Prolonged nausea and vomiting during pregnancy (Hyperemesis gravidarum): a literature review

Matas Kalinauskas¹, Akvilė Papievytė¹, Gabija Tamaliūnaitė¹

¹Lithuanian University of Health Sciences, Medical Academy, Faculty of Medicine



  Nausea and vomiting during pregnancy is a common condition that affects 50 to 90% of pregnant women during the first trimester of pregnancy. When vomiting is severe or prolonged during pregnancy, it is called hyperemesis gravidarum (HG) – a condition associated with electrolyte and acid-base imbalances, malnutrition, and weight loss. Although HG is less common than simple nausea and vomiting during pregnancy, it is considered one of the most common causes of hospitalization during the first trimester of pregnancy.There is currently no known clear mechanism for the development of HG, however, according to the authors of various sources, it is a multi etiological disease. The placenta and its secreted hormones are thought to play a key role in the development of HG. The influence of leptin, growth hormone, thyroid hormones, Helicobacter pylori, biotin, and other factors on HG development is also investigated in the literature.  A single definition of HG has not yet been validated, and clinical signs and patient complaints are used to make a clinical diagnosis. Untreated prolonged vomiting in pregnant women is complicated by electrolyte imbalance, dehydration, ketoacidosis, malnutrition, fetal growth failure, and life-threatening complications: Wernicke’s encephalopathy. In clinical practice, it is important to recognize and manage the early symptoms of HG in order to prevent more severe maternal and fetal health disorders. There are approved clinical tools for this – PUQE (pregnancy-unique quantification of emesis and nausea) scoring index to assess the severity of symptoms. HG treatment is usually symptomatic, to suppress vomiting, restore water and electrolyte balance, correct acid – base imbalances and ensure a complete diet. For treatment pharmacological and non-pharmacological methods are used: acupressure, ginger consumption. In more severe cases, HG is treated with drugs, depending on the duration of pregnancy, starting treatment with the least teratogenic drugs.

Keywords: hyperemesis gravidarum, nausea, vomiting, pregnancy, outcomes, maternal, fetal,  treatment.