• Artha Budi Susila Duarsa Faculty of Medicine, Al-Azhar Islamic University, 83232 Mataram, Indonesia
  • Aris Widiyanto Nursing Study Program, School of Health Sciences Mamba’ul ‘Ulum Surakarta, 57127 Surakarta, Indonesia
  • I Putu Dedy Arjita Faculty of Medicine, Al-Azhar Islamic University, 83232 Mataram, Indonesia
  • Joko Tri Atmojo Nursing Study Program, School of Health Sciences Mamba’ul ‘Ulum Surakarta, 57127 Surakarta, Indonesia
  • Ayu Anulus Faculty of Medicine, Al-Azhar Islamic University, 83232 Mataram, Indonesia
  • Santy Irene Putri Midwifery Study Program, Tribhuwana Tunggadewi University, 65144 Malang, Indonesia
  • Asruria Sani Fajriah Midwifery Study Program, Strada Indonesia Institute of Health Sciences, 64133 Kediri, Indonesia




cohort, hyperemesis gravidarum, nausea, risk factors, vomiting of pregnancy


Hyperemesis gravidarum (HG) is a pregnancy condition characterized by prolonged and severe nausea and vomiting of pregnancy, which causes dehydration and weight loss that requires extensive medical care and hospital admission. Studies of hyperemesis were limited in statistical power and generalizability as a result of being facility-based and relatively small in size. This study aimed to investigate the factors associated with HG among pregnant women. It systematically reviews articles published in PubMed, EMBASE, and Science Direct databases. Statistical analysis was carried out by Review Manager 5.3 (RevMan 5.3). Three hundreds and eighteen studies were found in the databases, and 6 of them met the qualifications. The results of this meta-analysis suggested that mothers with female baby (OR= 1.25; 95% CI: 1.20–1.31), with a previous history of HG (OR= 5.38; 95% CI: 1.10–26.36), multiparity (OR = 1.07; 95% CI: 0.94–1.22), with more than 1 fetus (OR= 2.13; 95%CI: 1.95–2.33), and underweight (OR= 1.19; 95%CI: 1.10–1.28) have higher risk to HG compared to those with male baby, without previous history of HG, primipara, single fetus, and normal BMI respectively. In addition, smoking mothers have a lower risk of HG compared to those who have never had a cigarette (OR= 0.69; 95%CI: 0.31–1.54). Finally, it suggested that mothers with female baby, history of previous HG, multiparity, underweight, and multi-baby are risk factors of HG. Meanwhile, smoking is perceived to be protective factors of HG


Fejzo MS, Trovik J, Grooten IJ, et al. Nausea and vomiting of pregnancy and hyperemesis gravidarum. Nat Rev Dis Prim. 2019;5(1):62. doi:10.1038/s41572-019-0110-3

Jarvis S, Nelson-Piercy C. Management of nausea and vomiting in pregnancy. BMJ. 2011;342:d3606. doi:10.1136/bmj.d3606

World Health Organization. World Health Organization . International Statistical Classification of Diseases and Related Health Problems. 10th Rev. Published 2007. Available from: http://apps.who.int/classifications/apps/icd/icd10online2007/

Roseboom TJ, Ravelli ACJ, van der Post JA, Painter RC. Maternal characteristics largely explain poor pregnancy outcome after hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol. 2011;156(1):56-59. doi:10.1016/j.ejogrb.2011.01.010

Annagür BB, Kerimoğlu ÖS, Gündüz Ş, Tazegül A. Are there any differences in psychiatric symptoms and eating attitudes between pregnant women with hyperemesis gravidarum and healthy pregnant women? J Obstet Gynaecol Res. 2014;40(4):1009-1014. doi:10.1111/jog.12274

Tan PC, Zaidi SN, Azmi N, Omar SZ, Khong SY. Depression, anxiety, stress and hyperemesis gravidarum: temporal and case controlled correlates. PLoS One. 2014;9(3): e92036. doi:10.1371/journal.pone.0092036

Tan PC, Vani S, Lim BK, Omar SZ. Anxiety and depression in hyperemesis gravidarum: prevalence, risk factors and correlation with clinical severity. Eur J Obstet Gynecol Reprod Biol. 2010;149(2):153-158. doi:10.1016/j.ejogrb.2009.12.031

Mullin PM, Ching C, Schoenberg F, et al. Risk factors, treatments, and outcomes associated with prolonged hyperemesis gravidarum. J Matern neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2012;25(6):632-636. doi:10.3109/14767058.2011.598588

McCarthy FP, Khashan AS, North RA, et al. A prospective cohort study investigating associations between hyperemesis gravidarum and cognitive, behavioural and emotional well-being in pregnancy. PLoS One. 2011;6(11): e27678. doi:10.1371/journal.pone.0027678

Hizli D, Kamalak Z, Kosus A, Kosus N, Akkurt G. Hyperemesis gravidarum and depression in pregnancy: is there an association? J Psychosom Obstet Gynaecol. 2012;33(4):171-175. doi:10.3109/0167482X.2012.717129

Vandraas KF, Vikanes A V, Vangen S, Magnus P, Støer NC, Grjibovski AM. Hyperemesis gravidarum and birth outcomes-a population-based cohort study of 2.2 million births in the Norwegian Birth Registry. BJOG. 2013;120(13):1654-1660. doi:10.1111/1471-0528.12429

Veenendaal MVE, van Abeelen AFM, Painter RC, van der Post JAM, Roseboom TJ. Consequences of hyperemesis gravidarum for offspring: a systematic review and meta-analysis. BJOG. 2011;118(11):1302-1313. doi:10.1111/j.1471-0528.2011.03023.x

Dodds L, Fell DB, Joseph KS, Allen VM, Butler B. Outcomes of pregnancies complicated by hyperemesis gravidarum. Obstet Gynecol. 2006;107(2 Pt 1):285-292. doi:10.1097/01.AOG.0000195060.22832.cd

Bailit JL. Hyperemesis gravidarium: Epidemiologic findings from a large cohort. Am J Obstet Gynecol. 2005;193(3 Pt 1):811-814. doi:10.1016/j.ajog.2005.02.132

Aksoy AN. Hyperemesis Incidence in Planned versus Unplanned Pregnancy. Eurasian J Med. 2008;40(2):72-74. https://pubmed.ncbi.nlm.nih.gov/25610031

Boelig RC, Barton SJ, Saccone G, Kelly AJ, Edwards SJ, Berghella V. Interventions for treating hyperemesis gravidarum. Cochrane database Syst Rev. 2016;(5):CD010607. doi:10.1002/14651858.CD010607.pub2

Fejzo MS, Ingles SA, Wilson M, et al. High prevalence of severe nausea and vomiting of pregnancy and hyperemesis gravidarum among relatives of affected individuals. Eur J Obstet Gynecol Reprod Biol. 2008;141(1):13-17. doi:10.1016/j.ejogrb.2008.07.003

Mahmoud G. Prevalence and risk factors of hyperemesis graviderum among Egyptian pregnant woman at the Woman’s Health Center. Med J Cairo Univ. 2012;80(2).

Einarson TR, Piwko C, Koren G. Quantifying the global rates of nausea and vomiting of pregnancy: a meta-analysis. J Popul Ther Clin Pharmacol = J la Ther des Popul la Pharmacol Clin. 2013;20(2):e171-e183.

Deeks JJ, Higgins JPT AD. Analysing Data and Undertaking Meta‐ Analyses. In: Cochrane Handbook for Systematic Reviews of Interventions Wiley; 2019.; 2019.

JPT H. Measuring inconsistency in meta-analyses. BMJ. Published online 2003:557-560.

OM D. Meta-analysis: Key features, potentials and misunderstandings. Res Pr Thromb Haemost. 2018;2:658-663.

Godavitarne C, Robertson A, Ricketts DM, Rogers BA. Understanding and interpreting funnel plots for the clinician. Br J Hosp Med (Lond). 2018;79(10):578-583. doi:10.12968/hmed.2018.79.10.578

Kjeldgaard HK, Eberhard-Gran M, Benth JŠ, Vikanes ÅV. Hyperemesis gravidarum and the risk of emotional distress during and after pregnancy. Arch Womens Ment Health. 2017;20(6):747-756. doi:10.1007/s00737-017-0770-5

Kjeldgaard HK, Eberhard-Gran M, Benth JŠ, Nordeng H, Vikanes ÅV. History of depression and risk of hyperemesis gravidarum: a population-based cohort study. Arch Womens Ment Health. 2017;20(3):397-404. doi:10.1007/s00737-016-0713-6

Kim HY, Cho GJ, Kim SY, et al. Pre-pregnancy risk factors for severe hyperemesis gravidarum: Korean population-based cohort study. Life. 2021;11(1):1-8. doi:10.3390/life11010012

Fiaschi L, Nelson-Piercy C, Tata LJ. Hospital admission for hyperemesis gravidarum: A nationwide study of occurrence, reoccurrence, and risk factors among 8.2 million pregnancies. Hum Reprod. 2016;31(8):1675-1684. doi:10.1093/humrep/dew128

Nurmi M, Rautava P, Gissler M, Vahlberg T, Polo-Kantola P. Incidence and risk factors of hyperemesis gravidarum: A national register-based study in Finland, 2005-2017. Acta Obstet Gynecol Scand. 2020;99(8):1003-1013. doi:10.1111/aogs.13820

Trogstad LIS, Stoltenberg C, Magnus P, Skjærven R, Irgens LM. Recurrence risk in hyperemesis gravidarum. BJOG An Int J Obstet Gynaecol. 2005;112(12):1641-1645. doi:10.1111/j.1471-0528.2005.00765.x

Dekkers GWF, Broeren MAC, Truijens SEM, Kop WJ, Pop VJM. Hormonal and psychological factors in nausea and vomiting during pregnancy. Psychol Med. 2019;50(2):229-236. doi:10.1017/S0033291718004105

Klebanoff MA, Koslowe PA, Kaslow R, Rhoads GG. Epidemiology of vomiting in early pregnancy. Obstet Gynecol. 1985;66(5):612-616.

Schiff MA, Reed SD, Daling JR. The sex ratio of pregnancies complicated by hospitalisation for hyperemesis gravidarum. BJOG. 2004;111(1):27-30. doi:10.1046/j.1471-0528.2003.00005.x

Matsuo K, Ushioda N, Nagamatsu M, Kimura T. Hyperemesis gravidarum in Eastern Asian population. Gynecol Obstet Invest. 2007;64(4):213-216. doi:10.1159/000106493

Karaca C, Güler N, Yazar A, Camlica H, Demir K, Yildirim G. Is lower socio-economic status a risk factor for Helicobacter pylori infection in pregnant women with hyperemesis gravidarum? Turkish J Gastroenterol Off J Turkish Soc Gastroenterol. 2004;15(2):86-89.

Vaknin Z, Halperin R, Schneider D, et al. Hyperemesis gravidarum and nonspecific abnormal EEG findings: a preliminary report. J Reprod Med. 2006;51(8):623-627.

del Mar Melero-Montes M, Jick H. Hyperemesis Gravidarum and the Sex of the Offspring. Epidemiology. 2000;12(1):123-124.

Askling J, Erlandsson G, Kaijser M, Akre O, Ekbom A. Sickness in pregnancy and sex of child. Lancet (London, England). 1999;354(9195):2053. doi:10.1016/S0140-6736(99)04239-7

Fell DB, Dodds L, Joseph KS, Allen VM, Butler B. Risk factors for hyperemesis gravidarum requiring hospital admission during pregnancy. Obstet Gynecol. 2006;107(2):277-284. doi:10.1097/01.AOG.0000195059.82029.74

Avşar TS, McLeod H, Jackson L. Health outcomes of smoking during pregnancy and the postpartum period: an umbrella review. BMC Pregnancy Childbirth. 2021 Mar 26;21(1):254. doi: 10.1186/s12884-021-03729-1. PMID: 33771100; PMCID: PMC7995767.

Y. Fan L, H. Jacobsen K. Risk Factors for Hyperemesis Gravidarum. Curr Womens Health Rev. 2010;6(4):309-317. doi:10.2174/157340410793362113




How to Cite

Duarsa, A. B. S., Widiyanto, A., Dedy Arjita, I. P., Atmojo, J. T. ., Anulus, A. ., Putri, S. I. ., & Fajriah, A. S. . (2022). RISK FACTORS OF HYPEREMESIS GRAVIDARUM: META-ANALYSIS FROM RETROSPECTIVE COHORT STUDIES. Malaysian Journal of Public Health Medicine, 22(3), 296–309. https://doi.org/10.37268/mjphm/vol.22/no.3/art.1678