One relatively unknown possible complication of extreme weight loss and malnutrition in Hyperemesis Gravidarum (HG) is Wernicke's Encephalopathy (WE). This neurological emergency typically develops after a prolonged vitamin B1 (thiamine or thiamin) deficiency, and is most often described after malnutrition in patients with chronic alcohol use disorders (AUD). There is an increased demand for thiamine during pregnancy, while the consequences of HG are often losing weight and losing important nutrients.
I work as a healthcare psychologist in a clinic for patients suffering from malnutrition and its unfortunate consequences. Because every case of Wernicke's Encephalopathy is one too many, my research group decided to review all the published case descriptions on non-alcoholic Wernicke Encephalopathy. Up until last year 177 cases on HG and WE were published in the literature. Unfortunately, this makes WE following HG the next to largest group after alcohol use disorders.
In our study, women in all age groups were at risk for Wernicke's Encephalopathy. The average weight loss was 12 kilograms (26.5 lb). Patients had been vomiting for a median of 7 weeks, and were often around the 17th week of their pregnancy. One third of all cases presented themselves with double sight, as a sign of Wernicke. Blurred vision was a presenting sign in one-fourth of all patients. Movement disorders and delirium were very common. Sadly, half of the fetuses did not survive Wernicke of the mother.
Wernicke's Encephalopathy can be treated with thiamine injections of 500mg/ 3 times per day. Because of late treatment, some patients developed Korsakoff’s syndrome. Also the patients that did not have Korsakoff’s syndrome had some issues in their attention, planning and memory. 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 Wernicke Encephalopathy.
Because nutrition is very important for the mother and fetus, knowledge on nutritional status can prevent the development of Wernicke's Encephalopathy and its consequences.