The nutritional status of people hospitalized for hyperemesis gravidarum

Background and aims: Hyperemesis gravidarum (HG) is defined as severe nausea and vomiting in pregnancy. Persistent nausea and vomiting can lead to weight loss and depletion of maternal nutrients. The severity and persistence of maternal undernutrition secondary to HG, as expressed by energy, macro- and micronutrient intake, has not been extensively studied. The aim of our study was to prospectively investigate the nutritional intake of people with HG during the first twenty weeks of their pregnancy. Methods: For this study, we included people admitted for HG, who participated in the Maternal and Offspring outcomes after Treatment of HyperEmesis by Refeeding randomized controlled trial (MOTHER RCT, NTR 4197). Individuals who refused randomization were studied in an observational cohort study. We included pregnant people between 5 and 20 weeks of gestation who had completed at least one dietary questionnaire from 19 hospitals in the Netherlands. This questionnaire was collected weekly, until 20 weeks of gestation or until symptoms abated, and registered symptom severity, maternal weight and dietary intake. We excluded participants who only had data available while on tube feeding, or within 2 days of tube cessation. A 24-hour intake was calculated for intake of energy, protein, carbohydrates, fat, saturated fat, iodine, iron, folate, omega3 fatty acids and thiamine. Results: Between 2013–2016, we collected 601 dietary questionnaires from 160 participants (varying between 1 to 12 per person). The daily intake of energy, protein, carbohydrates and fat was sufficient (more than 75% of recommended amount) in respectively 27%, 38%, 73% and 27% of dietary questionnaires. The daily intake of energy, protein, carbohydrates and fat was less than 50% of the recommended amount in respectively 44%, 39%, 17% and 43% of dietary questionnaires. 23% of dietary questionnaires exceeded the maximum recommended amount of saturated fat a day. For iodine and iron daily intake was sufficient in respectively 11% and 14% of dietary questionnaires. The daily intake of iodine and iron did not reach 50% of recommended amount in respectively 67% and 64%. Only three dietary questionnaires showed a sufficient intake of folate, 93% of dietary questionnaires did not reach 50% of recommended amount of folate. For omega3 fatty acids and thiamine the daily intake was sufficient in respectively 78% and 25%. The daily intake of omega 3 fatty acids and thiamine was less than 50% of the recommended amount in respectively 17% and 53%. Conclusion: Our findings demonstrate that intake of macro-and micronutrients as well as total energy intake is deficient in people who suffer from HG. This is a particular concern, as nutrient deficiency in pregnancy can negatively impact the health of the offspring.