325 (1996).
Evdokimova, V. et al. IGFBP7 binds to the IGF-1 receptor and blocks its activation by insulin-like growth factors. Sci. Signal. 5, ra92 (2012).
Liu, Z. K., Wang, R. C., Han, B. C., Yang, Y. & Peng, J. P. A novel role of IGFBP7 in mouse uterus: regulating uterine receptivity through Th1/Th2 lymphocyte balance and decidualization. PLOS ONE 7, e45224 (2012).
Loncar, G., Omersa, D., Cvetinovic, N., Arandjelovic, A. & Lainscak, M. Emerging biomarkers in heart failure and cardiac cachexia. Int. J. Mol. Sci. 15, 23878–23896 (2014).
Bader, R. et al. The IGFBP7 homolog Imp-L2 promotes insulin signaling in distinct neurons of the Drosophila brain. J. Cell Sci. 126, 2571–2576 (2013).
Fejzo, M., MacGibbon, K. & Mullin, P. Hormone receptor genes PGR and GFRAL linked to hyperemesis gravidarum. Am. J. Obstet. Gynecol. 220, S585–S586 (2019).
Aisemberg, J. et al. Progesterone is essential for protecting against LPS-induced pregnancy loss. LIF as a potential mediator of the anti-inflammatory effect of progesterone. PLOS ONE 8, e56161 (2013).
Wallace, E. M. et al. Maternal serum and amniotic fluid levels of macrophage inhibitory cytokine 1 in Down syndrome and chromosomally normal pregnancies. Prenat. Diagn. 24, 224–226 (2004).
Tong, S. et al. Serum concentrations of macrophage inhibitory cytokine 1 (MIC 1) as a predictor of miscarriage. Lancet 363, 129–130 (2004).
Jueckstock, J. K., Kaestner, R. & Mylonas, I. Managing hyperemesis gravidarum: a multimodal challenge. BMC Med. 8, 46 (2010).
Walsh, J. W., Hasler, W. L., Nugent, C. E. & Owyang, C. Progesterone and estrogen are potential mediators of gastric slow-wave dysrhythmias in nausea of pregnancy. Am. J. Physiol. 270, G506–G514 (1996).
Mauvais-Jarvis, F., Clegg, D. J. & Hevener, A. L. The role of estrogens in control of energy balance and glucose homeostasis. Endocr. Rev. 34, 309–338 (2013).
Niebyl, J. R. Clinical practice. Nausea and vomiting in pregnancy. N. Engl. J. Med. 363, 1544–1550 (2010).
Jerome, C. P. & Hendrickx, A. G. A tubal pregnancy in a rhesus monkey (Macaca mulatta). Vet. Pathol. 19, 239–245 (1982).
Vandraas, K. F. et al. Is hyperemesis gravidarum associated with placental weight and the placental weight-to-birth weight ratio? A population-based Norwegian cohort study. Placenta 34, 990–994 (2013).
Fejzo, M. S., Romero, R. & Goodwin, T. M. Patients with a history of hyperemesis gravidarum have similar symptoms during egg stimulation and develop ovarian hyperstimulation syndrome: case series. Fertil. Steril. 93, 267.e9-11 (2010).
Fejzo, M. S. et al. Change in paternity and recurrence of hyperemesis gravidarum. J. Matern. Fetal Neonatal Med. 25, 1241–1245 (2012).
De Ponti, F. Pharmacology of serotonin: what a clinician should know. Gut 53, 1520–1535 (2004).
Zhong, W., Hutchinson, T. E., Chebolu, S. & Darmani, N. A. Serotonin 5-HT3 receptor-mediated vomiting occurs via the activation of Ca2+/CaMKII-dependent ERK1/2 signaling in the least shrew (Cryptotis parva). PLOS ONE 9, e104718 (2014).
Taylor, L. G. et al. Antiemetic use among pregnant women in the United States: the escalating use of ondansetron. Pharmacoepidemiol. Drug Saf. 26, 592–596 (2017).
Goecke, T. W. et al. Two naturally occurring variants of the serotonin receptor gene HTR3C are associated with nausea in pregnancy. Acta Obstet. Gynecol. Scand. 89, 7–14 (2010).
Goodwin, T. M., Montoro, M., Mestman, J. H., Pekary, A. E. & Hershman, J. M. The role of chorionic gonadotropin in transient hyperthyroidism of hyperemesis gravidarum. J. Clin. Endocrinol. Metab. 75, 1333–1337 (1992).
Sun, S., Qiu, X. & Zhou, J. Clinical analysis of 65 cases of hyperemesis gravidarum with gestational transient thyrotoxicosis. J. Obstet. Gynaecol. Res. 40, 1567–1572 (2014).
Coulon, A. L. et al. Prolonged and severe gestational thyrotoxicosis due to enhanced hCG sensitivity of a mutant thyrotropin receptor. J. Clin. Endocrinol. Metab. 101, 10–11 (2016).
Rodien, P. et al. Abnormal stimulation of the thyrotrophin receptor during gestation. Hum. Reprod. Update 10, 95–105 (2004).
Malek, N. Z. H., Kalok, A., Hanafiah, Z. A., Shah, S. A. & Ismail, N. A. M. Association of transient hyperthyroidism and severity of hyperemesis gravidarum. Horm. Mol. Biol. Clin. Investig. https://doi.org/10.1515/hmbci-2016-0050 (2017).
Eliakim, R., Abulafia, O. & Sherer, D. M. Hyperemesis gravidarum: a current review. Am. J. Perinatol. 17, 207–218 (2000).
Kirshon, B., Lee, W. & Cotton, D. B. Prompt resolution of hyperthyroidism and hyperemesis gravidarum after delivery. Obstet. Gynecol. 71, 1032–1034 (1988).
Fejzo, M. S. et al. Genetic analysis of hyperemesis gravidarum reveals association with intracellular calcium release channel (RYR2). Mol. Cell. Endocrinol. 439, 308–316 (2017).
Zhao, J. et al. Elevated serum growth differentiation factor 15 levels in hyperthyroid patients. Front. Endocrinol. 9, 793 (2018).
Zhang, M., Sun, W., Qian, J. & Tang, Y. Fasting exacerbates hepatic growth differentiation factor 15 to promote fatty acid β-oxidation and ketogenesis via activating XBP1 signaling in liver. Redox Biol. 16, 87–96 (2018).
Ng, Q. X. et al. A meta-analysis of the association between Helicobacter pylori (H. pylori) infection and hyperemesis gravidarum. Helicobacter 23, e12455 (2018).
Grooten, I. J. et al. Helicobacter pylori infection: a predictor of vomiting severity in pregnancy and adverse birth outcome. Am. J. Obstet. Gynecol. 216, 512.e1–512.e9 (2017).
McParlin, C. et al. Treatments for hyperemesis gravidarum and nausea and vomiting in pregnancy: a systematic review. JAMA 316, 1392–1401 (2016).
Beyazit, F., Ozturk, F. H., Pek, E. & Unsal, M. A. Evaluation of the hematologic system as a marker of subclinical inflammation in hyperemesis gravidarum: a case control study. Ginekol. Pol. 88, 315–319 (2017).
Tunc, S. Y. et al. Serum levels of neopterin, inflammatory markers and oxidative stress indicators in hyperemesis gravidarum. J. Obstet. Gynaecol. Res. 42, 618–624 (2016).
Mosegaard, S. et al. An intronic variation in SLC52A1 causes exon skipping and transient riboflavin-responsive multiple acyl-CoA dehydrogenation deficiency. Mol. Genet. Metab. 122, 182–188 (2017).
Ishii, K. et al. Central nervous system and muscle involvement in an adolescent patient with riboflavin-responsive multiple acyl-CoA dehydrogenase deficiency. Brain Dev. 32, 669–672 (2010).
Oudman, E. et al. Wernicke’s encephalopathy in hyperemesis gravidarum: a systematic review. Eur. J. Obstet. Gynecol. Reprod. Biol. 236, 84–93 (2019).
Jorgensen, K. T., Nielsen, N. M., Pedersen, B. V., Jacobsen, S. & Frisch, M. Hyperemesis, gestational hypertensive disorders, pregnancy losses and risk of autoimmune diseases in a Danish population-based cohort. J. Autoimmun. 38, J120–J128 (2012).
Wright, L. B., Schoemaker, M. J., Jones, M. E., Ashworth, A. & Swerdlow, A. J. Breast cancer risk in relation to history of preeclampsia and hyperemesis gravidarum: prospective analysis in the generations study. Int. J. Cancer 143, 782–792 (2018).
Vandraas, K. F. et al. Hyperemesis gravidarum and maternal cancer risk, a Scandinavian nested case-control study. Int. J. Cancer 137, 1209–1216 (2015).
Fossum, S. et al. Cardiovascular risk profile at the age of 40-45 in women with previous hyperemesis gravidarum or hypertensive disorders in pregnancy: a population-based study. Pregnancy Hypertens. 12, 129–135 (2018).
Koren, G., Madjunkova, S. & Maltepe, C. The protective effects of nausea and vomiting of pregnancy against adverse fetal outcome–a systematic review. Reprod. Toxicol. 47, 77–80 (2014).
Hastoy, A. et al. [Hyperemesis gravidarum and pregnancy outcomes]. J. Gynecol. Obstet. Biol. Reprod. 44, 154–163 (2015).
Lane, A. S., Stallworth, J. L., Eichelberger, K. Y. & Trofatter, K. F. Vitamin K deficiency embryopathy from hyperemesis gravidarum. Case Rep. Obstet. Gynecol. 2015, 324173 (2015).
Toriello, H. V. et al. Maternal vitamin K deficient embryopathy: association with hyperemesis gravidarum and Crohn disease. Am. J. Med. Genet. A 161A, 417–429 (2013).
Koren, G. et al. Validation studies of the Pregnancy Unique-Quantification of Emesis (PUQE) scores. J. Obstet. Gynaecol. 25, 241–244 (2005).
Birkeland, E. et al. Norwegian PUQE (Pregnancy-Unique Quantification of Emesis and nausea) identifies patients with hyperemesis gravidarum and poor nutritional intake: a prospective cohort validation study. PLOS ONE 10, e0119962 (2015).
HER Foundation.HyperEmesis Level Prediction (HELP) Scoring Tool. Helpher.com http://www.helpher.org/downloads/COMPLETE%20NAUSEA%20AND%20VOMITING%20INDEX.pdf (2016).
Korouri E, M. K. et al. Performance of iPhone hyperemesis gravidarum care app. J. Clin. Case Rep. Case Stud. 2019, 53–59 (2019).
Royal College of Obstetricians and Gynaecologists. The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum (Green-top Guideline No. 69). Rcog.org.uk https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg69/ (2016).
Arsenault, Y. et al. The management of nausea and vomiting of pregnancy. J. Obstet. Gynaecol. Can. 24, 817–823 (2002).
ACOG. Practice bulletin clinical management guidelines for obstetrician-gynecologists No 153 nausea and vomiting of pregnancy. Obstet. Gynecol. 126, e12–e24 (2015).
Prentice, A. M., Prentice, A., Lamb, W. H., Lunn, P. G. & Austin, S. Metabolic consequences of fasting during Ramadan in pregnant and lactating women. Hum. Nutr. Clin. Nutr. 37, 283–294 (1983).
Dean, C. R., Shemar, M., Ostrowski, G. A. U. & Painter, R. C. Management of severe pregnancy sickness and hyperemesis gravidarum. BMJ 363, k5000 (2018).
Anand, P. & Gold, D. R. Nystagmus from Wernicke’s encephalopathy. N. Engl. J. Med. 377, e5 (2017).
Galvin, R. et al. EFNS guidelines for diagnosis, therapy and prevention of wernicke encephalopathy. Eur. J. Neurol. 17, 1408–1418 (2010).
Kjeldgaard, H. K. et al. The association between the degree of nausea in pregnancy and subsequent posttraumatic stress. Arch. Womens Ment. Health 22, 493–501 (2019).
National Institute for Health and Care Excellence. Post-traumatic Stress Disorder Nice.org.uk https://www.nice.org.uk/guidance/ng116/resources/posttraumatic-stress-disorder-pdf-66141601777861 (2018).
Veenendaal, M. V., van Abeelen, A. F., Painter, R. C., van der Post, J. A. & Roseboom, T. J. Consequences of hyperemesis gravidarum for offspring: a systematic review and meta-analysis. BJOG 118, 1302–1313 (2011).
Czeizel, A. E. et al. The effect of periconceptional multivitamin-mineral supplementation on vertigo, nausea and vomiting in the first trimester of pregnancy. Arch. Gynecol. Obstet. 251, 181–185 (1992).
Emelianova, S., Mazzotta, P., Einarson, A. & Koren, G. Prevalence and severity of nausea and vomiting of pregnancy and effect of vitamin supplementation. Clin. Invest. Med. 22, 106–110 (1999).
APPRAISAL of the use of vitamins B1 and B12 as supplements promoted for the stimulation of growth and appetite in children. Pediatrics 21, 860-864 (1958).
Kennedy, D. O. B. Vitamins and the brain: mechanisms, dose and efficacy–a review. Nutrients 8, 68 (2016).
Fejzo, M. S., Macgibbon, K. W., Romero, R., Goodwin, T. M. & Mullin, P. M. Recurrence risk of hyperemesis gravidarum. J. Midwifery Womens Health 56, 132–136 (2011).
Koren, G. & Maltepe, C. Pre-emptive therapy for severe nausea and vomiting of pregnancy and hyperemesis gravidarum. J. Obstet. Gynaecol. 24, 530–533 (2004). Although small and, therefore, in need of replication, this is the only study examining pre-emptive treatment to reduce HG in a subsequent pregnancy.
Boelig, R. C. et al. Interventions for treating hyperemesis gravidarum: a Cochrane systematic review and meta-analysis. J. Matern. Fetal Neonatal Med. 31, 2492–2505 (2018). A recent systematic review regarding antiemetic treatment for HG.
Matthews, A., Haas, D. M., O’Mathúna, D. P. & Dowswell, T. Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst. Rev. 9, CD007575 (2015). A systematic review regarding antiemetic treatments for NVP.
Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin No. 189: nausea and vomiting of pregnancy. Obstet. Gynecol. 131, e15–e30 (2018).
Jednak, M. A. et al. Protein meals reduce nausea and gastric slow wave dysrhythmic activity in first trimester pregnancy. Am. J. Physiol. 277, G855–G861 (1999).
Latva-Pukkila, U., Isolauri, E. & Laitinen, K. Dietary and clinical impacts of nausea and vomiting during pregnancy. J. Hum. Nutr. Diet 23, 69–77 (2010).
Bischoff, S. C. & Renzer, C. Nausea and nutrition. Auton. Neurosci. 129, 22–27 (2006).
Newman, V., Fullerton, J. T. & Anderson, P. O. Clinical advances in the management of severe nausea and vomiting during pregnancy. J. Obstet. Gynecol. Neonatal Nurs. 22, 483–490 (1993).
Arsenault, M. Y. et al. The management of nausea and vomiting of pregnancy. J. Obstet. Gynaecol. Can. 24, 817–831 quiz 832-813 (2002).
Yamahara, J., Huang, Q. R., Li, Y. H., Xu, L. & Fujimura, H. Gastrointestinal motility enhancing effect of ginger and its active constituents. Chem. Pharm. Bull. 38, 430–431 (1990).
Backon, J. Ginger in preventing nausea and vomiting of pregnancy; a caveat due to its thromboxane synthetase activity and effect on testosterone binding. Eur. J. Obstet. Gynecol. Reprod. Biol. 42, 163–164 (1991).
Metz, T. D. What is new in cannabis use in pregnancy?: Best articles from the past year. Obstet. Gynecol. 131, 594–595 (2018).
Young-Wolff, K. C. et al. Trends in self-reported and biochemically tested marijuana use among pregnant females in california from 2009-2016. JAMA 318, 2490–2491 (2017).
Denholm, L. & Gallagher, G. Physiology and pharmacology of nausea and vomiting. Anaest. Intens. Care Med. 19, 513–516 (2018).
Oakes, M., Law, W. J. & Komuniecki, R. Cannabinoids stimulate the TRP-channel dependent release of both serotonin and dopamine to modulate behavior in C. elegans. J. Neurosci. 39, 4142–4152 (2019).
Westfall, R. E., Janssen, P. A., Lucas, P. & Capler, R. Reprint of: Survey of medicinal cannabis use among childbearing women: patterns of its use in pregnancy and retroactive self-assessment of its efficacy against ‘morning sickness’. Complement. Ther. Clin. Pract. 15, 242–246 (2009).
Flake, Z. A., Linn, B. S. & Hornecker, J. R. Practical selection of antiemetics in the ambulatory setting. Am. Fam. Physician 91, 293–296 (2015).
Jordan, K., Sippel, C. & Schmoll, H. J. Guidelines for antiemetic treatment of chemotherapy-induced nausea and vomiting: past, present, and future recommendations. Oncologist 12, 1143–1150 (2007).
Etwel, F., Faught, L. H., Rieder, M. J. & Koren, G. The risk of adverse pregnancy outcome after first trimester exposure to h1 antihistamines: a systematic review and meta-analysis. Drug Saf. 40, 121–132 (2017).
Persaud, N., Meaney, C., El-Emam, K., Moineddin, R. & Thorpe, K. Doxylamine-pyridoxine for nausea and vomiting of pregnancy randomized placebo controlled trial: prespecified analyses and reanalysis. PLOS ONE 13, e0189978 (2018).
Nuangchamnong, N. & Niebyl, J. Doxylamine succinate-pyridoxine hydrochloride (Diclegis) for the management of nausea and vomiting in pregnancy: an overview. Int. J. Womens Health 6, 401–409 (2014).
Rao, A. S. & Camilleri, M. Review article: metoclopramide and tardive dyskinesia. Aliment. Pharmacol. Ther. 31, 11–19 (2010).
Huybrechts, K. F. et al. Antipsychotic use in pregnancy and the risk for congenital malformations. JAMA Psychiatry 73, 938–946 (2016).
Briggs, G. G., Freeman, R. K., Towers, C. V. & Forinash, A. B. Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk 11th edn (Wolters Kluwer, 2017).
Klauser, C. K. et al. Treatment of severe nausea and vomiting of pregnancy with subcutaneous medications. Am. J. Perinatol. 28, 715–721 (2011).
Zambelli-Weiner, A., Via, C., Yuen, M., Weiner, D. J. & Kirby, R. S. First trimester ondansetron exposure and risk of structural birth defects. Reprod. Toxicol. 83, 14–20 (2019).
Kaplan, Y. C., Richardson, J. L., Keskin-Arslan, E., Erol-Coskun, H. & Kennedy, D. Use of ondansetron during pregnancy and the risk of major congenital malformations: a systematic review and meta-analysis. Reprod. Toxicol. 86, 1–13 (2019).
Jahanbin, A., Shadkam, E., Miri, H. H., Shirazi, A. S. & Abtahi, M. Maternal folic acid supplementation and the risk of oral clefts in offspring. J. Craniofac. Surg. 29, e534–e541 (2018).
Fejzo, M. S., MacGibbon, K. W. & Mullin, P. M. Ondansetron in pregnancy and risk of adverse fetal outcomes in the United States. Reprod. Toxicol. 62, 87–91 (2016).
Sridharan, K. & Sivaramakrishnan, G. Interventions for treating nausea and vomiting in pregnancy: a network meta-analysis and trial sequential analysis of randomized clinical trials. Expert Rev. Clin. Pharmacol. 11, 1143–1150 (2018).
Bandoli, G., Palmsten, K., Forbess Smith, C. J. & Chambers, C. D. A review of systemic corticosteroid use in pregnancy and the risk of select pregnancy and birth outcomes. Rheum. Dis. Clin. North Am. 43, 489–502 (2017).
Mitchell-Jones, N., Farren, J. A., Tobias, A., Bourne, T. & Bottomley, C. Ambulatory versus inpatient management of severe nausea and vomiting of pregnancy: a randomised control trial with patient preference arm. BMJ Open 7, e017566 (2017).
Sanchez-Ferrer, M. L., Prieto-Sanchez, M. T., Orozco-Fernandez, R., Machado-Linde, F. & Nieto-Diaz, A. Central pontine myelinolysis during pregnancy: pathogenesis, diagnosis and management. J. Obstet. Gynaecol. 37, 273–279 (2017).
Majumdar, S. & Dada, B. Refeeding syndrome: a serious and potentially life-threatening complication of severe hyperemesis gravidarum. J. Obstet. Gynaecol. 30, 416–417 (2010).
Holmgren, C., Aagaard-Tillery, K. M., Silver, R. M., Porter, T. F. & Varner, M. Hyperemesis in pregnancy: an evaluation of treatment strategies with maternal and neonatal outcomes. Am. J. Obstet. Gynecol. 198, 56e1-4 (2008).
Grooten, I. J. et al. Early enteral tube feeding in optimizing treatment of hyperemesis gravidarum: the maternal and offspring outcomes after treatment of hyperemesis by refeeding (MOTHER) randomized controlled trial. Am. J. Clin. Nutr. 106, 812–820 (2017).
Vaisman, N., Kaidar, R., Levin, I. & Lessing, J. B. Nasojejunal feeding in hyperemesis gravidarum–a preliminary study. Clin. Nutr. 23, 53–57 (2004).
Stokke, G. et al. Hyperemesis gravidarum, nutritional treatment by nasogastric tube feeding: a 10-year retrospective cohort study. Acta Obstet. Gynecol. Scand. 94, 359–367 (2015).
UCLA Health System. HG Care Application for iPhone Apple.com https://apps.apple.com/us/app/hg-care-pregnancy-wellness/id1148105670 (2019).
Basch, E. et al. Symptom monitoring with patient-reported outcomes during routine cancer treatment: a randomized controlled trial. J. Clin. Oncol. 34, 557–565 (2016).
van Stuijvenberg, M. E., Schabort, I., Labadarios, D. & Nel, J. T. The nutritional status and treatment of patients with hyperemesis gravidarum. Am. J. Obstet. Gynecol. 172, 1585–1591 (1995).
Tan, P. C., Norazilah, M. J. & Omar, S. Z. Dextrose saline compared with normal saline rehydration of hyperemesis gravidarum: a randomized controlled trial. Obstet. Gynecol. 121, 291–298 (2013).
Abas, M. N., Tan, P. C., Azmi, N. & Omar, S. Z. Ondansetron compared with metoclopramide for hyperemesis gravidarum: a randomized controlled trial. Obstet. Gynecol. 123, 1272–1279 (2014).
He, X. L., Zhong, G. & He, Y. [Clinical observation on treatment of hyperemesis gravidarum by integrative chinese and western medicine and its influence on serum motilin]. Zhongguo Zhong Xi Yi Jie He Za Zhi 29, 872–874 (2009).
Michihata, N. et al. Safety and effectiveness of Japanese herbal Kampo medicines for treatment of hyperemesis gravidarum. Int. J. Gynaecol. Obstet. 145, 182–186 (2019).
Adlan, A. S., Chooi, K. Y. & Mat Adenan, N. A. Acupressure as adjuvant treatment for the inpatient management of nausea and vomiting in early pregnancy: a double-blind randomized controlled trial. J. Obstet. Gynaecol. Res. 43, 662–668 (2017).
Van den Heuvel, E., Goossens, M., Vanderhaegen, H., Sun, H. X. & Buntinx, F. Effect of acustimulation on nausea and vomiting and on hyperemesis in pregnancy: a systematic review of Western and Chinese literature. BMC Complement. Altern. Med. 16, 13 (2016).
Goodwin, T. M. et al. Secular trends in the treatment of hyperemesis gravidarum. Am. J. Perinatol. 25, 141–147 (2008).
Lacasse, A., Rey, E., Ferreira, E., Morin, C. & Berard, A. Nausea and vomiting of pregnancy: what about quality of life? BJOG 115, 1484–1493 (2008).
Magee, L. A. et al. Development of a health-related quality of life instrument for nausea and vomiting of pregnancy. Am. J. Obstet. Gynecol. 186, S232–S238 (2002).
Lacasse, A. & Berard, A. Validation of the nausea and vomiting of pregnancy specific health related quality of life questionnaire. Health Qual. Life Outcomes 6, 32 (2008).
Munch, S., Korst, L. M., Hernandez, G. D., Romero, R. & Goodwin, T. M. Health-related quality of life in women with nausea and vomiting of pregnancy: the importance of psychosocial context. J. Perinatol. 31, 10–20 (2011).
Tan, A., Lowe, S. & Henry, A. Nausea and vomiting of pregnancy: effects on quality of life and day-to-day function. Aust. NZ J. Obstet. Gynaecol. 58, 278–290 (2018).
Poursharif, B. et al. Elective pregnancy termination in a large cohort of women with hyperemesis gravidarum. Contraception 76, 451–455 (2007).
Poursharif, B. et al. The psychosocial burden of hyperemesis gravidarum. J. Perinatol. 28, 176–181 (2008).
Kjeldgaard, H. K., Eberhard-Gran, M., Benth, J. S. & Vikanes, A. V. Hyperemesis gravidarum and the risk of emotional distress during and after pregnancy. Arch. Womens Ment. Health 20, 747–756 (2017).
Mitchell-Jones, N. et al. Psychological morbidity associated with hyperemesis gravidarum: a systematic review and meta-analysis. BJOG 124, 20–30 (2017).
Dean, C., Bannigan, K. & Marsden, J. Reviewing the effect of hyperemesis gravidarum on women’s lives and mental health. Br. J. Midwifery 26, 109–119 (2018).
Munch, S. A qualitative analysis of physician humanism: women’s experiences with hyperemesis gravidarum. J. Perinatol. 20, 540–547 (2000).
Clark, S. S., Hughes, S. B. & McDonald, S. S. The impact of nausea and vomiting of pregnancy on quality of life: report of a national consumer survey and recommendations for improving care. Obstet. Gynecol. Surv. 68, S1–S10 (2013).
Heitmann, K., Svendsen, H. C., Sporsheim, I. H. & Holst, L. Nausea in pregnancy: attitudes among pregnant women and general practitioners on treatment and pregnancy care. Scand. J. Prim. Health Care 34, 13–20 (2016).
Gadsby, R., Barnie-Adshead, T. & Sykes, C. Why won't doctors prescribe antiemetics in pregnancy? BMJ 343, d4387 (2011).
Nazik, E. & Eryilmaz, G. Incidence of pregnancy-related discomforts and management approaches to relieve them among pregnant women. J. Clin. Nursing 23, 1736–1750 (2014).
James Lind Alliance Hyperemesis Gravidarum Nihr.ac.uk http://www.jla.nihr.ac.uk/priority-setting-partnerships/hyperemesis-gravidarum/ (2019).
Aoyagi, T., Terracina, K. P., Raza, A., Matsubara, H. & Takabe, K. Cancer cachexia, mechanism and treatment. World J. Gastrointest. Oncol. 7, 17–29 (2015).
Lerner, L. et al. Plasma growth differentiation factor 15 is associated with weight loss and mortality in cancer patients. J. Cachexia Sarcopenia Muscle 6, 317–324 (2015).
Turco, M. Y. et al. Trophoblast organoids as a model for maternal-fetal interactions during human placentation. Nature 564, 263–267 (2018).
Grooten, I. J., Vinke, M. E., Roseboom, T. J. & Painter, R. C. A systematic review and meta-analysis of the utility of corticosteroids in the treatment of hyperemesis gravidarum. Nutr. Metab. Insights 8, 23–32 (2015).
O'Donnell, A. et al. Treatments for hyperemesis gravidarum and nausea and vomiting in pregnancy: a systematic review and economic assessment. Health Technol. Assess. 20, 1–268 (2016).
Quan, H. et al. Assessing validity of ICD-9-CM and ICD-10 administrative data in recording clinical conditions in a unique dually coded database. Health Serv. Res. 43, 1424–1441 (2008).
Shelton, S. K. et al. Validation of an ICD code for accurately identifying emergency department patients who suffer an out-of-hospital cardiac arrest. Resuscitation 125, 8–11 (2018).
Yasmeen, S., Romano, P. S., Schembri, M. E., Keyzer, J. M. & Gilbert, W. M. Accuracy of obstetric diagnoses and procedures in hospital discharge data. Am. J. Obstet. Gynecol. 194, 992–1001 (2006).
Vikanes, A., Magnus, P., Vangen, S., Lomsdal, S. & Grjibovski, A. M. Hyperemesis gravidarum in the Medical Birth Registry of Norway - a validity study. BMC Pregnancy Childbirth 12, 115 (2012).
R. E. Gliklich, N. A. Dreyer, & M. B. Leavy (eds) Registries for Evaluating Patient Outcomes: A User’s Guide. AHRQ Methods for Effective Health Care (Agency for Healthcare Research and Quality, 2014).
British Pregnancy Advisory Service. ‘I Could not Survive Another Day’. Improving Treatment, Tackling Stigma: Lessons from Women’s Experience of Abortion for Severe Pregnancy Sickness Pregnancysicknesssupport.org.uk https://www.pregnancysicknesssupport.org.uk/documents/HGbpasPSSreport_docx.pdf (2015).
Lackner, J. R. Motion sickness: more than nausea and vomiting. Exp. Brain Res. 232, 2493–2510 (2014).
Mullican, S. E. & Rangwala, S. M. Uniting GDF15 and GFRAL: therapeutic opportunities in obesity and beyond. Trends Endocrinol. Metab. 29, 560–570 (2018).
Fejzo, M. S., Magtira, A., Schoenberg, F. P., Macgibbon, K. & Mullin, P. M. Neurodevelopmental delay in children exposed in utero to hyperemesis gravidarum. Eur. J. Obstet. Gynecol. Reprod. Biol. 189, 79–84 (2015). One of the few studies to look at neurodevelopmental outcomes in children exposed in utero to HG.
Fejzo, M., Kam, A., Laguna, A., MacGibbon, K. & Mullin, P. Analysis of neurodevelopmental delay in children exposed in utero to hyperemesis gravidarum reveals increased reporting of autism spectrum disorder. Reprod. Toxicol. 84, 59–64 (2019).
Mullin, P. M. et al. No increased risk of psychological/behavioral disorders in siblings of women with hyperemesis gravidarum (HG) unless their mother had HG. J. Dev. Orig. Health Dis. 3, 375–379 (2012).
Nulman, I. et al. Long-term neurodevelopment of children exposed to maternal nausea and vomiting of pregnancy and diclectin. J. Pediatr. 155, 45–50, 50.e1-2 (2009).
Koot, M. H. et al. Hyperemesis gravidarum and cardiometabolic risk factors in adolescents: a follow-up of the Northern Finland Birth Cohort 1986. BJOG 124, 1107–1114 (2017).
Roman, E. et al. Perinatal and reproductive factors: a report on haematological malignancies from the UKCCS. Eur. J. Cancer 41, 749–759 (2005).
Zdravkovic, T. et al. Human stem cells from single blastomeres reveal pathways of embryonic or trophoblast fate specification. Development 142, 4010–4025 (2015).
Segerer, S. E. et al. MIC-1 (a multifunctional modulator of dendritic cell phenotype and function) is produced by decidual stromal cells and trophoblasts. Hum. Reprod. 27, 200–209 (2012).
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.
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.
Peer review information
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.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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
About this article
Cite this article
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
This article is cited by
Fetal demise and Wernicke–Korsakoff syndrome in a patient with hyperemesis gravidarum: a case report
Journal of Medical Case Reports (2023)
Testing effects of partner support and use of oral contraception during relationship formation on severity of nausea and vomiting in pregnancy
BMC Pregnancy and Childbirth (2023)
Rates of maternal weight gain over the course of pregnancy and offspring risk of neurodevelopmental disorders
BMC Medicine (2023)
The effects of pyridoxine (vitamin B6) supplementation in nausea and vomiting during pregnancy: a systematic review and meta-analysis
Archives of Gynecology and Obstetrics (2023)
Antiemetic treatment of hyperemesis gravidarum in 1,064 Norwegian women and the impact of European warning on metoclopramide: a retrospective cohort study 2002–2019
BMC Pregnancy and Childbirth (2022)