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Nutritional consequences and management of hyperemesis gravidarum: a narrative review

Published online by Cambridge University Press:  16 September 2021

Kate Maslin Open the ORCID record for Kate Maslin [Opens in a new window]  and
Caitlin Dean Open the ORCID record for Caitlin Dean [Opens in a new window]
Kate Maslin*
Affiliation:
School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, Devon, UK.
Caitlin Dean
Affiliation:
Pregnancy Sickness Support, Bodmin, Cornwall, UK Department of Obstetrics and Gynaecology, Amsterdam Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
*
*Corresponding author: Kate Maslin, email: kate.maslin@plymouth.ac.uk
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Abstract

Hyperemesis gravidarum (HG) is a condition at the extreme end of the pregnancy sickness spectrum, estimated to affect 1–2 % of pregnant women. This narrative review provides an overview of the current literature concerning the nutritional implications and management of HG. HG can persist throughout pregnancy, causing malnutrition, dehydration, electrolyte imbalance and unintended weight loss, requiring hospital admission in most cases. In addition to its negative effect on maternal, physical and psychological wellbeing, HG can negatively impact fetal growth and may have adverse consequences on the health of the offspring. HG care and research have been hampered in the past due to stigma, inconsistent diagnostic criteria, mismanagement and lack of investment. Little is known about the nutritional intake of women with HG and whether poor intake at critical stages of pregnancy is associated with perinatal outcomes. Effective treatment requires a combination of medical interventions, lifestyle changes, dietary changes, supportive care and patient education. There is, however, limited evidence-based research on the effectiveness of dietary approaches. Enteral tube feeding and parenteral nutrition are generally reserved for the most intractable cases, where other treatment modalities have failed. Wernicke encephalopathy is a rare but very serious and avoidable consequence of unmanaged HG. A recent priority-setting exercise involving patients, clinicians and researchers highlighted the importance of nutrition research to all. Future research should focus on these priorities to better understand the nutritional implications of HG. Ultimately improved recognition and management of malnutrition in HG is required to prevent complications and optimise nutritional care.

Keywords

Hyperemesis gravidarumPregnancy nutritionMaternal malnutritionPregnancy sicknessPregnancy nausea vomiting
Type
Review Article
Information
Nutrition Research Reviews , Volume 35 , Issue 2 , December 2022 , pp. 308 - 318
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Nutrition Society

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