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Impact of Hyperemesis Gravidarum

Nausea and vomiting during pregnancy (NVP) can be mild (morning sickness) or more severe (hyperemesis gravidarum). NVP impacts a woman and her family greatly in every aspect of her life. The greatest impact is on her physical health and ability to perform her usual activities. The research on morning sickness shows that the greater the severity of symptoms, the greater the effect on the mother:

"The most profound effect of NVP is on maternal quality of life. NVP can have an impact on several levels: physical functioning (interference with work, household activities), psychological functioning (anxiety, depression), and social functioning (disruption of social activities)."

According to Motherisk, a organization that researches the safety or risk of drugs, chemicals and disease during pregnancy:

  • 55% of pregnant women feel depressed
  • 49% of women report NVP has adverse effects on relationship with their spouse
  • 55% of their partners mentioned that NVP has affected their day-to-day life
  • 47% of working women felt job efficiency to be reduced
  • 78% of women lost paid employment time (62 hours on average)
  • 68% of women went on sick leave

Quoted from "Burden of the Disease" presented  by Anthony R. Scialli, MD at "Nausea and Vomiting of Pregnancy: What's New?" The Reproductive Toxicology Center Satellite Session; September 3, 2000

Hyperemesis Gravidarum Compared to Morning Sickness

Women with the most severe nausea and vomiting (HG) are unable to care for themselves or their families for weeks, sometimes months. Some women may be unable to eat for lengthy periods and lose 5-10% or more of their pre-pregnancy body weight in the first few months. This in turn leads to debilitating fatigue, and sometimes depression. Even women who do not have severe nausea and vomiting (HG) sometimes choose elective termination (abortion) to avoid the misery and stress they will face.

Area Impacted: Morning Sickness: Hyperemesis Gravidarum:
Employment May lose an average of 0-3 weeks of employment and/or use sick time. Job performance is reduced. Often are unable to work for weeks or months and may lose their job or be forced to resign. 
Daily Activities Can perform most household responsibilities at some point during the day or week when symptoms are less intense. May be unable to perform even simple household chores or care for themselves (shower, drive, etc.) when symptoms are severe.
Energy Level Fatigue is mild to moderate and decreases workload. Recumbent rest is needed to alleviate symptoms. Fatigue may be severe for weeks or months. Bed rest is often a necessity. Prolonged fatigue is very common.
Relationships & Socialization Relationships may be stressed but social functioning is only temporarily curtailed. Relationships are often greatly strained and may dissolve. Isolation is common and may lead to depression. Abuse and neglect of the mother may occur.
Finances Financial loss due to medical care, loss of work, and use of sick time is significant but usually within a few thousand dollars. Financial loss due to medical care, loss of income, and additional paid services (child care, house cleaning, errands, etc.) can be devastating.
Stress Level Psychological stress is mild to moderate and may result in manageable depression during pregnancy. Psychological stress is typically moderate to severe and often results in anxiety and depression. Increased risk of postpartum depression (PPD).
Recovery Postpartum recovery is typical and usually takes a few months. Postpartum recovery is prolonged, averaging 6 months – 2 years.

Statistics for HG's Impact Are Underestimated

Morning sickness refers to mild nausea and vomiting of pregnancy, while hyperemesis refers to more severe forms of nausea and vomiting. The criteria used to diagnose HG often varies among health professionals and researchers. Very little research is done on the impact of hyperemesis as differentiated from morning sickness. Thus, actual statistical information is limited, and the impact of HG is greatly underestimated. Women who are very severe are typically hospitalized, representing only the 1-3% of pregnant women actually identified as having HG. The majority of women with HG are treated as outpatients with mild to severe symptoms. Further, there are reports from hundreds, if not thousands, of women who terminated out of desperation when given the diagnosis of morning sickness and given inadequate treatment. One study by Zhang, et al of 1867 women found a 10.8% incidence of severe vomiting. Many women are not represented in current statistics which only report the number of women hospitalized as inpatients. HG is not a rare disorder.

Estimates on the cost of inpatient care in 2000 was about $3,300 per stay for a total of $120 million. However, in recent years, the number of hospitalizations has increased and the number of women receiving IV nutritional therapies and expensive (yet often much more effective) medications has grown significantly. Adding to that cost supplemental physician visits, outpatient care, consulting physicians, and treatment for complications, and the annual cost could reach one billion dollars. Beyond financial impact, many family relationships dissolve and future family plans are almost always limited. Women often lose their employment because of the debility, and women are frequently undertreated and left feeling stigmatized by a disease erroneously presumed to be psychological.

More Info:

"Burden of the Disease"
A presentation by Dr. Anthony R. Scialli, MD, Director of The Reproductive Toxicology Center in Washington, D.C.

"When Morning Sickness Won't Go Away"
The realities of HG and suggested strategies for survival, as told to a medical writer.

Women's experiences with a pregnancy complication: causal explanations of hyperemesis gravidarum.
Read a journal article by Shari Munch, PhD on women's views of HG as biologically determined and its substantial impact on their daily functioning. (831 Kb downloadable PDF)

Offsite Research:

The impact of nausea and vomiting on women: a burden of early pregnancy.
Smith C, Crowther C, Beilby J, Dandeaux J.
The Australian & New Zealand Journal of Obstetrics & Gynaecology 2000 Nov;40(4):397-401

The women described substantial effects on working, household duties and parenting activities. Findings from this study suggest nausea and vomiting in early pregnancy has a profound impact on women's general sense of well-being and day to day life activities.
 

The burden of illness of severe nausea and vomiting of pregnancy in the United States.
Attard CL, Kohli MA, Coleman S, Bradley C, Hux M, Atanackovic G, Torrance GW.
American Journal of Obstetrics & Gynecology 2002 May;185(5 Suppl Understanding):S220-7

"...Nausea and vomiting of pregnancy can severely reduce a woman's QOL and ability to function. The degree of limitation is associated with the severity of symptoms."
 

Severe vomiting during pregnancy: antenatal correlates and fetal outcomes.
Zhang J, Cai WW.
Department of Maternal and Child Health, Shanghai Medical University, People's Republic of China.
Epidemiology. 1991 Nov;2(6):454-7

Neither the cause nor the effect of severe vomiting during pregnancy is well understood. This study examines possible causes of severe vomiting and associations between this disorder and fetal outcomes. One thousand eight hundred sixty-seven women with normal singleton live births were included in the analysis. The cumulative incidence of severe vomiting during pregnancy was 10.8%. Women with chronic liver disease had a threefold increased risk of severe vomiting during pregnancy. Paternal smoking was associated with a twofold increased risk of maternal vomiting. A modest association between severe vomiting and fetal growth retardation was identified (OR = 1.4, 95% CI: 0.9-2.3). Severe vomiting was also found to be associated with preeclampsia (OR = 1.5, 95% CI: 1.0-2.4). Our study indicates that passive smoking is a risk factor for vomiting during pregnancy, which may, in turn, increase the risk of fetal growth retardation.
 

Nausea and vomiting in pregnancy.
FitzGerald CM.
The British Journal of Medical Psychology 1984 Jun;57 ( Pt 2):159-65

"...no significant differences were discovered along demographic or social dimensions between women reporting no nausea, mild nausea and severe nausea during the first trimester of pregnancy. Not surprisingly, those women experiencing severe nausea reported significantly more sleep disturbances, fatigue and irritability."
 

Isolation from "being alive": coping with severe nausea and vomiting of pregnancy.
O'Brien B, Evans M, White-McDonald E.
Faculty of Nursing, University of Alberta, Canada. (e-mail: Beverley.obrien@ualberta.ca)
Nursing Research 2002 Sep-Oct;51(5):302-8

A process was identified wherein women experienced severe and unrelenting nausea and related symptoms which became progressively more debilitating, leaving them feeling uncertain about when and if they would recover. This caused the women to isolate themselves from their world in an effort to cope with symptoms. Severe nausea and vomiting of pregnancy is a complex and overwhelming syndrome.
 

A prospective study of nausea and vomiting during pregnancy.
Gadsby R, Barnie-Adshead AM, Jagger C.
Department of Epidemiology and Public Health, University of Leicester.
The British Journal of General Practice: The Journal of the Royal College of General Practitioners 1993 Jun;43(371):245-8)

It was found that 80% of women had symptoms, 28% experienced nausea only, while 52% had nausea and vomiting. The mean number of days from last menstrual period to onset and cessation of symptoms was 39 and 84, respectively, and 40% of women's symptoms ended abruptly. The median total number of hours of nausea per pregnancy in those 292 women experiencing symptoms was 56, with peak symptoms occurring in the ninth week. The symptom complex can be defined as episodic daytime pregnancy sickness. Seventy three of these women (35%) spent a mean of 62 hours away from their paid work because of symptoms of nausea and vomiting, showing the socioeconomic significance of this condition.
 

Updated on: Apr. 18, 2013

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