Nausea and vomiting occur in up to 90% of all pregnancies. Hyperemesis gravidarum (HG) has a prevalence of 0.35 to 1%, and is characterized by severe, persistent nausea and vomiting during the first trimester. Intractable vomiting requires aggressive support, including, at times, parenteral nutrition. Risk associations include increased body weight, multiple gestations, hyperemesis in a prior pregnancy, and nulliparity.
Up to half of women hospitalized for HG have liver enzyme abnormalities, generally occurring within the first 1 to 3 weeks following onset of vomiting. Aminotransferase levels may be as high as 2 to 3 times normal, but rarely above 1000 IU/L. The more severe the vomiting, the higher the elevation. Mild elevations in bilirubin (rarely above 4 mg/dL) and jaundice, occasionally with pruritus, occur.
Alkaline phosphatase levels are usually elevated beyond those seen with normal pregnancy.
The etiology of the hepatic abnormalities is unknown, but it is a relatively benign process. Liver abnormalities resolve rapidly with resolution of emesis. HG was at one time a lethal disease, however, with early diagnosis and aggressive support, both maternal and fetal mortality is now negligible.
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