Health Questions and Answers

Question: How is nausea and vomiting differentiated from hyperemesis gravidarum (HG)?

Answer:

There is no universally accepted definition for HG, but most clinicians consider this diagnosis in the setting of compromised fluid, electrolyte, and nutritional status. Some use a maternal weight loss of 5% and persistent significant ketonuria to make the diagnosis. A wide range of laboratory abnormalities may be seen, but a patient with moderate to severe disease will present with hyperchloremic metabolic alkalosis. In the setting of long-standing volume depletion, acidosis will be present. Both liver function tests and pancreatic enzymes amylase and lipase may be elevated.
HG is much less common than nausea and vomiting, affecting approximately five per thousand pregnancies. Women most at risk are those with multiple gestations, obese women, and nulliparas. Women with a previous history of HG have an increased risk of recurrence in a subsequent pregnancy compared to women with no history.

Reference: Creasy RK, Resnik R: Maternal Fetal Medicine, 4th ed. Philadelphia, WB Saunders, 1999, pp 122-131.

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