London Viktoriya, Grube Stephanie, Sherer David M, Abulafia Ovadia
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Medical Center, Brooklyn, NY, USA.
Pharmacology. 2017;100(3-4):161-171. doi: 10.1159/000477853. Epub 2017 Jun 23.
In the United States, hyperemesis gravidarum is the most common cause of hospitalization during the first half of pregnancy and is second only to preterm labor for hospitalizations in pregnancy overall. In approximately 0.3-3% of pregnancies, hyperemesis gravidarum is prevalent and this percentage varies on account of different diagnostic criteria and ethnic variation in study populations. Despite extensive research in this field, the mechanism of the disease is largely unknown. Although cases of mortality are rare, hyperemesis gravidarum has been associated with both maternal and fetal morbidity. The current mainstay of treatment relies heavily on supportive measures until improvement of symptoms as part of the natural course of hyperemesis gravidarum, which occurs with progression of gestational age. However, studies have reported that severe, refractory disease manifestations have led to serious adverse outcomes and to termination of pregnancies.
Despite extensive research in the field, the pathogenesis of hyperemesis gravidarum remains unknown. Recent literature points to a genetic predisposition in addition to previously studied factors such as infectious, psychiatric, and hormonal contributions. Maternal morbidity is common and includes psychological effects, financial burden, clinical complications from nutritional deficiencies, gastrointestinal trauma, and in rare cases, neurological damage. The effect of hyperemesis gravidarum on neonatal health is still debated in literature with conflicting results regarding outcomes of birth weight and prematurity. Available therapy options remain largely unchanged in the past several decades and focus on parenteral antiemetic medications, electrolyte repletion, and nutritional support. Most studies of therapeutic options do not consist of randomized control studies and cross-study analysis is difficult due to considerable variation of diagnostic criteria. Key Messages: Hyperemesis gravidarum carries a significant burden on maternal health and US health care. Most published research on pathogenesis is observational and suggests multifactorial associations with hyperemesis gravidarum. Precise, strictly defined criteria for clinical diagnosis are likely to benefit meta-analyses of further research studies regarding pathogenesis as well as therapeutic options.
在美国，妊娠剧吐是妊娠前半期住院治疗的最常见原因，在整个孕期住院原因中仅次于早产。妊娠剧吐在约0.3%-3%的妊娠中较为普遍，这一比例因诊断标准不同以及研究人群的种族差异而有所不同。尽管该领域已有广泛研究，但疾病机制仍 largely 未知。虽然死亡病例罕见，但妊娠剧吐与母婴发病均有关联。目前的主要治疗方法严重依赖支持性措施，直至症状改善，这是妊娠剧吐自然病程的一部分，随着孕周进展而出现。然而，研究报告称，严重、难治性疾病表现会导致严重不良后果及妊娠终止。
尽管该领域已有广泛研究，但妊娠剧吐的发病机制仍不清楚。近期文献指出，除了先前研究的如感染、精神和激素因素外，还存在遗传易感性。母体发病很常见，包括心理影响、经济负担、营养缺乏导致的临床并发症、胃肠道损伤，以及罕见的神经损伤。妊娠剧吐对新生儿健康的影响在文献中仍存在争议，关于出生体重和早产结局的结果相互矛盾。在过去几十年中，可用的治疗选择基本未变，主要集中在胃肠外止吐药物、电解质补充和营养支持。大多数治疗选择的研究并非随机对照研究，且由于诊断标准差异很大，跨研究分析困难。关键信息：妊娠剧吐给母体健康和美国医疗保健带来重大负担。大多数已发表的关于发病机制的研究是观察性的，表明与妊娠剧吐存在多因素关联。精确、严格定义的临床诊断标准可能有助于对关于发病机制以及治疗选择的进一步研究进行荟萃分析。
