symptomatology and outcomes of women with ......symptomatology and outcomes of women with...

Symptomatology and Outcomes of Women withHyperemesis Gravidarum as Reported in a Large Registry

Lisa M. Korst, Borzouyeh Poursharif, Kimber W. MacGibbon, Marlena S. Fejzo, Roberto Romero, and T. Murphy Goodwin1University of Southern California, Obstetrics and Gynecology, Los Angeles, California,

2Hyperemesis Education and Research Foundation, Leesburg, Virginia, 3NICHD, NIH, DHHS, Perinatology Research Branch, Detroit, Michigan

Objective

Our objective is to report the breadth and severityof their symptomatology, and their maternal andfetal outcomes. This is the first report of a largenumber of affected women from an HG registry.

Introduction

Hyperemesis gravidarum (HG) is a severe formof nausea and vomiting of pregnancy (NVP),occurring in 1-2% of pregnant women. Ourunderstanding of the spectrum of symptoms andoutcomes derives largely from small series of HGpatients, giving an incomplete view of thiscondition.

Methods

The nonprofit Hyperemesis Education and Research(HER) Foundation administered an on-line surveyfrom 2003-2005, questioning women regarding theirsymptomatology, and maternal and fetal outcomes.

A control population was recruited largely from on-lineparenting groups. HG was defined as significantweight loss and debility secondary to nausea andvomiting during pregnancy, typically requiringmedications and/or IV fluids for treatment. Womenwith at least one gestation of at least 27 weeksduration, were the subject of this analysis, and datafrom early pregnancies that were lost were notincluded. As women reported on multiplepregnancies, data regarding the specificcharacteristics and outcomes of pregnancies wereaggregated at the level of the woman. Thus, if thecharacteristic of interest was found in any one of herpregnancies, that characteristic was noted, and theproportion of women who had at least one pregnancywith that characteristic was reported. Odds ratios(OR) were adjusted for the number of pregnancies >27 weeks per woman.

Results

The study population included 819 cases and 541controls. Of the 384 women with HG who reportedhaving more than one pregnancy, 95% reported arecurrence.

Women reported their most severe weight lossamong all their pregnancies:

o 16% lost < 5% of pre-pregnancy weighto 27% lost 5%-10% of pre-pregnancy weighto 46% lost 10-20% of pre-pregnancy weighto 10% lost > 20% of pre-pregnancy weight

Weight loss > 15% (N=214, 26%) was significantlyassociated:

During Pregnancy with:oExcess salivationoGall bladder and liver dysfunctionoHematemesisoMuscle painoRenal failureoRetinal hemorrhage

In the Postpartum Period with:oLonger recovery timeoGall bladder dysfunctionoInsomniaoMuscle painoNauseaoPTSD

Women with weight loss > 15% were nearly twiceas likely as other women with HG to continue tohave symptoms throughout pregnancy [63/214(29%) vs. 117/605 (19%), OR = 1.73, 95% CI(1.20-2.47), P = 0.003].

Results (cont):

Postpartum, cases were more likely than controlsto report bonding difficulties and negativefeelings toward the baby, and continued excessvomiting and weight management problems.

Summary

oHG is associated with a broader spectrum ofsymptoms during pregnancy than has beenpreviously reported.

oSome physical changes related to HG do notresolve with delivery.

oChildren of mothers with HG are more likely tobe reported as having behavioral, emotional, andlearning disorders.

oSevere HG, as indicated by greater weight loss,is associated with greater morbidity duringpregnancy and higher persistence of HG-associated symptoms postpartum.

Conclusions

Prenatal care practitioners should be aware ofthe broad spectrum of symptoms related to HGso that they can provide appropriateinterventions and support.

Effects of HG persisting postpartum, and effectsof HG on the offspring have not previously beenreported and should be investigated further.

P < 0.001

465 (86%)57 (11%)

2 (0%)8 (1%)9 (2%)

656 (80%)57 (7%)40 (5%)28 (3%)38 (5%)

ResidenceUSAUKAustraliaCanadaOther

P < 0.001

442 (82%)6 (1%)

13 (2%)47 (9%)33 (6%)

698 (85%)20 (2%)31 (4%)16 (2%)54 (7%)

Race/EthnicityWhiteBlackHispanicAsianOther

P < 0.00135 + 6

35 (19-62)32 + 5

32 (20-62)Maternal age (yrs)

N = 541N = 819Number of subjects

P valuesControlsCases

Patient Demographics

Selected Pregnancy Characteristicsamong Cases and Controls

05

10

1520

253035

40

Hyper

saliv

atio

n

Hemat

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is

Ora

l Bleed

ing

Hypote

nsion

Mem

oryLoss

Musc

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n

Changed

Doctor

PPDig

estiv

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blem

s

PPFood

Avers

ions

PPPTSD

Childwith

Behav

iora

l Disord

er

Childwith

Emotio

nalDis

order

Childwith

Learn

ing

Disord

er

Childwith

Senso

ryDis

order

Pre

va

len

ce

(%)

Cases Controls