Study of serum copper and zinc in cases of hyperemesis gravidarum

Hyperemesis gravidarum, a literature review

Hyperemesis gravidarum (HG) is a condition causing severe nausea and vomiting in early pregnancy often resulting in hospital admission. The incidence of HG is approximately 0.5% of live births, said to be higher in multiple pregnancies, hydatidiform mole and other conditions associated with increased pregnancy hormone levels. Both the aetiology and pathogenesis of HG remain unknown. We conducted a literature review (1966-now) to summarize the current evidence on the aetiology and pathogenesis of HG. The potential role of pregnancy-related hormones such as progesterone, estrogen and HCG has been widely studied; however, various other hormones such as leptin, placental growth hormone, prolactin, thyroid and adrenal cortical hormones have been implicated in the aetiology of HG. In addition to endocrinological hypotheses, the rationale and evidence considering infectious, immunological, psychological, metabolic and anatomical causes for HG have been analysed here. Many studies suffer from the low number of patients included, the variable definition used for HG and varying assay methodology used in studies of hormone measurement. This review highlights the need for more extensive studies addressing the pathogenesis and aetiology of HG.

The nutritional status and treatment of patients with hyperemesis gravidarum

OBJECTIVE

The objective of this study was to evaluate the nutritional status of patients with hyperemesis gravidarum and the effect of a treatment regimen administered during hospitalization.

STUDY DESIGN

This was a descriptive, controlled study of 20 patients with hyperemesis gravidarum whose nutritional status was assessed and compared with that of 20 pregnant, nonvomiting matched controls. Blood nutrient status was reassessed after 10 days of treatment with an intravenous saline solution containing a multivitamin preparation and again at day 20.

RESULTS

Mean dietary intake of most nutrients fell below 50% of the recommended dietary allowances and differed significantly (p < 0.01) from that of controls. More than 60% of the patients had suboptimal biochemical status of thiamine, riboflavin, vitamin B6, vitamin A, and retinol-binding protein. Vitamin C, calcium, albumin, hematocrit, and hemoglobin values were significantly higher in those patients where the duration of vomiting had been longer, suggesting the presence of dehydration. Treatment was associated with cessation of vomiting and improvement in blood nutrient status. Pregnancy outcome was favorable in all patients.

CONCLUSION

The hyperemetic pregnant patient is at nutritional risk; prompt initiation of corrective therapy is recommended.