As a researcher/clinician/medical writer-author I have collected oodles of papers from medical journals for over 35 years! Likely I estimate over 1000 papers on hyperemesis gravidarum (HG) and/or severe nausea and vomiting of pregnancy (NVP) and supporting information some might be of interest to you. You have logged to learn more about this topic; as a sufferer or as someone caring for a woman suffering.

To understand why progress in both research and bedside care has been so slow, one only needs to read what providers were taught… in the yesteryear. Please note this is only a sampling of content, not a compendium.

1973 Modern Obstetrics for Students (Chicago, Il)
Patient is nervous, intelligent, self-centered or frightened. Diet: small attractive meals. “Mushy” foods, and milky drinks are to be avoided.

1975 Textbook for Midwives (Edinburgh, Scotland)
80% of women with sensitive nervous systems, psychological factor of hospitalization away from home promotes recovery.
Diet: “push up diet”. (no specifics)

1975 Textbook for Midwives, 8th ed. (London, UK)
Emotions stimulate the sympathetic nervous system, which in turn influences the endocrine system. Psychological fear predominates. Private room, airy and bright. No food for 24 hours. To banish the idea of vomiting, remove the vomit bowl. Serve meals every 2-2 ½ hours since an empty stomach contracts more violently. First meal of tea, crisp toast, Marmite or Borvil drinks (NB: like salty boullion) acceptable. Too many cold sweet drinks irritating to the stomach.

1979 Psychological care during pregnancy and the postpartum period (NY)
Disorder of Western civilization, no metabolic, hormonal or other psychological factor which definitely account for these symptoms.
Diet: no suggestions.

1979 Interruptions in Family Health During Pregnancy (NY)
Provide sedatives, quiet room, psychotherapy, good ventilation, restrict visitors. Nasogastric tube feedings, intra-venous multi vitamins.
Diet: no suggestions.

1980 Advances in Psychosomatic Obstetrics and Gynecology (Berlin, German)
100% severe disturbance provoked by psychological causes, oral attempt to abort.

1980 Williams’ Obstetrics, 16th ed. (USA)
Psychological in 75% of cases.
Diet: no suggestions.

1981 Obstetrics and Essentials of Clinical Practice (Boston, MA)
90% psychological.
Diet: avoidance of foods that cause nausea (individual), ingestion of dry food upon rising, avoidance of food until 10-11 AM.

1981 Pregnancy: a psychological and social study (London, UK)
Hospitalization ends vomiting. History of eating disorders, frigid, neurotic. One of the five psychoneurotic conditions of pregnancy.
Diet: no suggestions.

1985 Maternal-Newborn Nursing (Boston, MA)
Begins about 6 weeks and ends at 12 weeks. For severe cases, hospitalization needed. No food or visitors for the first 24 hours. Then dry toast, clear liquids. If successful, then a soft diet and then regular meals. If clear liquids do not work, then a tube feeding is tried. If no success, then total parenteral nutrition.

1985 Modern Obstetrics in General Practice (Oxford, UK)
Maybe be symbolic rejection of the pregnancy.
Oral diet: no suggestions.

1986 Undergraduate Obstetrics and Gynecology, 2nd ed. (Bristol, UK)
75% psychological.
Diet: dry biscuits and toast. Avoid fatty foods.

1989 Medical Problems During Pregnancy (Norwalk, Ct)
Psychiatric support needed in some cases. Changes is physiological state due to pregnancy.
Diet: oral feedings resumed only after vomiting has ceased. Probably due to low blood sugars due to the alteration of hormones with pregnancy.

There you have it! About 17 years of medical thoughts….
Miriam Erick, MS RDN

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