Understanding Hyperemesis

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Home | Understanding Hyperemesis | Risks and Outcomes

Risks and Outcomes

Research shows that women with nausea and vomiting during pregnancy have similar outcomes as those who do not, unless they have prolonged or severe symptoms. The greatest risk appears to be in women who have large weight losses, and/or who fail to gain weight for two consecutive trimesters. A few studies find lower birth weight and increased rate of complications, however, the data so far varies, partly due to the inconsistent use of criteria to determine severity or diagnose hyperemesis gravidarum.

There is consistent research to suggest that left untreated, HG can result in adverse consequences for both mother and child. The medical interventions (e.g. antiemetics, TPN) given to these women also determines outcome as they can greatly impact severity.

The challenge in caring for women with HG is weighing the risks of potential complications and misery with the risks of antiemetic therapies. Medications are often given after more conservative measures fail, however, the delay in treatment may make her vomiting more resistant to conventional medical care.

There are a number of medications that have been used and deemed safe due to their long history of use without significant increases in the malformation rate. Yet, newer drugs often prove to be much more effective, and do not appear to increase the rate of malformations. Physicians often are not aware of these medications for the treatment of HG and thus are very reluctant or even unwilling to use them.

Following are links to information on teratology, the study of environmentally induced congenital anomalies, as well as articles and research on outcomes of women treated for HG.

Offsite Research:

Safety & Considerations with Antiemetic Therapies

Medical, social, and legal implications of treating nausea and vomiting of pregnancy.
Brent R.
Jefferson Medical College, Philadelphia, Penn, USA.
American Journal of Obstetrics and Gynecology 2002 May;185 (5 Suppl Understanding):S262-6.

Teratogenicity of recently introduced medications in human pregnancy.
Lo WY, Friedman JM.
Department of Medical Genetics, University of British Columbia, Vancouver, Canada.
Obstetrics and Gynecology 2002 Sep;100(3):465-73.

Evidence-based view of safety and effectiveness of pharmacologic therapy for nausea and vomiting of pregnancy (NVP).
Magee LA, Mazzotta P, Koren G.
Department of Specialized Women's Health, BC Women's Hospital and Health Centre, Vancouver, Canada. (e-mail: lmagee@cw.bc.ca)
American Journal of Obstetrics and Gynecology 2002 May;185(5 Suppl Understanding):S256-61.

Perception of teratogenic risk of common medicines.
Sanz E, Gomez-Lopez T, Martinez-Quintas MJ.
Department of Pharmacology, School of Medicine, University of La Laguna, La Laguna, Tenerife, Canary Islands, Spain. (e-mail: esanz@ull.es)
European Journal of Obstetrics, Gynecology and Reproductive Biology 2001 Mar;95(1):127-31.

The high and unrealistic perception of teratogenic risk amongst women and health professionals may lead to abortions of otherwise wanted and healthy children.

Potential human teratogenicity of frequently prescribed drugs.
Friedman JM, Little BB, Brent RL, Cordero JF, Hanson JW, Shepard TH.
Department of Medical Genetics, University of British Columbia, Vancouver, Canada.
Obstetrics and Gynecology 1990 Apr;75(4):594-9.

Human teratogens: A critical evaluation.
Orna Diav-Citrin, Gideon Koren
Nausea and Vomiting of Pregnancy: State of the Art 2000 Conference

(Excellent comprehensive information on teratogens)

Nausea of pregnancy, antinausea preparations and congenital heart defects: A population-based case-control study
Roumiana S. Boneva, Cynthia A. Moore, Lorenzo Botto, Lee-Yang Wong, J. David Erickson
Nausea and Vomiting of Pregnancy: State of the Art 2000 Conference

The perception of teratogenic risk by women with nausea and vomiting of pregnancy.
Paolo Mazzotta, Laura Magee, Caroline Maltepe, Arielah Lifshitz, Yvette Navioz, Gideon Koren
Nausea and Vomiting of Pregnancy: State of the Art 2000 Conference

More PubMed Research on Safety, Antiemetics, and Pregnancy »

Outcomes of Pregnancies Complicated by Nausea and Vomiting

Hyperemesis gravidarum. A comparison of single and multiple admissions.
Godsey RK, Newman RB.
Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston 29425.
Journal of Reproductive Medicing 1991 Apr;36(4):287-90.

Despite published reports that hyperemesis gravidarum has no impact on ultimate perinatal outcome, this study indicated that women admitted repeatedly have a more severe nutritional disturbance, associated with significantly reduced maternal weight gain and neonatal birth weight. These risks argue for more aggressive antenatal treatment and increased fetal surveillance in pregnancies complicated by recurrent hyperemesis gravidarum.

Pregnancy outcome in patients requiring parenteral nutrition.
Russo-Stieglitz KE, Levine AB, Wagner BA, Armenti VT.
Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Journal of Maternal and Fetal Medicine 1999 Jul-Aug;8(4):164-7.

Antenatal complications and perinatal outcome in patients with nausea and vomiting-complicated pregnancy.
Robert H.K. Chin

Hyperemesis gravidarum during pregnancy and delivery outcome: A registry study.
Bengt Källén

Nausea and vomiting in pregnancy and pregnancy outcome: An epidemiological overview.
Ronald M. Weigel

Nausea and vomiting of pregnancy and its association with pregnancy outcome.
Forrest D. Tierson

The association between abortion and nausea and vomiting of pregnancy.
Paolo Mazzotta, Laura Magee, Gideon Koren

More PubMed Research on Outcomes of Pregnancies Complicated by Nausea and Vomiting »

Updated on: Aug. 09, 2006