Hyperemesis Gravidarum Symptoms May Persist Post Partum


CHICAGO — Many women with severe hyperemesis gravidarum experience clinical symptoms that persist well beyond delivery, a survey shows.

A 2-year online survey coordinated through the nonprofit Hyperemesis Education & Research Foundation compared postpartum symptoms in 891 women diagnosed with hyperemesis gravidarum (HG) (162 of whom received parenteral nutrition) and 541 controls who did not experience weight loss during pregnancy from severe nausea and vomiting, researchers reported at the annual meeting of the American College of Obstetricians and Gynecologists.

Highly significant differences were seen in both the prevalence and duration of numerous postpartum symptoms between women with HG and controls, reported Dr. Gerson D. Hernandez of the University of Southern California, Los Angeles.

These symptoms included:

▸ Food aversions (34% vs. 6%).

▸ Gastroesophageal reflux (23% vs. 5%).

▸ Digestive problems (21% vs. 3%).

▸ Continued nausea (13% vs. 5%).

▸ Gallbladder problems (9% vs. 2%).

▸ Persistent fatigue (52% vs. 25%).

▸ Muscle weakness (24% vs. 8%).

The subgroup of women who required parenteral nutrition during pregnancy had the highest prevalence of persistent postpartum nausea, fatigue, and muscle weakness—symptoms that in some cases lasted months or even longer.

Fatigue, for example, persisted beyond a year in 23% of these women, and food aversions, in 17%.

“It has been the common clinical impression that all symptoms associated with HG resolve after pregnancy. This is the case for the majority of HG cases, but not all, as we can see in our results,” Dr. Hernandez said in an interview.

Clearly, more needs to be known about what is different about the subgroup of women with severe HG, particularly those with long-lasting postpartum symptoms, he added.

“The etiology of these symptoms, as well as the cause of their intensity and duration in this subgroup of the pregnant population remains unknown,” he said.

Hypotheses range from psychological—behavior modification during months of pregnancy leading to long-term food aversion—to physical, including theories about long-term consequences of “the marked nutritional deprivation that these women undergo,” Dr. Hernandez noted.

“We do know that there is something different about them that makes them still have problems after pregnancy,” he said.

A goal of the research team is to focus on ways to identify women most at risk for severe HG and to develop and implement a comprehensive management plan for them during and after their pregnancies, said Dr. Hernandez.

He was assisted in the research by associates from the USC department of obstetrics and gynecology and division of maternal-fetal medicine in Los Angeles, and the Hyperemesis Education & Research Foundation of Leesburg, Va.

None of the investigators reported conflicts of interest relevant to the study.

Fatigue persisted beyond a year in 23% of these women, and food aversions, in 17%.


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