Summarize this content to 100 words Researchers have reviewed the evidence related to hyperemesis gravidarum and provided guidance for the diagnosis and treatment of this condition.Hyperemesis gravidarum, or severe nausea and vomiting in pregnancy, can have detrimental effects on maternal quality of life and on the patient’s children. The review provided an overview of the condition based on studies listed on PubMed, including information on its definition, potential causes, health outcomes, and treatment.Larissa A.W. Jansen, MD”There is still a lot we don’t know about hyperemesis, so research is essential in this patient group,” study author Larissa A.W. Jansen, MD, an obstetrician-gynecologist at Erasmus MC in the Netherlands and PhD candidate at Amsterdam UMC, told Medscape Medical News. While awareness has increased in the past few years, Jansen hopes the review will highlight the need for more work on this topic.The review was published on April 15 in the Canadian Medical Association Journal.More Than Morning Sickness”It’s important for clinicians to know that there is a definition for hyperemesis,” said Jansen. A patient with hyperemesis gravidarum has severe nausea or vomiting within the first 16 weeks of pregnancy that affects their daily living and ability to eat or drink normally. About a third of patients with hyperemesis gravidarum continue to have severe nausea and vomiting until the third trimester, and recent research has shown that the condition can lead to adverse outcomes for the child in addition to the parent.The definition of hyperemesis gravidarum is primarily used in research settings but could also be helpful in clinical practice, said Jansen. While the cause is not well understood, the authors summarized recent studies investigating potential causes, including endocrine factors, genetic associations, and Helicobacter pylori infection.A range of medications and treatments can safely be used in pregnant patients to help reduce nausea. The review lists possible antiemetic treatments (eg, a formulation of doxylamine succinate and pyridoxine hydrochloride) and nonpharmacological therapies and provides information on efficacy and safety. For example, cannabis, which some patients may turn to for its antinausea effect, is not advised because of potential neurocognitive complications in the child. Most other treatments listed do not entail high risk for complications and can be prescribed safely.Seeking Preventive TreatmentProviding this information is important because “there are still people with hyperemesis who don’t get treatment,” said Jansen. These patients may be influenced by a perception that nausea is always normal in pregnancy or that there are no treatments available. In fact, some patients may not know they have hyperemesis gravidarum.Jansen hopes that more large-scale studies will be conducted in the future. In particular, “future research should focus on treatment,” she said, adding that studies may not have been conducted to date because there is little money in hyperemesis gravidarum research. Additionally, “it’s a difficult patient group,” said Jansen. Patients have a range of reactions to treatments, which may reduce but not eliminate nausea.A preventative treatment could be particularly helpful, said Jansen. Some patients with hyperemesis gravidarum may avoid or hesitate to become pregnant again because patients with a history of the condition are at a higher risk for recurrence.An Understudied FieldDarine El-Chaâr, MDCommenting on the review for Medscape Medical News, Darine El-Chaâr, MD, a researcher and maternal fetal medicine physician at the Ottawa Hospital and associate professor of obstetrics and gynecology at the University of Ottawa, Ottawa, Ontario, Canada, said that it provides a good overview for a wide audience. Specialists, however, would benefit from more in-depth clinical guidelines when developing treatment plans, according to El-Chaâr, who did not participate in the review.Like many topics related to pregnancy, hyperemesis gravidarum is understudied, said El-Chaâr. She added it may be particularly understudied because most patients are resilient and “get through it.” However, “they were suffering through it. I think we’re ignoring the suffering that they go through.”Diane Francoeur, MD, CEO of the Society of Obstetricians and Gynaecologists of Canada, was pleased to see attention given to hyperemesis gravidarum. Because many patients and providers believe the nausea is normal, “there’s still a lot of stigmatization,” said Francoeur. Francoeur hopes the review will reassure people that many medications are safe to take during pregnancy. “We try to use as little medication as possible, but there are some that you need to take.”Diane Francoeur, MDFrancoeur also appreciated that the authors considered possible genetic predispositions for hyperemesis gravidarum. “It’s reassuring in a way to hear that because they get told all the time, ‘It’s in your head.’ But it’s not in their head, it’s in their genes.”No funding for the review was reported. Jansen, El-Chaâr, and Francoeur reported no relevant financial relationships.Gwendolyn Rak is a health reporter for Medscape Medical News based in Brooklyn, New York.
Review Examines Hyperemesis Gravidarum Diagnosis, Treatment
