Authors: Miriam A Erick.
In 2020 there were 3,613,647 live births in the US. Fifty to 90% of those pregnancies were affected by nausea and vomiting of pregnancy (NVP) while the most severe NVP, known as hyperemesis gravidarum (HG) affected 1.5- 3.0% of those gravidas. In 2014 58,436 gravidas were hospitalized with HG. While hospital admissions for HG were down 42%, the number seen in Emergency departments rose by 27.7%. Although HG has been viewed as a positive predictor of a favorable pregnancy outcome, patients who also demonstrate weight loss and electrolyte disturbance may be a distinct entity and at greater risk for growth retardation and fetal anomalies. Poorly managed HG can result in compounded maternal injuries, increased rates of therapeutic abortions and suicide ideation, as well as a high rate of fetal loss. This study focuses on one of the most severe catastrophes originating from HG: Wernicke’s encephalopathy (WE) continues to be an under-recognized and often misunderstood disease in all populations. The acknowledged cause of WE is vitamin B1 or thiamin deficiency, a specific form of malnutrition. Unfortunately, this syndrome is most often recognized at autopsy, especially among non-alcoholics.
One manifestation of WE is cognitive dysfunction which may explain the increase in suicidal ideation and/or elected terminations. The current mounting legislation of pregnancy termination limits will complicate the decision to abort for critically ill gravidas and their medical providers. However, antecedent events to WE are extremely poor nutritional intake leading to excessive weight loss and delayed nutritional interventions which can mitigate these situations.
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