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Hyperemesis Gravidarum: Risk of Recurrence in Subsequent Pregnancies

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Abstract

This study aimed to examine whether the recurrence risk of hyperemesis gravidarum (HG) is modified by the timing of diagnosis, the severity of illness, and interpregnancy interval. The Kaiser Permanente Southern California 1998–2020 longitudinally linked medical records were used to examine the recurrence risk of HG in the first two (n = 93,444) and first three (n = 17,492) successive pregnancies. The timing of diagnosis- and the severity of illness-specific recurrence risks were examined by estimating the adjusted relative risks (aRR). The risks of HG in the second pregnancy among patients with and without previous HG were 23.8% and 3.4%, respectively (aRR: 8.20; 95% confidence interval [CI]: 7.52, 8.94). The recurrence risk persisted regardless of the trimester at diagnosis and the gestational age of delivery in the first pregnancy. The recurrence risk was greater for patients with metabolic disturbances requiring in-hospital treatment (30.0%) than those managed on an outpatient basis (18.6%) in the first pregnancy (aRR: 10.84 95% CI: 9.66, 12.16). Although Asian/Pacific Islander (RR = 12.9) and White (RR = 8.9) patients had higher HG recurrence risk regardless of the gestational age at delivery in the first pregnancy, all patients had significant recurrence risk only if their first pregnancy was delivered after 32 weeks of gestation. African American patients had the highest recurrence rate (34.4%). HG recurrence risk was unaffected by interpregnancy interval and correlated with the number of previous pregnancies complicated by HG. There is an increased recurrence risk of HG in subsequent pregnancies that is influenced by race/ethnicity and gestational age at delivery. The number of pregnancies complicated by HG synergistically adds to the recurrence risk.

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Acknowledgements

The authors thank Ms. Sole Cardoso and Ms. Chantal C. Avila for their technical support. Dr. Getahun and Ms. Chiu had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The study team would like to thank the Kaiser Permanente member patients who contributed electronic health information to this study.

Funding

This study is supported by the Kaiser Permanente Direct Community Benefit Funds.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, CA, USA

    Michael J. Fassett

  2. Department of Psychiatry, Shore University Medical Center, Neptune, NJ, USA

    Morgan R. Peltier

  3. Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA

    Adrian H. Lopez

  4. Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Avenue, 2nd Floor, Pasadena, CA, 91101, USA

    Vicki Y. Chiu & Darios Getahun

  5. Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA

    Darios Getahun

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  1. Michael J. Fassett
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Correspondence to Darios Getahun.

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The opinions expressed are solely the authors’ responsibility and do not necessarily reflect the official views of the Kaiser Permanente Community Benefit Funds. The funding agency has no role in the design, conduct, and report of this study.

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Fassett, M.J., Peltier, M.R., Lopez, A.H. et al. Hyperemesis Gravidarum: Risk of Recurrence in Subsequent Pregnancies. Reprod. Sci. 30, 1198–1206 (2023). https://doi.org/10.1007/s43032-022-01078-8

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  • DOI: https://doi.org/10.1007/s43032-022-01078-8

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