Hyperemesis gravidarum: Maternal and neonatal future health

Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting in pregnancy, which can lead to undernutrition in pregnant women. HG is known to have an high impact on maternal wellbeing at time of suffering from HG, yet little is known about long-term adverse maternal and offspring health effects. In a prospective cohort of women admitted for HG, we found that the utility of thyroid function at time of admission as a marker for HG disease severity was limited. HG’s persisting effects on mental wellbeing after pregnancy were demonstrated in this thesis: we showed that depression, anxiety and post-traumatic stress disorder symptoms were frequently reported up to 5 years after their HG pregnancy. Additionally, we found that HG recurred in the vast majority of pregnancies (89%) and that many women had postponed a pregnancy (40%) or considered termination of an otherwise wanted pregnancy (23%) because of HG. Persisting effects among the offspring of HG affected pregnancies were a possible increase in cardiometabolic risk, based on the finding that lower maternal weight gain was associated with higher Apolipoprotein-B levels in offspring cord blood. We could not demonstrate any beneficial effects of early enteral tube feeding. Two systematic reviews and meta-analyses showed that HG is associated with adverse offspring health outcomes in the short and long-term. Lastly, another systematic review, consisting of mostly case-reports, demonstrated that HG can lead to vitamin K deficiency and that both neonatal and maternal complications due to HG related vitamin K deficiency have been reported.