Hyperemesis Gravidarum, Diagnosis, and Pathogenesis

Abstract

Nausea and vomiting are common in pregnancy and the condition may be mild or severe disabling disease. The severe form is known as Hyperemesis Gravidarum (HG) which is characterized by dehydration, electrolyte and metabolic imbalances, and nutritional deficiencies that may cause hospital admission. The severity of Nausea and Vomiting in Pregnancy (NVP) may be assessed by Pregnancy Unique Qualification of Emesis (PUQE) which showed a relatively accurate evaluation of the patient's lifestyle including sleeping hours. Focused history and examination are needed to exclude differential diagnosis because the diagnosis of this condition is mainly determined clinically. Moreover, lab investigations are useful tools to assess complications as electrolyte or metabolic imbalances and renal affection. Besides, they help in determine etiologies in refractory cases. Many theories have been hypothesized to contribute to understanding the pathogenesis of HG. They have been postulated based on associations which are either causal, sequential or coincidental. Many efforts are needed to accurately establish these relationships in terms of well-designed studies of adequate sample size. The hormonal theory is one of the main theories involved in the pathogenesis of the disease specifically human Chorionic Gonadotropin (hCG), estrogen, progesterone, and serotonin. Psychological theory has conflicting evidencebased studies. Therefore, more studies are needed to decide whether psychological problems cause HG or this is a coincidental or sequential relationship. The immunological theory is newly defined and supported by high levels of cellfree fetal DNA and cytokines.

Hiperemesis gravídica: abordaje y opciones terapéuticas

“…Se ha estudiado la relación entre la HG y el hipertiroidismo transitorio del embarazo, principalmente por la semejanza entre la estructura molecular del hCG y el receptor de la hormona estimulante de la tiroides (TSHR). Una mutación a nivel de estos receptores puede causar que algunas pacientes sean más sensibles a la hCG, incluso ante niveles séricos normales de esta hormona (9). Sin embargo, el hipertiroidismo por sí solo raramente causa náuseas y vómitos, por lo cual se ha descartado el papel del TSHR en la HG y sigue predominando el rol de la hCG en esta patología (7).…”

“…Las náuseas y los vómitos en el embarazo son más frecuentes ante niveles altos de estradiol y disminuyen ante niveles bajos de este (7). Además, se sabe que las náuseas y vómitos son efectos adversos comunes de los anticonceptivos orales que contienen estrógenos (9). Las mujeres fumadoras presentan menores niveles de estrógeno y hCG, y han demostrado tener menor incidencia de HG (7,9).…”

“…Además, se sabe que las náuseas y vómitos son efectos adversos comunes de los anticonceptivos orales que contienen estrógenos (9). Las mujeres fumadoras presentan menores niveles de estrógeno y hCG, y han demostrado tener menor incidencia de HG (7,9).…”

Complementary Therapies in Reducing of Emesis Gravidarum

“…Nausea and vomiting in early pregnancy are very common, affecting approximately 80% of the pregnancies, hyperemesis gravidarum is a severe form affecting 0.3-1.0% of the pregnancies (Gabra et al, 2019). Mild to moderate nausea and vomiting are common in early pregnancy and known as emesis gravidarum, while the most severe form is called Hyperemesis gravidarum (Azizah et al, 2022).…”

Effect of high levels of human chorionic gonadotropin and estradiol on degree of hyperemesis gravidarum

“…Women who were unable to manage severe nausea and vomiting symptoms and chose abortion have been reported in case reports. Furthermore, over half of working pregnant women said that their job efficiency has been harmed by nausea and vomiting, and around a quarter of these women have had to take time off work due to these problems 6 . This is making it also socioeconomic problem.…”