Hyperemesis gravidarum in northern Israel: a retrospective epidemiological study

Hyperemesis gravidarum (HG) is characterized by severe intractable nausea and vomiting in pregnancy leading to electrolyte imbalance, ketonuria, and weight loss. The cause is unknown. This study sought to investigate the prevalence and characteristics of HG in the Western Galilee in two ethnic populations and to estimate its economic burden.

Data on ethnicity, age, gestational age, number of pregnancies, and length of hospitalization were collected from the medical files of all women with HG admitted to the Galilee Medical Center in 2010-2013. Findings were compared between Arabs and Jews. Prevalence was assessed relative to total number of births. Economic burden was assessed by cost of hospitalization and work days lost.

The cohort included 184 women, 124 Arabic (67.4 %) and 60 Jewish (32.6 %). There were 13,630 births at the medical center during the study period, for a calculated prevalence of HG of 1.2 %. There was no difference in the relative proportions of Arabs and Jews between the cohort and the total women giving birth at our center. Mean patient age was 27.2 years, gestational age 9.3 weeks, parity 2.35. Mean age was significantly higher in the Jewish group. There were no significant between-group differences in the other clinical parameters. Mean number of hospitalization days was 2.24 days, and of additional rest days prescribed, 4.62. The calculated annual cost of HG was 452,943.42 NIS (120,144.14 USD), crudely extrapolated to a nationwide cost of 15-20 million NIS (5,300,000 USD).

The prevalence and characteristics of HG are similar in the Arabic and Jewish populations of northern Israel. Mean gestational age at admission for HG was lower in our study than earlier ones, probably owing to the universal health care provided by law in Israel. HG prevalence was twice that reported previously in southern Israel but still within the range observed in other world regions. The socioeconomic differences between Arabs and Jews in the Galilee are smaller than elsewhere in Israel, suggesting a multifactorial etiology of HG. HG poses a major economic burden which should be considered when planning health policies. Further studies of this issue are warranted.