title: Symptoms and pregnancy outcomes associated with extreme weight loss among women with hyperemesis gravidarum.
abstract: OBJECTIVE
  To report the weight loss and associated symptoms experienced by a large cohort of women with hyperemesis gravidarum (HG).
  
  
  METHODS
  Data were obtained from an HG website registry, where women with HG were recruited on-line. Respondents were included if they experienced at least 1 live birth>27 weeks' gestation. Extreme weight loss was defined as a loss of >15% of prepregnancy weight.
  
  
  RESULTS
  Of the 819 women surveyed, 214 (26.1%) met criteria for extreme weight loss. These women were twice as likely to be Hispanic or nonwhite. Extreme weight loss (p<0.001) was associated with indicators of the severity of HG, such as hospitalization and use of parenteral nutrition, and with multiple symptoms during pregnancy, such as gallbladder and liver dysfunction, renal failure, and retinal hemorrhage. Among all women surveyed, 22.0% reported that symptoms lasted throughout pregnancy; this finding was nearly twice as likely among women with extreme weight Loss: 63 of 214 (29.4%) vs. 117 of 605 (19.3%) (OR=1.73, 95% CI 1.2-2.5, p=0.003). For some women, symptoms continued postpartum and included food aversions, muscle pain, nausea, and posttraumatic stress. Approximately 16% of babies were born prematurely, and 8% reportedly weighed <2500 g. Among women with extreme weight loss, 9.3% reported having a child with a behavioral disorder.
  
  
  CONCLUSIONS
  Extreme weight loss is common among women with HG, suggesting that HG is a form of prolonged starvation in pregnancy and that the long-term effects of this condition on women and their offspring warrant further investigation.
authors.affiliation: University of Southern California, Department of Obstetrics and Gynecology, Los Angeles, California 90033, USA.
authors.forename: Marlena S
authors.initials: MS
authors.lastname: Fejzo
authors.forename: Borzouyeh
authors.initials: B
authors.lastname: Poursharif
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Korst
authors.forename: Shari
authors.initials: S
authors.lastname: Munch
authors.forename: Kimber W
authors.initials: KW
authors.lastname: MacGibbon
authors.forename: Roberto
authors.initials: R
authors.lastname: Romero
authors.forename: T Murphy
authors.initials: TM
authors.lastname: Goodwin
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006939:Hyperemesis Gravidarum / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011295:Prenatal Care / Q000379:methods; D011296:Prenatal Diagnosis / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D015431:Weight Loss; D016387:Women's Health; D055815:Young Adult