Severe HG May Lead to Termination, Sequelae


SAN DIEGO – Almost a quarter of 505 women with hyperemesis gravidarum reported voluntarily terminating at least one pregnancy solely because of the severity of the condition, an international survey found.

More than 12% of women said they had terminated more than one pregnancy secondary to hyperemesis gravidarum (HG), and 30% said they feared future pregnancies because of the extreme nausea and vomiting they suffered previously in pregnancy.

Rates of termination among the 344 American women (27%) were roughly equal to rates of the group as a whole, which had about a 25% termination rate. “It was quite startling,” Dr. Borzouyeh Poursharif said of the finding concerning pregnancy termination.

Dr. Poursharif, a research fellow at the University of Southern California, Los Angeles, along with coinvestigators from USC and the National Institute of Child Health and Human Development's perinatology research branch in Detroit, analyzed registry data and results of an online survey conducted by the Hyperemesis Education and Research Foundation. They reported their results in a series of three posters at the annual meeting of the American College of Obstetricians and Gynecologists.

Among women who had terminated at least one pregnancy because of the condition, 60% perceived a “negative health provider attitude,” vs. 28% of those who did not voluntarily terminate a pregnancy, suggesting that physicians may benefit from more education about the severity of the condition and potentially effective treatments and psychosocial support measures, said Dr. Poursharif.

Compared with those who did not terminate pregnancies, women who terminated were less likely to report family or career dysfunction, decreased physical activity, or eating problems, reflecting “the burden of HG on women's lives,” the authors concluded.

Among 819 women from 31 countries who registered with the foundation, nearly half reported losing 10%-20% of their prepregnancy weight; only 16% reported losing 5% or less of their prepregnancy weight.

Generally, HG is defined as severe nausea, vomiting and associated symptoms, and a loss of greater than 5% of body weight.

More than a quarter of the women had lost at least 15% of their prepregnancy weight, a cutoff associated with severe complications both during and after pregnancy, Dr. Poursharif said in an interview at the meeting.

One in five women in the registry reported that their symptoms continued until term or beyond.

The 214 women with the greatest weight loss (more than 15%) faced a fivefold elevated risk of renal failure and retinal hemorrhage and fourfold elevated risk of liver dysfunction. Other complications significantly elevated in this group included the diagnosis of gall bladder disease in pregnancy, hematemesis, and neurologic changes.

They were more likely to have received inpatient treatment, intravenous fluids, total parenteral nutrition, and prescriptions for the medication ondansetron (Zofran). This group also experienced significantly more complications, which lasted more than 1 month beyond pregnancy, including nausea, digestive problems, gallbladder disease, insomnia, muscle pain, and food aversions.

Dr. Poursharif emphasized that neither the database nor the online survey results are considered to be representative of all women with HG. “We think that these were people who were so sick, they were desperate enough to search online, [where they] found this site and answered the surveys,” he said.

However, he noted that the findings do portray a surprisingly severe portrait of women suffering extreme cases of HG and highlight the need for more research into the true prevalence of the condition in its more extreme forms.

The database revealed that more than 20 treatment options were used by 765 women in 1,193 pregnancies.

Intravenous hydration, antihistamines, bed rest, and alternative therapies (acupuncture, herbal medicines, homeopathy, antinausea wristbands, and chiropractic) were used most frequently over a 20-year period, with the use of ondansetron dramatically increasing since 1990.

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