Gerede Angeliki, Stavros Sofoklis, Moustakli Efthalia, Potiris Anastasios, Orgianelis Ilias, Zikopoulos Athanasios, Drakakis Peter, Domali Ekaterini, Eleutheriades Makarios, Nikolettos Nikolaos
Department of Obstetrics and Gynecology, Democritus University of Thrace, 69100 Alexandroupolis Campus, Greece.
Third Department of Obstetrics and Gynecology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece.
Med Sci (Basel). 2025 Aug 14;13(3):132. doi: 10.3390/medsci13030132.
Hyperemesis gravidarum (HG) is the leading cause of hospitalization during early pregnancy, affecting approximately 0.3-3% of pregnancies. It represents the most severe end of the nausea and vomiting in pregnancy (NVP) spectrum and is associated with substantial maternal morbidity and potential adverse fetal outcomes. Despite extensive research, the exact pathophysiology remains poorly understood, and optimal management strategies continue to be debated.
This narrative review synthesizes current evidence on the complications and treatment approaches for HG. A literature search was conducted in PubMed, Scopus, and Medline up to October 2024 using predefined keywords. Eligible sources included observational studies, cohort studies, descriptive studies, and case reports. Systematic reviews, meta-analyses, and non-English articles were excluded.
HG is associated with a broad spectrum of complications, including dehydration, electrolyte imbalances, Wernicke's encephalopathy, cardiac arrhythmias, thromboembolism, and adverse pregnancy outcomes such as fetal growth restriction and preterm birth. Pharmacological treatments-most notably doxylamine-pyridoxine (the only FDA-approved therapy), ondansetron, metoclopramide, and corticosteroids-have demonstrated varying efficacy and safety profiles. Non-pharmacological interventions such as acupressure, dietary adjustments, psychotherapy, and hypnosis have also been studied, although evidence remains limited.
HG requires a comprehensive and individualized management approach. While doxylamine-pyridoxine remains the cornerstone of therapy, other pharmacologic and supportive measures may offer additional benefit. Continued research is essential to clarify the underlying mechanisms, improve therapeutic efficacy, and develop evidence-based guidelines that integrate both medical and psychosocial care for affected women.
妊娠剧吐（HG）是孕早期住院的主要原因，影响约0.3%-3%的妊娠。它代表了妊娠恶心和呕吐（NVP）谱中最严重的一端，与严重的母体发病和潜在的不良胎儿结局相关。尽管进行了广泛研究，但确切的病理生理学仍知之甚少，最佳管理策略仍在争论中。
本叙述性综述综合了关于HG并发症和治疗方法的现有证据。截至2024年10月，在PubMed、Scopus和Medline中使用预定义关键词进行了文献检索。符合条件的来源包括观察性研究、队列研究、描述性研究和病例报告。排除系统评价、荟萃分析和非英文文章。
HG与广泛的并发症相关，包括脱水、电解质失衡、韦尼克脑病、心律失常、血栓栓塞以及胎儿生长受限和早产等不良妊娠结局。药物治疗——最显著的是多西拉敏-吡哆醇（唯一获得美国食品药品监督管理局批准的疗法）、昂丹司琼、甲氧氯普胺和皮质类固醇——已显示出不同的疗效和安全性。非药物干预措施，如穴位按压、饮食调整、心理治疗和催眠也已被研究，尽管证据仍然有限。
HG需要全面和个性化的管理方法。虽然多西拉敏-吡哆醇仍然是治疗的基石，但其他药物和支持措施可能会带来额外益处。持续研究对于阐明潜在机制、提高治疗效果以及制定将医疗和心理社会护理整合到受影响妇女中的循证指南至关重要。
