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Wernicke's encephalopathy in hyperemesis gravidarum: A systematic review.
Eur J Obstet Gynecol Reprod Biol. 2019 May; 236:84-93.EJ

Abstract

Pregnant women have an increased demand for thiamine. In hyperemesis gravidarum (HG) thiamine rapidly depletes, which can lead to Wernicke's Encephalopathy (WE). Our objective was to systematically review the signs and symptoms of WE in HG. We conducted our search from inception using Mesh terms hyperemesis, Wernicke Encephalopathy, Korsakoff's syndrome, and pregnancy. We searched Pubmed, Embase, Cochrane, Web of Science, Psychinfo, PiCarta, and Cinahl. We defined WE as mental, oculomotor, and motoric alterations and thiamine deficiency; HG was defined as severe nausea, and vomiting during pregnancy; adequate WE treatment as >500 mg/day intramuscular or intravenous. Our search yielded 146 case studies reporting on 177 cases. Pregnant WE patients became thiamine depleted between 10-15 weeks of gestation. Patients had been vomiting for a median of 7 weeks before WE, and had lost 12.1 kg. Prodromal signs of WE were nausea and vomiting (100%), double vision (37.4%), and blurred vision (27.4%). Treatment with subtherapeutic thiamin dose was common (63.6%), WE was exacerbated by intravenous glucose administration (14.1%). We found chronic cognitive disorders occurred in 65.4%, pregnancy loss in 50%, and maternal death in 5% of cases. Thiamine supplementation was insufficient or absent from treatment plans. To eradicate WE in pregnancy, it is necessary to give 100 mg of intravenous or intramuscular thiamine in HG patients with persistent or severe late onset vomiting to prevent them from developing WE.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Oudman E
Experimental Psychology, Helmholtz Institute, Utrecht University, the Netherlands; Korsakoff Center Slingedael, Lelie Care Group, Rotterdam, the Netherlands. Electronic address: E.oudman@leliezorggroep.nl.
Wijnia JW
Experimental Psychology, Helmholtz Institute, Utrecht University, the Netherlands; Korsakoff Center Slingedael, Lelie Care Group, Rotterdam, the Netherlands.
Oey M
Experimental Psychology, Helmholtz Institute, Utrecht University, the Netherlands; Korsakoff Center Slingedael, Lelie Care Group, Rotterdam, the Netherlands.
van Dam M
Experimental Psychology, Helmholtz Institute, Utrecht University, the Netherlands; Korsakoff Center Slingedael, Lelie Care Group, Rotterdam, the Netherlands.
Painter RC
University Medical Centres Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, the Netherlands.
Postma A
Experimental Psychology, Helmholtz Institute, Utrecht University, the Netherlands; Korsakoff Center Slingedael, Lelie Care Group, Rotterdam, the Netherlands.

MeSH

FemaleHumansHyperemesis GravidarumPregnancyThiamineVitamin B ComplexWernicke Encephalopathy

Pub Type(s)

Journal Article
Systematic Review

Language

eng

PubMed ID

30889425

Citation

Oudman, Erik, et al. "Wernicke's Encephalopathy in Hyperemesis Gravidarum: a Systematic Review." European Journal of Obstetrics, Gynecology, and Reproductive Biology, vol. 236, 2019, pp. 84-93.
Oudman E, Wijnia JW, Oey M, et al. Wernicke's encephalopathy in hyperemesis gravidarum: A systematic review. Eur J Obstet Gynecol Reprod Biol. 2019;236:84-93.
Oudman, E., Wijnia, J. W., Oey, M., van Dam, M., Painter, R. C., & Postma, A. (2019). Wernicke's encephalopathy in hyperemesis gravidarum: A systematic review. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 236, 84-93. https://doi.org/10.1016/j.ejogrb.2019.03.006
Oudman E, et al. Wernicke's Encephalopathy in Hyperemesis Gravidarum: a Systematic Review. Eur J Obstet Gynecol Reprod Biol. 2019;236:84-93. PubMed PMID: 30889425.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Wernicke's encephalopathy in hyperemesis gravidarum: A systematic review. AU - Oudman,Erik, AU - Wijnia,Jan W, AU - Oey,Misha, AU - van Dam,Mirjam, AU - Painter,Rebecca C, AU - Postma,Albert, Y1 - 2019/03/12/ PY - 2019/01/26/received PY - 2019/03/04/revised PY - 2019/03/04/accepted PY - 2019/3/20/pubmed PY - 2019/12/18/medline PY - 2019/3/20/entrez KW - Clinical nutrition KW - Hyperemesis gravidarum KW - Thiamine KW - Wernicke’s encephalopathy SP - 84 EP - 93 JF - European journal of obstetrics, gynecology, and reproductive biology JO - Eur J Obstet Gynecol Reprod Biol VL - 236 N2 - Pregnant women have an increased demand for thiamine. In hyperemesis gravidarum (HG) thiamine rapidly depletes, which can lead to Wernicke's Encephalopathy (WE). Our objective was to systematically review the signs and symptoms of WE in HG. We conducted our search from inception using Mesh terms hyperemesis, Wernicke Encephalopathy, Korsakoff's syndrome, and pregnancy. We searched Pubmed, Embase, Cochrane, Web of Science, Psychinfo, PiCarta, and Cinahl. We defined WE as mental, oculomotor, and motoric alterations and thiamine deficiency; HG was defined as severe nausea, and vomiting during pregnancy; adequate WE treatment as >500 mg/day intramuscular or intravenous. Our search yielded 146 case studies reporting on 177 cases. Pregnant WE patients became thiamine depleted between 10-15 weeks of gestation. Patients had been vomiting for a median of 7 weeks before WE, and had lost 12.1 kg. Prodromal signs of WE were nausea and vomiting (100%), double vision (37.4%), and blurred vision (27.4%). Treatment with subtherapeutic thiamin dose was common (63.6%), WE was exacerbated by intravenous glucose administration (14.1%). We found chronic cognitive disorders occurred in 65.4%, pregnancy loss in 50%, and maternal death in 5% of cases. Thiamine supplementation was insufficient or absent from treatment plans. To eradicate WE in pregnancy, it is necessary to give 100 mg of intravenous or intramuscular thiamine in HG patients with persistent or severe late onset vomiting to prevent them from developing WE. SN - 1872-7654 UR - https://www.unboundmedicine.com/medline/citation/30889425/Wernicke's_encephalopathy_in_hyperemesis_gravidarum:_A_systematic_review_ DB - PRIME DP - Unbound Medicine ER -