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Emergency department burden of hyperemesis
gravidarum in the United States from 2006 to 2014
Grace Geeganage, BA; Johanna Iturrino, MD; Scott A. Shainker, DO, MS; Sarah Ballou, PhD; Vikram Rangan, MD;
Judy Nee, MD
BACKGROUND: Hyperemesis gravidarum is the most severe form of nausea and vomiting of pregnancy, potentially affecting both maternal
and pregnancy health. Hyperemesis gravidarum often results in emergency department visits, although the exact frequency and costs associated
with these visits have not been well studied.
OBJECTIVE: This study aimed to analyze the trends in hyperemesis gravidarum emergency department visits, inpatient admissions, and the
associated costs between 2006 and 2014.
STUDY DESIGN: Patients were identified from the 2006 and 2014 Nationwide Emergency Department Sample database files using Interna-
tional Classification of Diseases, Ninth Revision diagnosis codes. Patients with a primary diagnosis of hyperemesis gravidarum, nausea and vomit-
ing of pregnancy, and all nondelivery pregnancy-related diagnoses (all antepartum visits) were identified. All groups were analyzed; trends in
demographics, number of emergency department visits, and visit costs were compared. Costs were inflation-adjusted to 2021 US dollars.
RESULTS: Emergency department visits for hyperemesis gravidarum increased by 28% from 2006 to 2014; however, the proportion of those
who were subsequently admitted to the hospital decreased. The average cost of an emergency department visit for hyperemesis gravidarum
increased by 65% ($2156 to $3549), as opposed to an increase of 60% for all antepartum visits ($2218 to $3543). The aggregate cost for all
hyperemesis gravidarum visits increased by 110% ($383,681,346 to $806,696,513) from 2006 to 2014, which was similar to the increase
observed for all antepartum emergency department visits.
CONCLUSION: From 2006 to 2014, emergency department visits for hyperemesis gravidarum increased by 28%, with associated costs
increasing by 110%, whereas the number of admissions from the emergency department for hyperemesis gravidarum decreased by 42%.
Key words: healthcare utilization, medical economics, Nationwide Emergency Department Sample, nausea and vomiting of pregnancy
Introduction
Hyperemesis gravidarum (HG) is the
most disruptive and severe form of nau-
sea and vomiting of pregnancy
(NVP).
1,2
HG is one of the most com-
mon indications for hospital admission
during early pregnancy,
3,4
and is esti-
mated to occur in 0.5%
5
to 1.2% of
pregnant patients.
6
HG is typically accompanied by loss
of >5% of prepregnancy weight and
inadequate nutrition.
1,2
HG can also
have a profound effect on mental
health, including posttraumatic stress
symptoms, and thoughts and actions of
delaying or avoiding another preg-
nancy.
7−9
Pregnancies complicated by
HG are associated with higher antepar-
tum and total pregnancy costs; a 2005
meta-analysis reported the average total
cost over the pregnancy as $7499 with-
out HG and $17,938 with HG (reported
in 2005 US dollars).
5
Increased risk of HG is associated
with younger age, multiple gestations,
and certain preexisting conditions such
as hyperthyroidism, psychiatric illness,
diabetes mellitus, and gastrointestinal
disorders.
5,10
The pathophysiology of
HG is poorly understood, but some
studies have shown a genetic predispo-
sition to HG.
11,12
A genome-wide asso-
ciation study found an association
between the presence of HG in pregnant
patients and the placenta and appetite
genes GDF15 and IGFBP7.
13
Petry et
al
14
found an association between
higher GDF15 serum levels and second-
trimester nausea and vomiting or antie-
metics use in pregnant patients. HG is
managed with rehydration, pyridoxine,
and antiemetics, which have been
shown to be effective at preventing
emergency department (ED) revisits
and rehospitalization.
15−18
However,
randomized controlled trials have gen-
erally been of “low quality.”
19
Despite the frequent use of the ED by
pregnant patients for HG treatment, to
the best of our knowledge there have
been no previous studies quantifying
ED use for HG, the cost of these visits,
or trends in ED use and cost over time.
This study aims to both update and add
to the limited existing literature on the
prevalence and cost of ED visits for HG.
From the Division of Gastroenterology, Beth
Israel Deaconess Medical Center and Harvard
Medical School, Boston, MA (Ms Geeganage
and Drs Iturrino, Ballou, Rangan, and Nee);
Division of Obstetrics and Gynecology, Beth
Israel Deaconess Medical Center and Harvard
Medical School, Boston, MA (Dr Shainker).
G.G. and J.I. share first authorship.
The authors report no conflict of interest.
G.G. received research funding from the
Charles Hamilton Houston Program at the
Amherst College Loeb Center.
Patient consent was not required because no
personal information or details were included.
The findings of this study were presented at the
45th annual meeting of the New England
Perinatal Society, Newport, RI, April 8−10, 2022.
Cite this article as: Geeganage G, Iturrino J,
Shainker SA, et al. Emergency department
burden of hyperemesis gravidarum in the
United States from 2006 to 2014. Am J Obstet
Gynecol Glob Rep 2023;3:100166.
Corresponding author: Johanna Iturrino, MD,
jiturrin@bidmc.harvard.edu
2666-5778/$36.00
© 2023 The Authors. Published by Elsevier Inc. This is
an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-
nd/4.0/)
http://dx.doi.org/10.1016/j.xagr.2023.100166
Original Research ajog.org
February 2023 AJOG Global Reports 1
Materials and Methods
Data sources
This study evaluated the trends in ED
visits for patients with a primary diag-
nosis of HG between 2006 and 2014
using the Nationwide Emergency
Department Sample (NEDS), a database
maintained by the Healthcare Cost and
Utilization Project (HCUP) and the
Agency for Healthcare Research and
Quality (AHRQ). NEDS is the largest
all-payer publicly available database on
ED visits in the United States. The 2006
database contains approximately 26 mil-
lion cases from 955 hospitals in 24
states, weighted to estimate 120 million
ED visits; the 2014 database contains
»31 million cases from 945 hospitals in
34 states, weighted to estimate almost
138 million ED visits.
20
The database is
a nationally representative patient-level
sample of data with paired hospital and
geographic characteristics. Statistics on
ED trends over time and demographic
data by International Classification of
Diseases, Ninth Revision (ICD-9) codes
are freely available on HCUPnet.
21
The
numbers of ED visits for the years
between 2006 and 2014 were obtained
from HCUPnet. Data for the number of
births per year per age group were
obtained from the National Vital Statis-
tics Reports (NVSR) for each respective
year.
22
Study variables
HG cases were identified by primary
diagnosis using ICD-9 codes for mild
HG (643.0X) and severe HG (643.1X).
Mild and severe diagnoses were com-
bined into “hyperemesis gravidarum”
because of the lack of consistent diag-
nostic criteria.
23
In addition, patients
with a primary diagnosis of NVP
(643.2X, 643.8X, 643.9X) and all nonde-
livery pregnancy-related diagnoses (any
antepartum condition) were analyzed as
comparisons. Comparisons were made
on variables predefined by HCUP,
including age, ED cost, discharge status,
household income, hospital location
(large metropolitan, medium and small
metropolitan, and micropolitan and
rural), and primary insurer (Medicare,
Medicaid, private, self-pay, no charge,
and other). The secondary diagnoses
were also reviewed to examine common
secondary complaints.
HCUP defines a “large metropolitan
area”as a central or suburban county of
a city with ≥1 million population.
“Medium and small”metro areas are
counties with a population <1 million
but >50,000. “Micropolitan and rural”
areas are rural counties with a popula-
tion <50,000. Household income is
reported as the median income for the
patient’s zip code relative to the national
median income. The median income of
the patient’s zip code is reported using
demographic data from Claritas.
24
Statistical analysis
The rate per 100,000 ED visits for a spe-
cific diagnosis was calculated by divid-
ing the number of ED visits with that
primary diagnosis by the total number
of ED visits and multiplying by 100,000.
Trends in admission over time are
reported as percentage of ED visits that
result in hospital admission. Rates of
ED visits from 2006 to 2014 are
reported as proportions of births in that
year that resulted in an ED visit for HG.
The percentage of US births with a visit
to the ED for HG or NVP each year was
calculated by extrapolating the NEDS
data to NVSR data assuming an average
of 1 fetus per pregnant patient. All cost
data were adjusted for inflation to June
2021 US dollars using the Consumer
Price Index inflation calculator.
25
The
total aggregate cost data were calculated
by multiplying the mean cost by the
total number of ED visits. Statistical
analysis was performed on the 2006 and
2014 NEDS data using IBM SPSS Statis-
tics, Version 28.0 (IBM Corp, Armonk,
NY) and RStudio (RStudio, Boston,
MA). For quantitative variables, the
mean, median, standard deviation, and
standard error were calculated. For cat-
egorical variables, the proportions for
each category were tallied. The 95%
confidence intervals (CIs) were calcu-
lated by adding and subtracting the
standard error from the mean.
Results
Patient demographics
The mean age at presentation for preg-
nant patients with HG visiting the ED
increased slightly from 2006 to 2014
(24.2−25.3 years) (Figure 1). The pro-
portion of patients in the youngest
group (<19 years old) had the largest
decrease from 2006 to 2014 (19.8% to
13.4%), whereas the proportion of
patients aged >30 years increased from
16.7% to 21.2%. The proportion of
patients in the lowest-income quartile
increased from 34.5% to 37.7%, whereas
those in the highest-income quartile
decreased from 13.6% to 12.4% between
2006 and 2014. The proportion of
patients with HG covered by Medicaid
increased from 47.9% to 57.6%
(Table 1). Per US births, the percentage
of pregnant patients with a visit to the
ED for HG increased across all age
brackets, with the largest increase in the
youngest group (Figure 2). The trends
AJOG Global Reports at a Glance
Why was this study conducted?
This study was conducted to examine the use of the emergency room over time
in the treatment of hyperemesis gravidarum and how these trends correlate with
admissions and cost.
Key findings
The number of emergency department visits for hyperemesis gravidarum
increased from 2006 to 2014, but the proportion of people admitted to inpatient
care decreased. The cost of emergency department visits for hyperemesis gravi-
darum increased over time, even with adjustment for inflation.
What does this add to what is known?
This study adds to limited existing literature on emergency department visits for
hyperemesis gravidarum, which is important given the large number of patients
who use the emergency department for care.
Original Research ajog.org
2AJOG Global Reports February 2023
for pregnant patients with NVP visiting
the ED were similar to those observed
in pregnant patients with HG (Table 2).
Demographic data for patients visiting
the ED with any antepartum condition
also follow similar trends (Supplemen-
tary Table 1).
Emergency department visits
In 2014, HG was the third most com-
mon reason, after threatened abortion
and genitourinary tract infection, for
early pregnancy ED visits (Supplemen-
tary Table 2), with 7.2% of those visits
having reported HG as the primary
diagnosis. The number of ED visits with
HG as the primary diagnosis increased
by 27.7% from 2006 to 2014, as opposed
to a 15% increase in all ED visits. Per
100,000 ED visits, the visit rate
increased from 148.2 to 164.9. Out of all
US births, the percentage of pregnant
patients with HG or NVP who visited
the ED increased from 4.2% to 5.7%
between 2006 and 2014 (Figure 3).
Despite the increase in ED visits for
HG, admission rates from the ED
decreased from 7.7% to 4.5% from 2006
to 2014 (Supplemental Figure 1). In
2014, HG was the fourth most common
reason for admission for pregnant
patients (Supplementary Table 3). Simi-
larly, in that time, the number of ED
visits for NVP increased by 67%, and
the rate per 100,000 ED visits increased
from 29.1 to 42.4. NVP admission rates
decreased from 2.6% to 1.5% (Supple-
mentary Figure 1).
Emergency department costs
The mean ED cost per patient for HG
increased from $2156.25 (95% CI,
2151.54−2160.96) to $3549.07 (95% CI,
3549.05−3556.09)—a 65% increase
(Supplementary Figure 2). The aggre-
gate cost for HG increased by 110%
from $383,681,346 (95% CI,
382,843,692−384,518,999) to
$806,696,513 (95% CI, 805,100,999
−808,292,027) (Supplementary Figure
3). Similarly, the mean ED cost per
patient for NVP increased by 73% from
$1993.93 (95% CI, 1984.43−2003.43) to
$3441.27 (95% CI, 1990.93−2015.92).
The aggregate cost of NVP increased
from $69,534,321 (95% CI, 69,203,121
−69,865,521) to $201,099,897 (95% CI,
200,369,751−201,830,044)—a 189%
increase. For patients with any antepar-
tum condition visiting the ED, the
trends in costs are similar (Supplemen-
tary Table 1).
Secondary diagnoses
The most common secondary diagnoses
after a primary diagnosis of HG were
dehydration, genitourinary tract infec-
tion, diarrhea, and abdominal pain. In
2006, 12.5% of HG patients who visited
the ED had dehydration as a secondary
diagnosis; in 2014, the incidence
decreased to 8.1%. Patients with a
primary diagnosis of NVP had similar
common secondary diagnoses. In 2006,
5.2% of NVP patients had dehydration
listed as a secondary diagnosis, and
4.8% had a coexisting urinary tract
infection (UTI). In 2014, 5.0% of NVP
patients had UTI listed as a secondary
diagnosis, and 3.0% of patients had
dehydration as a secondary diagnosis.
Discussion
Principal findings
Using the NEDS data on all US ED vis-
its, this study found an over 27%
increase in all ED visits for HG between
2006 and 2014. Despite this, there was a
nearly 60% reduction in HG admissions
during the same time. Comparable with
the increase in costs of all antepartum
ED visits between 2006 to 2014, the
average cost of an ED visit for HG
increased by 65%, and the aggregate
cost increased by 110%.
Results
Demographic findings of this study are
consistent with previous studies. The
mean age of HG patients at ED visit
increased from 24.2 to 25.3 years from
2006 to 2014, comparable with the
increase in mean age for any (related to
HG or not) antepartum visit from 25.2
to 26.3 years. The average age at ED
visit of HG patients was 1.11 years
lower than the average age at any ante-
partum ED visit, which is consistent
with current belief that HG primarily
affects pregnant patients of younger
ages.
5
We also observed a decrease in
HG and NVP patients aged <24 years,
and an increase in HG and NVP
patients aged >25 years. This follows
the upward trend of the average age of
giving birth.
Our findings are consistent with pre-
vious work with respect to insurance
status and payer mix.
26
The proportion
of patients with Medicaid as the pri-
mary insurer increased from 47.9% to
57.6% from 2006 to 2014, which is com-
parable with the increase observed for
all antepartum visits. Pregnant patients
in the lowest 2 income quartiles visit the
ED more frequently than pregnant
patients in the higher income levels,
likely because of the lack of access to
FIGURE 1
Mean age by diagnosis over time
Trends in mean age of all pregnant patients presenting to the ED with a primary diagnosis of NVP or
HG compared with the mean age of childbirth in the United States between 2006 and 2014.
ED, emergency department; HG, hyperemesis gravidarum; NVP, nausea and vomiting of pregnancy.
Geeganage. Emergency department burden of hyperemesis gravidarum. Am J Obstet Gynecol Glob Rep 2023.
ajog.org Original Research
February 2023 AJOG Global Reports 3
established obstetrical care in early
pregnancy.
27
Recent reviews report HG as the most
common reason for hospitalization in the
first half of pregnancy, and as second
only to preterm labor for hospitalization
overall.
3,28
In contrast, our study shows
that HG was the third most common
indication for ED visits during early preg-
nancy (Supplementary Table 2)andthe
fourth most common reason for inpa-
tient admission from the ED (Supple-
mentary Table 3). Similarly, Monti et al
29
recently published a study using 2017
data from 246 hospitals in the state of
California identifying HG as the fourth
most common reason for ED visit in
early pregnancy and the third most com-
mon reason for inpatient admission from
the ED during pregnancy.
Despite the decrease in the number of
births in the United States between 2006
and 2014, this study found an increase
in HG and NVP ED visits.
30,31
Although the reasons for this increase
remain unknown, we believe that the
following could help explain this trend:
reduced capacity at outpatient infusion
service, payer restrictions on admission
for outpatient services, increased use of
observation status, and reduced capacity
of obstetrical services over time.
32
Simi-
larly, a possible explanation for the 65%
increase in the average cost of a HG ED
visit but a 110% increase in the aggre-
gate cost of HG ED visits is that the cost
burden of treating HG is shifted to the
ED instead of being charged to the inpa-
tient. Further research is also needed to
determine why patients are decreasingly
admitted as inpatients. However, it
should be noted that the cost increased
at a similar rate for HG as for all ante-
partum ED visits, which may indicate
that increasing cost is not diagnosis-
specific. By comparison, the average
cost per patient for all ED visits
increased by 93%, suggesting that treat-
ing HG may not be as costly as treating
other diagnoses.
Clinical implications
As ED visits for HG and NVP rise, with
concurrent rising ED visit costs, these
trends raise the question of where is the
best location for treatment of HG and
NVP. We believe that seeking care in an
emergency room setting for such symp-
toms is a poor utilization of ED resour-
ces, which are already strained during
the current pandemic.
33
In the increas-
ingly restrictive climate regarding
healthcare access, without new innova-
tive care settings and additional access,
patients and providers are limited to
few alternatives to the ED. Furthermore,
given the current global pandemic,
there are additional safety concerns for
pregnant patients, who may be particu-
larly susceptible to infection.
34
Research implications
This study found that although the
number of HG ED visits has increased,
the proportion of patients admitted has
decreased. Further studies are needed to
TABLE 1
Emergency department visits with primary diagnosis of hyperemesis
gravidarum
Observation
2006
N (%)
Mean (SD)
2014
N (%)
Mean (SD)
N primary dx of HG
N per 100,000 ED visits
Mean age (y)
Range
<19
20−24
25−29
30−34
35−39
>40
Mean ED cost ($)
Median ED cost ($)
Total aggregate cost ($)
Mean number of diagnoses
Range
Discharge status
Discharged
Admitted
Median-income quartile
Highest-income level
Second quartile
Third quartile
Lowest-income level
Region
Northeast
Midwest
South
West
Patient location
Large metropolitan
Medium and small metropolitan
Micropolitan and rural
Primary insurer
Medicare
Medicaid
Private insurance
Self-pay
No charge
Other
177,940
148.2
24.2 (5.3)
12−54
35,195 (19.8)
68,531 (38.5)
44,495 (25.0)
21,004 (11.8)
7322 (4.1)
1392 (0.8)
2156.24 (1757.02)
1808.57
383,681,345.60
2.2 (1.6)
1−21
164,229 (92.3)
13,711 (7.7)
24,060 (13.6)
38,868 (21.9)
50,557 (28.6)
61,929 (34.5)
26,623 (15.0)
41,685 (23.4)
76,602 (43.0)
33,030 (18.6)
94,571 (53.2)
55,557 (31.2)
27,241 (15.3)
1506 (0.9)
85,316 (47.9)
56,069 (31.5)
27,748 (15.6)
1947 (1.1)
4769 (2.7)
227,298
164.9
25.3 (5.4)
11−52
30,559 (13.4)
83,698 (36.8)
64,968 (28.6)
33,658 (14.8)
12,214 (5.4)
2203 (1.0)
3549.07 (3119.55)
2848.02
806,696,512.86
2.9 (2.1)
1−25
217,043 (95.5)
10,256 (4.5)
28,160 (12.4)
44,102 (19.4)
66,586 (29.3)
85,726 (37.7)
37,184 (16.4)
53,486 (23.5)
96,270 (42.3)
40,358 (17.8)
118,337 (52.1)
77,617 (34.2)
30,558 (13.4)
2879 (1.3)
130,890 (57.6)
62,868 (27.7)
22,809 (10.0)
842 (0.4)
6697 (2.9)
Descriptive statistics for all pregnant patients who visited the ED with a primary dx of HG. All charges reported in 2021 US dol-
lars. Percentages may not add up to 100% because of missing data.
dx, diagnosis; ED, emergency department; HG, hyperemesis gravidarum; SD, standard deviation.
Geeganage. Emergency department burden of hyperemesis gravidarum. Am J Obstet Gynecol Glob Rep 2023.
Original Research ajog.org
4AJOG Global Reports February 2023
address the reason for these trends and
potential correlations between treat-
ments given in the ED and discharge
status. In addition, many unanswered
questions remain because of the limita-
tions of the NEDS database, which does
not include information on gestational
age or fetal number, which has been
shown to correlate with HG symp-
toms.
12
This study also does not
account for urgent care visits, obstet-
rics-specific triage units, or direct
admissions bypassing the ED, which are
not included in the NEDS, and may be
interesting to examine and compare
with ED care. Lastly, and critically
important, the absence of race or eth-
nicity data in the NEDS database results
in a critical void of data that are neces-
sary to understand any disparities on
this topic.
Strengths and limitations
This study has many strengths. First, we
used the NEDS database, a weighted,
nationally representative dataset of all
ED visits, strengthening the generaliz-
ability of our findings across the United
States. Second, despite the limitations of
working with large databases, by using
data from several national databases
(NEDS, AHRQ, NVSR), we further
increased the generalizability of these
results. Third, relative to the existing lit-
erature, this was a large study on ED
visits for HG and NVP.
This study also has limitations. As
with other publicly available and
nationally representative datasets, the
NEDS contains deidentified data that
are dependent on hospital coding; thus,
we were unable to confirm the accuracy
of the diagnoses or determine whether a
single individual used the ED multiple
times for the same diagnosis. The data-
base only identifies the US region
(Northeast, South, Midwest, West) with
regard to hospital location, so it is not
possible to address policy changes such
as Medicaid expansion by state and
their effect on ED visits. Lastly, cases
were identified by primary diagnosis,
raising the possibility that some patients
with a secondary or tertiary diagnosis of
HG were excluded from the analysis.
FIGURE 2
Hyperemesis gravidarum visits by age group over time
Percentage of US births with an emergency department visit for hyperemesis gravidarum by age
group, 2006 vs 2014. Similar trends were observed for nausea and vomiting of pregnancy.
Geeganage. Emergency department burden of hyperemesis gravidarum. Am J Obstet Gynecol Glob Rep 2023.
TABLE 2
Emergency department visits with primary diagnosis of nausea and
vomiting of pregnancy
Observation
2006
N (%)
Mean (SD)
2014
N (%)
Mean (SD)
N primary dx of NVP
N per 100,000 ED visits
Mean age (y)
Range
<19
20−24
25−29
30−34
35−39
>40
Mean ED cost ($)
Median ED cost ($)
Total aggregate cost ($)
Mean number of diagnoses
Range
Discharge status
Discharged
Admitted
Median-income quartile
Highest-income level
Second quartile
Third quartile
Lowest-income level
Region
Northeast
Midwest
South
West
Patient location
Large metropolitan
Medium and small metropolitan
Micropolitan and rural
Primary insurer
Medicare
Medicaid
Private insurance
Self-pay
No charge
Other
34,873
29.1
24.1 (5.4)
12-47
7182 (20.6)
13,669 (39.2)
8279 (23.7)
3928 (11.3)
1559 (4.5)
256 (0.7)
1993.93 (1596.81)
1649.63
69,534,320.89
2.3 (1.6)
1−19
33,984 (97.4)
890 (2.6)
3729 (10.7)
7270 (20.8)
10,346 (29.7)
12,975 (37.2)
4348 (12.5)
7278 (20.9)
17,680 (50.7)
5567 (15.9)
16,363 (47.0)
12,038 (34.5)
6351 (18.2)
272 (0.8)
19,811 (54.2)
9818 (28.2)
4587 (13.1)
248 (0.7)
940 (2.7)
58,436
42.4
25.4 (5.4)
12-52
7342 (12.6)
21,410 (36.6)
16,713 (28.6)
9099 (15.6)
3171 (5.4)
682 (1.2)
3441.37 (2878.65)
2776.01
201,099,897.32
2.9 (2.0)
1−28
57,571 (98.5)
865 (1.5)
5845 (10.0)
10,397 (17.8)
17,004 (29.1)
24,342 (41.7)
11,752 (20.1)
12,371 (21.1)
26,929 (46.1)
7384 (12.6)
29,563 (50.6)
20,506 (35.1)
8155 (13.9)
1053 (1.8)
34,888 (59.7)
15,589 (26.7)
5083 (8.7)
163 (0.3)
1598 (2.7)
Descriptive statistics for all pregnant patients who visited the ED with a primary dx of NVP. All charges reported in 2021 US dol-
lars. Percentages may not add up to 100% because of missing data.
dx, diagnosis; ED, emergency department; NVP, nausea and vomiting of pregnancy; SD, standard deviation.
Geeganage. Emergency department burden of hyperemesis gravidarum. Am J Obstet Gynecol Glob Rep 2023.
February 2023 AJOG Global Reports 5
ajog.org Original Research
Conclusions
ED visits for HG have increased by
27.7% between the years 2006 and 2014,
whereas inpatient admissions have
decreased by 42%. The increase in HG
ED visits is disproportional to the
trends in US births over the same years.
The costs associated with ED visits for
HG have risen proportionally with costs
associated with all antepartum ED vis-
its. &
Supplementary materials
Supplementary material associated with
this article can be found in the online
version at doi:10.1016/j.xagr.2023.
100166.
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FIGURE 3
Percentage of ED visits per US births
Trends in percentage of total US births with an ED visit for NVP and HG between 2006 and 2014.
ED, emergency department; HG, hyperemesis gravidarum; NVP, nausea and vomiting of pregnancy.
Geeganage. Emergency department burden of hyperemesis gravidarum. Am J Obstet Gynecol Glob Rep 2023.
6AJOG Global Reports February 2023
Original Research ajog.org
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February 2023 AJOG Global Reports 7
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