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Kondo T, Nakamura M, Kawashima J, Matsumura T, Ohba T, Yamaguchi M, Katabuchi H, Araki E. Hyperemesis gravidarum followed by refeeding syndrome causes electrolyte abnormalities induced rhabdomyolysis and diabetes insipidus. Endocr J 2019; 66:253-258. [PMID: 30700639 DOI: 10.1507/endocrj.ej18-0496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although hyperemesis gravidarum (HG), an extreme form of morning sickness, is a common complication during pregnancy, HG associated simultaneous onset of rhabdomyolysis and diabetes insipidus due to electrolyte abnormalities are rare. A 34-year-old woman with severe HG at 17 weeks of gestation complicated with appetite loss, weight reduction by 17 kg, general fatigue, myalgia, weakness and polyuria was identified to have simultaneous hypophosphatemia (1.6 mg/dL) and hypokalemia (2.0 mEq/L). Appetite recovery and the improvement of the hypophosphatemia (3.2 mg/dL) were observed prior to the first visit to our department. At the admission, she presented polyuria around 7,000~8,000 mL/day with impaired concentrating activity (U-Osm 185 mOsm/L), and abnormal creatine kinase elevation (4,505 U/L). The electrolyte disturbances and physio-metabolic abnormalities in undernourished state due to HG let us diagnose this case as refeeding syndrome (RFS). In this case, abnormal loss by vomiting, insufficient intake and previous inappropriate fluid infusion as well as the development of RFS may accelerate the severity of hypokalemia due to HG. Thus, as her abnormalities were considered as results of rhabdomyolysis and diabetes insipidus due to severe HG associated hypokalemia based on RFS, oral supplementation of potassium chloride was initiated. After 6 days of potassium supplementation, her symptoms and biochemical abnormalities were completely resolved. Severe HG followed by RFS can be causes of electrolyte abnormalities and subsequent complications, including rhabdomyolysis and renal diabetes insipidus. Appropriate diagnosis and prompt interventions including adequate nutrition are necessary to prevent electrolyte imbalance induced cardiac, neuromuscular and/or renal complications.
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Havnen GC, Truong MBT, Do MLH, Heitmann K, Holst L, Nordeng H. Women's perspectives on the management and consequences of hyperemesis gravidarum - a descriptive interview study. Scand J Prim Health Care 2019; 37:30-40. [PMID: 30822254 PMCID: PMC6454401 DOI: 10.1080/02813432.2019.1569424] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Hyperemesis gravidarum (HG) affects 0.3-3% of pregnant women and is a leading cause of hospitalization in early pregnancy. The aim of the study was to investigate women's treatment and management of HG, as well as the consequences of HG on women's daily life. DESIGN AND SETTING A cross-sectional study based on a structured telephone interview and an online questionnaire. Participants were recruited by social media and by the Norwegian patient's organization for HG. SUBJECTS Norwegian women that experienced HG. MAIN OUTCOME MEASURE Women's perspectives on management and consequences of HG. RESULTS The study included 107 women. Maternal morbidity was profound; about 3/4 of participants were hospitalized due to HG, and the majority showed clinical signs of dehydration (79%), ketonuria (75%), and >5% weight loss (84%). Antiemetics were used by >90% and frequently prescribed "as needed". Metoclopramide (71%) and meclozine (51%) were most commonly used. Participants described HG as having severe psychosocial consequences and profound impact on daily activities. Almost two out of five reported thoughts of elective abortion, and 8 women had at least one elective pregnancy termination due to HG. Overall, 20 women (19%) changed GPs due to dissatisfaction with HG management. CONCLUSION Despite the high psychosocial burden and major impact on daily activities, many women with HG reported a lack of support from healthcare professionals and suboptimal management. Greater awareness and knowledge among healthcare professionals is needed to improve care for women with HG. Key Points There is a paucity of studies on management and the consequences of HG on women's daily lives and psychosocial burden. We found that: • Many women described HG as one of their worst life experiences with profound morbidity. • Many women reported suboptimal management of HG and lack of support from healthcare professionals. • Greater understanding of patient perspectives among healthcare professionals is important to improve care and management for HG patients.
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Bronshtein M, Gover A, Beloosesky R, Dabaja H, Ginsberg Y, Weiner Z, Khatib N. Characteristics and Outcomes of Ptyalism Gravidarum. THE ISRAEL MEDICAL ASSOCIATION JOURNAL : IMAJ 2018; 20:573-575. [PMID: 30221872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Ptyalism gravidarum (PG) is a condition of hypersalivation that affects pregnant women early in gestation. Symptoms include massive saliva volumes (up to 2 liters per day), swollen salivary glands, sleep deprivation, significant emotional distress, and social difficulties. OBJECTIVES To examine maternal and fetal characteristics and pregnancy outcomes of patients with PG. METHODS Patients diagnosed with PG in our clinic during the years 2001-2016 were identified and contacted. Demographic data were extracted from patient charts and clinical and outcome data was collected via telephone interviews. RESULTS The incidence of PG was 1/963 (0.09%) in our sample. Eleven out of 22 women (40%) with PG were also diagnosed with hyperemesis gravidarum. Fetal gender did not increase the risk. Of the mothers presenting with PG, 37% had a positive family history for this condition. There was no associated increase in the rate of fetal or maternal complications. Two women reported a resolution of the symptoms immediately following hypnosis with acupuncture treatment. CONCLUSIONS Although PG represents an unpleasant mental and physical condition, it does not pose any specific risk to the health of the mother or increase adverse perinatal outcomes for the fetus. Alternative medicine could play a role in the treatment of PG.
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Uysal G, Cagli F, Akkaya H, Nazik H, Karakukcu C, Sutbeyaz S, Yilmaz ES. Hyperemesis gravidarum is not a negative contributing factor for postpartum bone mineral density. J Chin Med Assoc 2018; 81:619-622. [PMID: 29398518 DOI: 10.1016/j.jcma.2017.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Hyperemesis gravidarum (HG), related to protracted vomiting and nausea, is a common cause of hospitalization during the first trimester of pregnancy. It can be accompanied by ketonuria, dehydration, and weight loss. Our aim was to investigate bone loss in patients with HG. METHODS In our study, we investigated decreased bone mineral density (BMD)in a total of 79 patients (40 HG and 39 control) by means of dual energy X-ray absorptiometry (DEXA) measurements and laboratory parameters related to HG. All patients received DEXA measurement during the early postpartum period (usually two days after delivery, prior to discharge).This study was registered in the database via the Protocol Registration and Results System (PRS) (NCT03127293). RESULTS There was no significant difference in DEXA results (lumbar spine and total hip) and laboratory parameters between case and control groups, although a significant difference in vitamin intake was identified between cases and controls (65% vs. 92%, respectively, p = 0.003). Except for low serum levels of vitamin D, other laboratory parameters were in normal range in both groups. CONCLUSION Pregnancies complicated by HG did not have decreased bone mineral density compared to those without HG. There is no evidence to relate HG to future osteoporosis.
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Madsen LRF, Søgaard M. [Rhabdomyolysis caused by hyperemesis gravidarum]. Ugeskr Laeger 2017; 179:V10160731. [PMID: 28263150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Hyperemesis gravidarum (HG) is a condition of severe nausea and vomiting during pregnancy, accompanied by dehydration, electrolyte derangement and lack of nutrition. We describe a 26-year-old woman pregnant at 29 weeks of gestation, complaining about muscle pain and difficulties standing up after suffering from long-term HG followed by a weight loss of 35 kg. She had severe hypokalaemia and abnormally elevated muscle enzyme concentrations as a result of a massive catabolic process. We discuss severe HG as a rare cause of rhabdomyolysis and the importance of early aggressive resuscitation to avoid renal failure.
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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; 20:747-756. [PMID: 28842762 PMCID: PMC5691116 DOI: 10.1007/s00737-017-0770-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 08/07/2017] [Indexed: 12/11/2022]
Abstract
Hyperemesis gravidarum (HG) is a pregnancy condition characterised by severe nausea and vomiting. Previous studies have shown an association between HG and depressive symptoms during pregnancy, but little is known about the risk of maternal psychological distress following an HG pregnancy. The objective of the current study was therefore to assess the association between HG and emotional distress during and after pregnancy. This was a population-based pregnancy cohort study using data from the Norwegian Mother and Child Cohort Study. A total of 851/92,947 (0.9%) had HG. Emotional distress was measured by the Hopkins Symptom Checklist (SCL-5) in gestational weeks 17 and 32 and 6 and 18 months postpartum. The generalised estimating equations model was estimated for assessing time trends in emotional distress. Adjustments were made for previous HG, lifetime history of depression, maternal age, parity, BMI, smoking before pregnancy, physical activity, length of education, and pelvic girdle pain. Women with HG had higher odds for emotional distress than women without HG at the 17th (p < 0.001) and 32nd gestational weeks (p = 0.001) in addition to 6 months postpartum (p = 0.005) but not 18 months postpartum (p = 0.430). Adjusted odds for emotional distress varied significantly over time for women with and without HG (p = 0.035). Women with HG were more likely to report emotional distress compared to women without HG during pregnancy and 6 months postpartum, but the difference between the groups disappeared 18 months after birth. The results suggest that the increased risk of developing emotional distress may primarily be a consequence of HG.
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Germes-Piña F, Acosta-Orozco DM, Flores-Franco RA, Verdugo-Castro PN. [Pneumomediastinum associated with hyperemesis gravidarum: a case report]. GINECOLOGIA Y OBSTETRICIA DE MEXICO 2016; 84:586-592. [PMID: 29424979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The hyperemesis gravidarum is a severe illness of nauseas and vomit that is present in the first trimester of the pregnancy, it has an incidence of 0.3 to 2%, it has been associated to weight loss, electrolytic disturbances, ketonuria, dehydration and in very seldom cases spontaneous pneumomediastinum. CLINICAL CASE A 21 years old female patient, primigest, in the first trimester of gestation, she started her disease with nauseas and vomiting more than 15 times during 6 hours period, odynophagia, dysphonia and pain in the cervical region, loss of 5 kilograms in the last month. The physical examination showed the patient in bad conditions, dehydration, neck with volume increased and emphysema subcutaneus, crakles until torax. Laboratory findings with hypokalemia, leukocytosis, acute kidney failure, and elevation of hepatic enzymes. The initial treatment was with intravenous fluids resuscitation, hydroelectrolytic balance restoration, antiemetic treatment and rest, it was taken TC of neck and torax, and was exclude any laryngeal and esophageal injury and perforation, but it showed air in the mediastinum. Conservative management with favorable evolution and completed resolution in 7 days. CONCLUSION It is very important that the medical doctor must keep in mind the different diagnosis of and take an opportune decision in case of present those complications potentially fatal to the mother.
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Anwar J, Soomro S, Javed K, Omer S. MRI Findings In Acute Wernicke's Encephalopathy, Caused By Hyperemesis Gravidarum. J Ayub Med Coll Abbottabad 2016; 28:409-410. [PMID: 28718572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 25-year old pregnant female with history of confusion and drowsiness for 02 days was referred by neurophysician for MRI brain. MRI demonstrated T2W/FLAIR hyper intensities in medial thalami, periaqueductal areas with variable diffusion restriction, apparent as hyper intense signal on DWI and no signal change on ADC mapping that was typically consistent with Wernicke's encephalopathy. A high index of suspicion is necessary, as delayed or lack of treatment can lead to high morbidity and mortality.
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Coulon AL, Savagner F, Briet C, Vernin M, Munier M, Chabre O, Rodien P. Prolonged and Severe Gestational Thyrotoxicosis Due to Enhanced hCG Sensitivity of a Mutant Thyrotropin Receptor. J Clin Endocrinol Metab 2016; 101:10-1. [PMID: 26580241 DOI: 10.1210/jc.2015-3670] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Gestational thyrotoxicosis, whether associated with hyperemesis gravidarum or not, is thought to be due to excessive human chorionic gonadotropin (hCG) secretion. CASE DESCRIPTION We report here the second case of gestational thyrotoxicosis associated with hyperemesis gravidarum due to a mutation of the TSH receptor, providing thyroid hypersensitivity to hCG. CONCLUSION Severe and lasting gestational thyrotoxicosis with normal hCG concentration should lead to sequencing of the TSH receptor gene.
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Vandraas KF, Vikanes ÅV, Støer NC, Troisi R, Stephansson O, Sørensen HT, Vangen S, Magnus P, Grjibovski AM, Grotmol T. Hyperemesis gravidarum and risk of cancer in offspring, a Scandinavian registry-based nested case-control study. BMC Cancer 2015; 15:398. [PMID: 25963309 PMCID: PMC4430929 DOI: 10.1186/s12885-015-1425-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 05/06/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hyperemesis gravidarum is a serious condition affecting 0.8-2.3% of pregnant women and can be regarded as a restricted period of famine. Research concerning potential long-term consequences of the condition for the offspring, is limited, but lack of nutrition in-utero has been associated with chronic disease in adulthood, including some cancers. There is growing evidence that several forms of cancer may originate during fetal life. We conducted a large study linking the high-quality population-based medical birth- and cancer registries in Norway, Sweden and Denmark, to explore whether hyperemesis is associated with increased cancer risk in offspring. METHODS A registry-based nested case-control study. Twelve types of childhood cancer were selected; leukemia, lymphoma, cancer of the central nervous system, testis, bone, ovary, breast, adrenal and thyroid gland, nephroblastoma, hepatoblastoma and retinoblastoma. Conditional logistic regression models were applied to study associations between hyperemesis and risk of childhood cancer, both all types combined and separately. Cancer types with five or more exposed cases were stratified by age at diagnosis. All analysis were adjusted for maternal age, ethnicity and smoking, in addition to the offspring's Apgar score, placental weight and birth weight. Relative risks with 95% confidence intervals were calculated. RESULTS In total 14,805 cases and approximately ten controls matched on time, country of birth, sex and year of birth per case (147,709) were identified. None of the cancer types, analyzed combined or separately, revealed significant association with hyperemesis. When stratified according to age at diagnosis, we observed a RR 2.13 for lymphoma among adolescents aged 11-20 years ((95% CI 1.14-3.99), after adjustment for maternal ethnicity and maternal age, RR 2.08 (95% CI 1.11-3.90)). The finding was not apparent when a stricter level of statistical significance was applied. CONCLUSIONS The main finding of this paper is that hyperemesis does not seem to increase cancer risk in offspring. The positive association to lymphoma may be by chance and needs confirmation.
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Fejzo MS, Magtira A, Schoenberg FP, Macgibbon K, Mullin PM. Neurodevelopmental delay in children exposed in utero to hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol 2015; 189:79-84. [PMID: 25898368 DOI: 10.1016/j.ejogrb.2015.03.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 03/20/2015] [Accepted: 03/23/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The purpose of this study is to determine the frequency of emotional, behavioral, and learning disorders in children exposed in utero to hyperemesis gravidarum (HG) and to identify prognostic factors for these disorders. STUDY DESIGN Neurodevelopmental outcomes of 312 children from 203 mothers with HG were compared to neurodevelopmental outcomes from 169 children from 89 unaffected mothers. Then the clinical profiles of patients with HG and a normal child outcome were compared to the clinical profiles of patients with HG and a child with neurodevelopmental delay to identify prognostic factors. Binary responses were analyzed using either a Chi-square or Fisher Exact test and continuous responses were analyzed using a t-test. RESULTS Children exposed in utero to HG have a 3.28-fold increase in odds of a neurodevelopmental diagnosis including attention disorders, learning delay, sensory disorders, and speech and language delay (P<0.0005). Among characteristics of HG pregnancies, only early onset of symptoms (prior to 5 weeks gestation) was significantly linked to neurodevelopmental delay. We found no evidence for increased risk of 13 emotional, behavioral, and learning disorders, including autism, intellectual impairment, and obsessive-compulsive disorder. However, the study was not sufficiently powered to detect rare conditions. Medications, treatments, and preterm birth were not associated with an increased risk for neurodevelopmental delay. CONCLUSION Women with HG are at a significantly increased risk of having a child with neurodevelopmental delay. Common antiemetic treatments were not linked to neurodevelopmental delay, but early symptoms may play a role. There is an urgent need to address whether aggressive treatment that includes vitamin and nutrient supplementation in women with early symptoms of severe nausea of pregnancy decreases the risk of neurodevelopmental delay.
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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:e92036. [PMID: 24637791 PMCID: PMC3956867 DOI: 10.1371/journal.pone.0092036] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 02/19/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the temporal and case-controlled correlations of anxiety, depression and stress with hyperemesis gravidarum. STUDY DESIGN We performed a longitudinal cohort study of women with hyperemesis gravidarum using the Depression, Anxiety and Stress Scale (DASS-21) to evaluate psychological distress at hospitalization and in the third trimester of pregnancy (from 28 weeks gestation). Third pregnancy trimester controls were recruited from routine antenatal clinic attendees who were matched to gestational age at the second DASS-21 assessment in the HG cohort. RESULTS The prevalences of nausea and vomiting, depression, anxiety and stress caseness in newly hospitalised hyperemesis gravidarum women were 100% and 100%, 19%, 69% and 21% which by the third trimester had fallen to 15.7% and 9.9%, 4%, 19% and 3% and in third trimester controls were 15.9% and 14.2%, 14%, 61% and 20% respectively. Within the hyperemesis gravidarum cohort, nausea, vomiting depression, anxiety and stress reduced significantly by an absolute 84.3% (95% CI 76.2%-89.8%), 90.1% (82.8%-94.2%), 14.9% (7.2%-23.0%), 49.6% (38.6%-58.7%) and 18.2% (10.4%-26.4%) respectively between hospitalization for hyperemesis gravidarum and at the third trimester. In the third trimester, when comparing the hyperemesis gravidarum cohort to controls, the risk of nausea or vomiting was similar but depression, anxiety and stress were significantly lower: adjusted odds ratio AOR 0.10 (95% CI 0.03-0.5), 0.11 (0.05-0.23) and 0.08 (0.02-0.33) respectively. CONCLUSION Our study revealed a reassuring pattern of a strong rebound from depression, anxiety and stress in women with hyperemesis gravidarum such that by the third pregnancy trimester the level of psychological distress was even lower than in controls. This observation imply that much of the psychological distress in acute hyperemesis gravidarum is self-limiting and probably in the causal pathway of hyperemesis gravidarum. Care in women with hyperemesis gravidarum should focus on the relief of nausea and vomiting.
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Justin C, Annamalai AK, Pricilla G, Muralidharan K, Srinivasan KG, Gurnell M. More than just morning sickness. QJM 2013; 106:1123-5. [PMID: 23842485 DOI: 10.1093/qjmed/hct153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Nausea and vomiting in pregnancy are common complaints and vary considerably in duration and severity. Hyperemesis gravidarum represents the extreme end of the spectrum associated with dehydration and weight loss. As embryonic organogenesis occurs during the first trimester, pharmacological intervention for any condition during this period poses a significant clinical dilemma requiring careful assessment of risks and benefits. In the UK, there are no formal national guidelines for the management of hyperemesis gravidarum. In addition, no high-quality evidence exists for i.v. fluid and electrolyte replacement in hyperemesis gravidarum, and a Cochrane review on interventions for the treatment of nausea and vomiting in pregnancy specifically excluded studies on hyperemesis gravidarum. In this article, we review the evidence for the efficacy and safety of different management options for hyperemesis gravidarum.
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Ayyavoo A, Derraik JGB, Hofman PL, Biggs J, Bloomfield FH, Cormack BE, Stone P, Cutfield WS. Severe hyperemesis gravidarum is associated with reduced insulin sensitivity in the offspring in childhood. J Clin Endocrinol Metab 2013; 98:3263-8. [PMID: 23750032 DOI: 10.1210/jc.2013-2043] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hyperemesis gravidarum alters maternal (and possibly fetal) nutrition throughout pregnancy, but there are no data on long-term effects on offspring metabolism. Thus, we aimed to assess whether severe hyperemesis gravidarum (SHG) affects glucose homeostasis and body composition in the offspring in childhood. METHODS Healthy prepubertal children (aged 4-11 years) born at term were studied: offspring of mothers who were admitted to hospital with SHG (n = 36) and offspring of mothers from control pregnancies (n = 42). Primary outcome was insulin sensitivity measured using iv glucose tolerance tests and Bergman's minimal model. Other assessments included lipid and hormonal profiles and body composition using whole-body dual-energy x-ray absorptiometry. RESULTS Insulin sensitivity in SHG children was 20% lower than in controls (8.49 vs 10.60 × 10(-4)·min(-1)·(mU/L); P = .014). SHG children also had higher fasting insulin (6.88 vs 5.04 mIU/L; P = .024) and lower IGF binding protein 1 (11.8 vs 19.0 ng/mL; P = .004) concentrations than controls. Baseline cortisol concentrations were 22% higher in SHG offspring (256 vs 210 nmol/L; P = .021). Children in both groups were anthropometrically similar. CONCLUSION Children born to mothers who experienced SHG have lower insulin sensitivity, which may increase their long-term risk of developing diabetes mellitus. Follow-up of SHG offspring is essential to determine later risk of metabolic disease.
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Abstract
Current research shows that women tend to receive less dental care than usual when they are pregnant. In 2012, the first national consensus statement on oral health care during pregnancy was issued, emphasizing both the importance and safety of routine dental care for pregnant women. This article reviews the current recommendations for perinatal oral health care and common oral manifestations during pregnancy. Periodontal disease and its association with preterm birth and low birth weight are also discussed, as is the role played by dental intervention in these adverse outcomes.
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Harpsøe MC, Jørgensen KT, Frisch M, Jess T. Risk of inflammatory bowel disease according to self-rated health, pregnancy course, and pregnancy complications: a study within the Danish National Birth Cohort. PLoS One 2013; 8:e59698. [PMID: 23527254 PMCID: PMC3602009 DOI: 10.1371/journal.pone.0059698] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 02/17/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Poor self-rated health (SRH) has been connected to immunological changes, and pregnancy complications have been suggested in the etiology of autoimmune diseases including inflammatory bowel disease (IBD). We evaluated the impact of self-rated pre-pregnancy health and pregnancy course, hyperemesis, gestational hypertension, and preeclampsia on risk of IBD. METHODS Information was collected by questionnaires from The Danish National Birth Cohort (enrolment 1996-2002) at 16(th) and 30(th) week of pregnancy and 6 months postpartum. A total of 55,699 women were followed from childbirth until development of IBD (using validated National Hospital Discharge Register diagnoses), emigration, death, or end of follow-up, 31(st) of October, 2011. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Cox proportional hazards models adjusting for age and evaluating pre-pregnancy BMI, parity, alcohol and tobacco consumption, and socio-occupational status as potential confounders. RESULTS Risk of IBD increased with decreasing level of self-rated pre-pregnancy health (p = 0.002) and was elevated in women with poor self-rated pregnancy course (HR, 1.61, 95% CI 1.22-2.12). Associations persisted for more than 5 years postpartum. Hyperemesis and preeclampsia were not significantly associated with risk of IBD. CONCLUSIONS This is the first prospective observational study to suggest that poor self-rated health--in general and in relation to pregnancy--is associated with increased risk of IBD even in the long term though results needs further confirmation. Symptoms of specific pregnancy complications were, on the other hand, not significantly associated with risk of IBD.
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Pilone V, Di Micco R, Monda A, Villamaina E, Gentile M, Forestieri P. LAGB in pregnancy: slippage after hyperemesis gravidarum. Report of a case. Ann Ital Chir 2012; 83:429-432. [PMID: 23064305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Bariatric surgery procedures are more and more performed in women of reproductive age, whose fertility often increases after weight loss, so they frequently become pregnant. In this condition they require appropriate management, according to the type of procedure, malabsorptive or restrictive. If health risks related to obesity (gestational diabetes, pregnancy induced hypertension, pre-eclampsia) decrease after weight loss, other risks related to bariatric procedures could appear. LAGB is a safe and well-tolerated procedure, but some complications could appear more frequently during pregnancy; some symptoms could be suggestive for important complications, that if not treated in the best way could threaten mother and child's health. Emesis of the first trimester could favor slippage, thus influencing feeding and fetal growth. The slippage of the band is a common complication of LAGB, that usually does not lead to serious conditions, but in our case the pregnant risked a lot because of malnutrition. The purpose of this article is to present an obstetric case study of a woman who experienced this complication postbariatric surgery and the implications for mother and child. A correct diagnosis and management of the clinical case led to a positive conclusion, thus underlining bariatric surgery and its complications should be known and taken into account by every physician.
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Daaloul W, Jlili L, Ouerdiane N, Masmoudi A, Ben Hamouda S, Bouguerra B, Sfar R. [Fatal complication of hyperemesis gravidarum: Wernicke's encephalopathy]. LA TUNISIE MEDICALE 2012; 90:663. [PMID: 22987369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Huang W, Zhu P, Gao R, Lu Y, Liang Z, Tao F. [Association between hyperemesis gravidarum and fetal growth restriction]. WEI SHENG YAN JIU = JOURNAL OF HYGIENE RESEARCH 2012; 41:602-608. [PMID: 23057324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To estimate the association between hyperemesis gravidarum (HG) and the risk of fetal growth restriction (FGR), and the possible mechanisms by which HG contributing to the risk of FGR. METHODS The maternal socio-demographic characteristics, hyperemesis gravidarum, food intake changes and psychological stress during pregnancy of 2 522 women were assessed through questionnaires. The neonatal outcome data were obtained from medical records. RESULTS Women with HG were combined with higher psychological stress, including pregnancy related anxiety during first trimester, anxiety and depression in the third trimester, and with lower gestational weight gain compared with women without HG. In the multiple logistic regression model, FGR was significantly associated with premature delivery (RR = 1.94, 95% CI 1.05-3.56), female infants (RR = 2.50, 95% CI 1.67-3.76), less milk products intake during pregnancy (RR = 1.87, 95% CI 1.10-3.18), lower scores of anxiety during first trimester (RR = 2.05, 95% CI 1.27-3.31), higher scores of depression in the third trimester (RR = 1.85, 95% CI 1.05-3.25), and lower gestational weight gain (RR = 1.75, 95% CI 1.04-2.95). Path model showed that women with HG are predisposed to experience less milk products intake and more psychological stress during pregnancy, which could reduced maternal weight gain, and finally result in increasing the risk of FGR. CONCLUSION Hyperemesis gravidarum could not independently increase the risk of FGR. However, HG is significantly associated with multiple risk factors, through which HG indirectly increased the risk of FGR. Psychological stress and food intake during pregnancy mediated the negative effects of HG on FGR.
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Mullin PM, Ching C, Schoenberg F, MacGibbon K, Romero R, Goodwin TM, Fejzo MS. Risk factors, treatments, and outcomes associated with prolonged hyperemesis gravidarum. J Matern Fetal Neonatal Med 2012; 25:632-6. [PMID: 21916750 PMCID: PMC3560915 DOI: 10.3109/14767058.2011.598588] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To identify factors associated with prolonged Hyperemesis Gravidarum (HG). STUDY DESIGN About 395 women completed a survey regarding pre-existing conditions, treatments and outcomes. Responses were compared using two-sided t-tests or the F-test. RESULTS Participants with prolonged HG are slightly younger and weigh more. Pre-existing factors associated with prolonged HG include allergies and a restrictive diet. Prolonged HG is associated with hematemesis, dizziness, fainting and antiemetic treatment. Following pregnancy, those with prolonged HG reported more posttraumatic stress, motion sickness, muscle weakness and infants with irritability, severe colic and growth restriction. CONCLUSION Multiple pre-existing conditions and poor maternal and infant outcomes were associated with prolonged HG. The most significant condition prior to pregnancy was allergies suggesting a possible autoimmune component affecting duration of HG. In addition, the most significant lifestyle choice linked to prolonged HG was a restrictive diet. Future research is needed to determine whether a change in diet prior to pregnancy may lead to a shorter duration of HG and its associated outcomes.
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Chitra S, Lath KVS. Wernicke's encephalopathy with visual loss in a patient with hyperemesis gravidarum. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2012; 60:53-56. [PMID: 23029727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE We describe a case of Wernicke's encephalopathy associated with visual loss that was caused by hyperemesis gravidarum. METHODS A 25 year old lady in her 20th week of her pregnancy consulted us. She had history of nausea and vomiting for 3 months with resultant weight loss. She now presented with sub-acute onset of visual loss in both her eyes, and gait disturbance with unsteadiness. Upon ophthalmologic examination she was found to have a visual acuity of 6/60 in both eyes; abduction restriction, nystagmus and retinal hemorrhages and macular oedema in both eyes. She also had truncal, stance and gait ataxia. RESULTS She was treated with parenteral thiamine and her visual loss reversed and her ataxia improved dramatically. Magnetic resonance imaging (MRI) brain with diffusion weighted imaging showed findings consistent with Wernicke's Encephalopathy. CONCLUSION Wernicke's Encephalopathy can occur in many hitherto under-recognised clinical scenarios associated with inadequate oral intake like hyperemesis gravidarum, after gastric bypass surgeries and those on total parenteral nutrition. Visual loss is increasingly being recognized as the additional, reversible feature of Wernicke's Encephalopathy. The changes that occur on MRI brain, especially on the diffusion weighted images, are characteristic and considered diagnostic of Wernicke's Encephalopathy.
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