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#Grand Rounds

What is the Recurrence Risk for Hyperemesis Gravidarum?

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BACKGROUND AND PURPOSE:

  • Nurmi et al. ( AJOG 2018) studied the recurrence rate for hyperemesjs gravidarum (HG)

METHODS:

  • Analysis of Finnish healthcare registries
    • ≥1 pregnancy ending in delivery following a pregnancy diagnosed with HG
    • Index case: The first pregnancy with HG
  • Recurrence rate was calculated by comparing
    • The number of hyperemetic pregnancies that followed the index pregnancy
    • Total number of pregnancies that followed the index pregnancy
  • Additional associations between recurring HG were analyzed including
    • Age | Parity | Prepregnancy BMI | Smoking | Marital and socioeconomic status | Domicile | Month of delivery | ART | Sex | Number of fetuses

RESULTS:

  • 544 pregnancies with HG | 1,723 pregnancies without HG
    • Overall recurrence rate: 24%
  • Chronological distribution patterns in subsequent pregnancies
    • 1 pregnancy after the index pregnancy: 25% HG recurrence
    • >1 pregnancy after the index pregnancy: 11% HG recurrence in all subsequent pregnancies
    • 22% had a HG diagnosis in ≥1 but not all subsequent pregnancies
  • Index pregnancy associations
    • Parity of 2 vs parity of 1: Recurrence more common (adjusted odds ratio (OR) 1.33; P = .046)
    • Overweight women: Recurrence less common (adjusted OR 0.58; P = .036)
    • Smoking after the first trimester: Recurrence less common (adjusted OR; 0.27, P < .001)
  • Subsequent pregnancy associations: Recurrence less common (compared to non-smokers)
    • Quitting smoking in the first trimester (adjusted OR, 0.32, P = .010)
    • Smoking continued after the first trimester (adjusted OR, 0.38, P = .002)
  • Female sex of the fetus was associated with higher odds of recurring hyperemesis (adjusted OR, 1.29, P = .012)

CONCLUSION:

  • HG recurrence is unpredictable but does not recur in majority of women, with a trend for decreasing risk with each new pregnancy
  • Smoking decreased risk of recurring HG, consistent with other findings
    • Chemicals in smoke may reduce expression of placental proteins

Learn More – Primary Sources:

Recurrence patterns of hyperemesis gravidarum

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Related ObG Topics:

Practical obstetrics info for your women's healthcare practice
Nausea and Vomiting in Pregnancy – Management Options for Hyperemesis Gravidarum

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