The risks of hyperemesis gravidarum for pregnant people and their offspring
| Risk | Management |
|---|---|
| Short-term maternal outcomes | |
| Weight loss (21) | Refer to a dietitian (preferably with experience in treating hyperemesis gravidarum) (21) |
| Dehydration (21) | Administer IV fluids in either an outpatient clinic or inpatient setting (22) |
| Electrolyte imbalances (21) | Hospital admission to correct electrolyte imbalances (21) |
| Wernicke encephalopathy (23) | Offer thiamine supplementation to patients admitted with prolonged lack of nutrient intake, especially before administration of dextrose or enteral or parenteral nutrition (22) |
| Vitamin K deficiency (24) | Consider vitamin K supplementation (150 μg IV) |
| Thromboembolism (25) | Consider thrombosis prophylaxis in patients admitted to hospital or in patients with other risk factors for thromboembolism (21) |
| Depression, anxiety, or PTSD (2), (26), (27) | Ask about depressive symptoms and offer psychosocial help (21) |
| Suicidal ideation (28) | Ask about suicidal ideation and refer if necessary |
| Consideration of pregnancy termination (28) | Ask if patient is considering pregnancy termination, talk about recurrence risks, expand antiemetic treatment, and refer if necessary |
| Long-term maternal outcomes | |
| Changes to family planning (7) | After a pregnancy affected by hyperemesis gravidarum, suggest follow-up to discuss future pregnancy and, if desired, make a plan for treatment of hyperemesis gravidarum in a next pregnancy (7) |
| Depression, anxiety, or PTSD (2), (29) | Offer psychosocial help (21) |
| Perinatal outcomes | |
| Placental abruption (30) | |
| Birth weight < 1500 g (30) | Offer ultrasonography to measure fetal growth in pregnancy if symptoms persist beyond second trimester |
| Preterm delivery (30) | |
| Resuscitation or admission to NICU (30) | |
| Long-term outcomes to offspring | |
| Reduced insulin sensitivity (30) | |
| Anxiety disorders (31) | |
| Sleep problems (31) | |
| Attention-deficit/hyperactivity disorder (31) | |
| Autism spectrum disorder (31) | |
| Testicular cancer (31) | |
Note: IV = intravenous, NICU = neonatal intensive care unit, PTSD = posttraumatic stress disorder.