Prevalence of hyperemesis gravidarum and associated factors among pregnant women at comprehensive specialized hospitals in northwest Ethiopia: Multicenter cross-sectional study

Background

Hyperemesis gravidarum is one of the problems encountered among pregnant women due to persistent and excessive vomiting starting before the end of the 22nd week of gestation. The current study aimed to assess the prevalence of hyperemesis gravidarum and associated factors among pregnant women at comprehensive specialized hospitals in northwest Ethiopia.

Methods

A multi-facility-based cross-sectional study was conducted at comprehensive specialized hospitals from 1st June 2022 to 30th July 2022. The data were entered using EPI Data Version 4.6 statistical software and analyzed using SPSS Version 26. Descriptive statistics such as frequency, mean, and percentage were calculated. Univariable and multivariable binary logistic regression analyses were carried out to identify the associated factors of hyperemesis gravidarum.

Results

In all, 404 study participants were enrolled. About 16.8% of pregnant women were found to have hyperemesis gravidarum. Age < 20 year (AOR = 3.170; 95% CI: 1.119, 8.980), study participants who cannot read and write (AOR = 5.662; 95% CI: 2.036, 15.7470), grade 1-8 (AOR = 4.679; 95% CI: 1.778, 12.316), and grade 9-10 (AOR = 8.594; 95% CI: 3.017, 24.481), being housewife (AOR = 6.275; 95% CI: 1.052, 37.442), living in urban area (AOR = 2.185; 95% CI: 1.035, 4.609), having previous hyperemesis gravidarum (AOR = 2.463; 95% CI: 1.210, 5.012), having family history of hyperemesis gravidarum (AOR = 2.014; 95% CI: 1.002, 4.047), unplanned pregnancy (AOR = 2.934; 95% CI: 1.030, 8.351), having recent abortion (AOR = 2.750; 95% CI: 1.010, 7.483), and gravidity (AOR = 1.956; 95%CI: 1.023, 3.737) were factors associated with hyperemesis gravidarum.

Conclusion

The prevalence of hyperemesis gravidarum is higher. Low maternal age, lower educational level, being a housewife, being an urban resident, having previous hyperemesis gravidarum, having a family history, having an unplanned pregnancy, and having a recent abortion were significantly associated with hyperemesis gravidarum.

The Effect of Hyperemesis Gravidarum on Macular Thickness, Corneal Thickness, and Intraocular Pressure in Pregnancy

AIM

Physiological changes in intraocular pressure as well as in the cornea and macula may occur during pregnancy. Therefore, we decided to investigate the effect of hyperemesis gravidarum on macular thickness, corneal thickness and intraocular pressure (IOP).

MATERIAL AND METHODS

A total of 110 people, 55 of whom were diagnosed with hyperemesis gravidarum and 55 of whom were in the control group, were included in the study. The inclusion criteria for the study were as follows: first trimester (8-14 weeks of gestation) pregnancy with positive fetal heartbeat and no history of systemic disease, no continuous use of medication, diagnosis of hyperemesis gravidarum (ketonuria and weight loss of more than 3 kilograms or 5% of body weight), body mass index (BMI) within normal limits, age between 18 and 40, no alcohol use or smoking.

RESULTS

In the HG group compared to the control group, there was a difference between the CCT values of both the right and left eyes (p<0.01). There was a difference in both right and left IOP values in patients in the HG group compared to the control group (p<0.05), and there was no correlation between ketonuria scores and right and left eye CCT values, right and left eye macular thickness, and right and left eye pressure in patients diagnosed with HG (p>0.05).

CONCLUSION

In hyperemesis gravidarum, changes occur in IOP, corneal thickness, and macular thickness. In ophthalmic examinations in the pregestational period, especially for women with systemic disease, it may be important for clinicians to take the necessary precautions in this regard.

[Hyperemesis Gravidarum - an Interprofessional and Interdisciplinary Challenge - Evidence-Based Review]

Hyperemesis gravidarum (HG) is a multifactorial disease characterized by severe and persisting nausea and vomiting, impairment of oral intake, weight loss of at least 5%, electrolyte abnormalities, and dehydration. The prevalence of HG ranges from 0.3 to 10% worldwide. The diagnosis is made by the patient's prehistory, clinical symptoms, physical examination, and the typical laboratory abnormalities. Therapeutic cornerstones are nutrition advice, consultation of life style, psychological/psychosocial support of the mother as well as the administration of antiemetics in a stepwise approach, depending on the severity of symptoms, and finally admission to hospital in severe cases. Treatment of patients requires close interprofessional and interdisciplinary cooperation.

Hyperemesis gravidarum and eating disorders before and after pregnancy: A register-based study

OBJECTIVE

Hyperemesis gravidarum (HG) is a severe form of excessive vomiting during pregnancy. The connection between psychiatric morbidity and HG has been debated, but only a few studies have focused on eating disorders (EDs). The objective of this study was to evaluate the association between HG and both pre-pregnancy and new post-pregnancy EDs.

METHODS

A register-based controlled study. HG diagnoses were retrieved from healthcare registers between 2005 and 2017. Women with HG in their first pregnancy resulting in delivery were chosen as cases (n = 4265; the HG group) and women with no HG as controls (n = 302,663; the non-HG group). The associations between EDs and HG were analyzed by binary logistic regression, adjusted with age, body mass index, smoking, socioeconomic status, and pre-pregnancy psychiatric diagnoses.

RESULTS

In the HG group, 1.6% and in the non-HG group, 0.2% had a pre-pregnancy ED. Women with ED were more likely to have HG in their first pregnancy compared with women with no history of EDs (adjusted odds ratio [AOR] 9.4, 95% CI 6.52-13.66, p < .0001). Moreover, 0.4% of the women in the HG group and 0.1% of the women in the non-HG group had a new ED diagnosis after pregnancy, and thus the women in the HG group were more likely to have an ED diagnosis after pregnancy (AOR I 3.5, 95% CI 1.71-7.15, p < .001, AOR II 2.7, 95% CI 1.30-5.69, p = .008).

DISCUSSION

We found a bidirectional association between ED and HG, suggesting a shared etiology or risk factors between these disorders. This finding emphasizes the importance of collaboration across various specialties when treating these patients.

PUBLIC SIGNIFICANCE

Our findings suggest a bidirectional association between HG and EDs before and after pregnancy. This finding provides essential information for healthcare professionals working with pregnant women. As both of these disorders are known to have far-reaching effects on the lives of both the mother and her offspring, our results help clinicians to target special attention and interventions to the patients suffering from these disorders.

Women's experiences of Hyperemesis Gravidarum (HG) and of attending a dedicated multi-disciplinary hydration clinic

PROBLEM

Hyperemesis Gravidarum (HG) is a severe form of nausea and vomiting in pregnancy that affects 1-3 % of women and has profound nutritional, physical and psychological consequences. Previous research identified that women with HG report inadequate infrastructure for day case management.

INTRODUCTION

A multi-disciplinary HG day case service (IRIS Hydration Clinic) was launched and provides routine care for women with HG in a dedicated unit. The multi-disciplinary team involves midwives, dietitians, obstetricians and perinatal mental health.

AIMS

To explore women's experiences of HG and of attending the dedicated clinic.

METHODS

Ten interviews were conducted with women who attended the clinic. Data were transcribed and analysed using Reflexive Thematic Analysis.

FINDINGS

The physical and psychological impact of HG was captured. The appreciation for the dedicated clinic was a common theme, regarding having somewhere specific for treatment rather than ad-hoc treatment. 'Relationships' was a significant theme - women described the benefits of continuity of care and the positive impact of peer support. Areas for improvement were explored, such as expansion and extra sensitivity around some women's issues around weight gain/loss.

DISCUSSION

HG causes significant ill-health and its impact remains undervalued. Women had highly positive experiences of attending the dedicated HG clinic. The impact of continuity and individualized care in a day-case setting improved women's experiences of this condition.

CONCLUSION

The dedicated HG clinic was highly valued by women experiencing the condition. The IRIS clinic provides much-needed validation for a medical condition with little understanding from the general public or many healthcare professionals.

Retrospective Analysis of Hyperemesis Gravidarum and Its Psychological Impact during Hospital Admission

Background

The aim of this study was to evaluate hyperemesis gravidarum in pregnant women and its psychological impact.

Methods

This retrospective study included 109 pregnant females suffering from hyperemesis gravidarum admitted during 2019-2020 at Maternity Ain shams university hospital.

Results

Disease severity and laboratory investigations such as Na and K levels (P = 0.007 and < 0.001, respectively) and serum creatinine level (P < 0.001) were significantly positively correlated. Depressive symptoms included guilt feeling for leaving family (49.5% patients), suicidal thoughts (9.2%), crying (56.9%) and lost concentration (33.9%).

Conclusions

Medical staff should be aware of psychological impact of the disease and refer to specialists if needed.

Impact of a primary care pharmacist consultations on pregnant women's medication use: the SafeStart intervention study linked to a national prescription database

BACKGROUND

Prior studies show that pharmacist consultations are highly appreciated by pregnant women and feasible in community pharmacies. However, it is unknown whether such counseling has an impact on medication use during pregnancy.

AIM

This study aimed to assess whether a pharmacist consultation in early pregnancy was associated with pregnant women's medication use, with a focus on antiemetic medications.

METHOD

The SafeStart study recruited Norwegian pregnant women in the first trimester between February 2018 and February 2019. Women in the intervention group received a pharmacist consultation in a community pharmacy or by phone. A follow-up questionnaire was completed 13 weeks after enrollment. Data from the SafeStart study were linked to the Norwegian Prescription Database. Logistic regression was used to assess the association between the pharmacist intervention and medication use in the second trimester.

RESULTS

The study included 103 women in the intervention group and 126 in the control group. Overall prescription fills in the first and second trimesters were 55% and 45% (intervention group) and 49% and 52% (control group), respectively. In total, 16-20% of women in the first trimester and 21-27% of women in the second trimester had a prescription for antiemetics. The pharmacist intervention was not associated with women's medication use in the second trimester.

CONCLUSION

This study did not detect an impact of a pharmacist consultation on pregnant women's use of medications. In the future, pharmacist consultations should focus on other outcome factors, such as risk perception, knowledge level, and the use of other health care services. Trial registration The SafeStart study is registered with ClinicalTrials.gov (identifier: NCT04182750, registration date: December 2, 2019).

The predictive value of HALP score and systemic immune inflammation (SII) index in hyperemesis gravidarum

AIM

Hyperemesis gravidarum (HG) is one of the most common serious diseases in early pregnancy. This study aimed to investigate the clinical significance of hemoglobin, albumin, lymphocyte, and platelet (HALP) score and systemic immune inflammation (SII) index in the presence and severity of HG.

METHODS

This retrospective case-control study was conducted in a training and educational university hospital between January 2019 and July 2022. A total of 521 pregnant women, of whom 360 were diagnosed with HG at 6-14 weeks of gestation and 161 were low-risk pregnancies, were included in the study. Patients' demographic characteristics and laboratory parameters were recorded. Patients with HG were divided into three categories: mild (n = 160), moderate (n = 116), and severe (n = 84), according to disease severity. The modified PUQE scoring was used to determine the severity of HG.

RESULTS

The mean age of the patients was 27.6 (16-40) years. We divided the pregnant women into the control group and HG group. The HALP score was significantly lower in the HG group (average, 2.8 ± 1.3), whereas the SII index was found to be significantly higher (average, 895.8 ± 458.1). A negative correlation was found between the increase in the severity of HG and HALP score. The HALP score was the lower in severe HG (mean, 2.16 ± 0.81) and was significantly different from other HG categories (p < 0.01). Moreover, a positive correlation was noted between increased HG severity and SII index levels. The SII index was higher in the severe HG group and was significantly different from the others (1001.2 ± 437.2) (p < 0.01).

CONCLUSIONS

The HALP score and SII index can be useful, cost-effective, and easily accessible objective biomarkers to predict the presence and severity of HG.

The Role Of Systemic Immune-Inflammation Index In The Severity Of Hyperemesis Gravidarum

BACKGROUND

Hyperemesis gravidarum(HEG) is one of the severe health problems in early pregnancy. Obstetricians should be aware of systemic inflammation in HEG patients to provide better preventive strategies.

AIM

Hyperemesis gravidarum(HEG) is one of the most common causes of hospitalization in early pregnancy. Complete blood count parameters can be used as inflammatory markers in patients with HEG. We aimed to investigate the Systemic Immune-Inflammation Index (SII)in predicting the severity of HEG.

METHODS

This cross-sectional study was performed with 469 pregnant women diagnosed and hospitalized with HEG. The study parameters were calculated from complete blood count tests and urine analysis. Demographic characteristics, the Pregnancy Unique Quantification of Emesis (PUQE) scale values, and ketonuria levels at hospital admission were recorded. The neutrophil‑to‑lymphocyte ratio (NLR), platelet‑to‑lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and SII, calculated by the formula (neutrophil × platelet/lymphocyte), were evaluated for predicting the severity of HEG.

RESULTS

There was a positive correlation between the increased degree of ketonuria and SII. The cut-off value of SII for predicting the severity of HEG was 1071.8 (AUC 0.637, 95% CI (0.582-0.693), p<.001), and sensitivity and specificity were 59% and 59%, respectively. The cut-off value of SII to predict the length of hospitalization was 1073.6(AUC: 0.565, 95% CI: (0.501-0.628), p= 0.039); sensitivity and specificity were 56.3% and 55.5%, respectively CONCLUSIONS: : The clinical utility of SII in predicting HEG severity is limited due to relatively low sensitivity and specificity. Further research is needed to determine the importance of inflammatory indices in HEG patients.

Association between Hyperemesis Gravidarum in pregnancy on postnatal ability of infants to attend to a play task with their mother

Research indicates a higher prevalence of attention deficits in children exposed to HG in utero compared to controls with some claiming that the deficit is due to prenatal effects of malnutrition in HG mothers and others that it is due to maternal mental health after birth. The current study examines the effect of hyperemesis gravidarum (HG) diagnosis during pregnancy on infant attention controlling for maternal stress, depression anxiety and attachment. Thirty-eight infants mean age 4 months were videotaped with their mothers (19 mothers with a hyperemesis diagnosis and 19 controls) during play with a soft toy and looking at a picture book. Infant attention was operationalized as gaze direction towards the play activity, mother, and 'distracted' (indicated by looking away from play or mother). Mothers completed stress, depression, anxiety, and attachment questionnaires. HG exposed infants attended for significantly less time during play with a book or soft toy compared to controls. Maternal stress, depression, anxiety, and attachment did not differ in HG mothers and controls. Infant ability to attend to the toy, book, mother or being distracted did not relate to maternal postnatal attachment, or mental health. These results suggest that the prenatal environment, especially exposure to HG might be associated with reduced infant attention abilities independent of maternal postnatal health.

Use of Mirtazapine and Olanzapine in the Treatment of Refractory Hyperemesis Gravidarum: A Case Report and Systematic Review

Hyperemesis gravidarum (HG) is a rare condition (1.1%) characterized by excessive vomiting, malnutrition, dehydration, and laboratorial alterations. Herein, we describe the even rarer and serious presentation of refractoriness to the usual treatment of antiemetics and parenteral nutrition, with improvement only after the use of olanzapine and mirtazapine. Two subsequent pregnancies of the same woman with HG are described, which were associated with severe weight loss, anemia, hyponatremia, hypokalemia, and mild dysfunction of liver enzymes. In the third pregnancy, the usual treatment for HG was not successful, requiring enteral nutrition and the introduction of olanzapine. In the fourth pregnancy, the patient refused to use enteral nutrition for refractory HG. Hence, the patient was started on mirtazapine at an initial dose of 15 mg/day, which was gradually increased to 30 mg/day. The patient responded well to the new regimen, as demonstrated by the decrease in symptoms, the gain of 10 kg in the pregnancy, and delivering a healthy newborn. A systematic review of literature showed 11 articles and 30 cases that successfully used mirtazapine in HG. Good clinical outcomes were seen with 4 days of the treatment and at an initial dose of 15 mg/day. However, most of these reports were from psychiatric profiles, with a predominance of depression and anxiety symptoms, and a poor description of the obstetric conditions and the disease progression itself. Pulmonary hypertension was described in one case and neonatal hyperexcitability in another. The case described in this paper reinforces the idea that mirtazapine and olanzapine can be considered in refractory HG, with good results. In the world literature, this is the second case of HG that has been successfully treated with olanzapine and the first in Latin America treated with mirtazapine.

Impact of a Mobile Application for Tracking Nausea and Vomiting During Pregnancy (NVP) on NVP Symptoms, Quality of Life, and Decisional Conflict Regarding NVP Treatments: MinSafeStart Randomized Controlled Trial

Background

Pregnant women are active users of mobile apps for health purposes. These apps may improve self-management of health-related conditions. Up to 70% of pregnant women experience nausea and vomiting (NVP). Even mild NVP can significantly reduce quality of life (QoL), and it can become an economic burden for both the woman and society. NVP often occurs before the first maternal care visit; therefore, apps can potentially play an important role in empowering pregnant women to recognize, manage, and seek appropriate treatment for NVP, when required.

Objective

This study investigated whether the MinSafeStart (MSS) mobile app could impact NVP-related symptoms, QoL, and decisional conflict regarding NVP treatment.

Methods

This randomized controlled trial enrolled 268 pregnant women with NVP in Norway from 2019 to 2020. The intervention group had access to the MSS app, which could be used to track NVP symptoms and access tailored advice. NVP severity was rated with the Pregnancy Unique Quantification of Emesis (PUQE) score. The control group followed standard maternal care. We collected data on maternal baseline characteristics, NVP severity, QoL, and decisional conflict using 2 sets of online questionnaires. One set of questionnaires was completed at enrollment, and the other was completed after 2 weeks. We performed linear regression analyses to explore whether the use of the MSS app was associated with NVP severity, QoL, or decisional conflict.

Results

Among the 268 women enrolled in the study, 192 (86.5%) completed the baseline questionnaires and were randomized to either the intervention (n=89) or control group (n=103). In the intervention group, 88 women downloaded the app, and 468 logs were recorded. In both groups, women were enrolled at a median of 8 gestational weeks. At baseline, the average PUQE scores were 4.9 and 4.7; the average QoL scores were 146 and 149; and the average DCS scores were 40 and 43 in the intervention and control groups, respectively. The app had no impact on NVP severity (aβ 0.6, 95% Cl −0.1 to 1.2), QoL (aβ −5.3, 95% Cl −12.5 to 1.9), or decisional conflict regarding NVP treatment (aβ −1.1, 95% Cl −6.2 to 4.2), compared with standard care.

Conclusions

Tracking NVP symptoms with the MSS app was not associated with improvements in NVP symptoms, QoL, or decisional conflict after 2 weeks, compared with standard care. Future studies should include a process evaluation to improve our understanding of how pregnant women use the app and how to optimize its utility within maternity care. Specifically, studies should focus on how digital tools might facilitate counseling and communication between pregnant women and health care providers regarding NVP management during pregnancy.

Trial Registration

ClinicalTrails.gov (NCT04719286): https://www.clinicaltrials.gov/ct2/show/NCT04719286

Usability of Pregnancy-Unique Quantification of Emesis questionnaire in women hospitalised for hyperemesis gravidarum: a prospective cohort study

OBJECTIVES

Pregnancy-Unique Quantification of Emesis (PUQE) questionnaire is mainly used in outpatient care to assess the severity of nausea and vomiting of pregnancy (NVP). Our aim was to evaluate the usability of the Finnish-translated PUQE in hospitalised women with hyperemesis gravidarum (HG).

DESIGN

Prospective cohort study.

SETTING

University hospital in Finland.

PARTICIPANTS

Ninety-five women admitted due to HG for at least overnight.

PRIMARY AND SECONDARY OUTCOME MEASURES

Categorised and continuous PUQE scores, physical and mental quality of life (QoL) and urine ketones at admission and at discharge, analysing the first admission and readmissions separately.

RESULTS

The most common PUQE categories at admission were 'moderate' and 'severe', whereas at discharge they were 'mild' and 'moderate'. Likewise, continuous PUQE scores improved between admission and discharge (p<0.0001). At admission, women rating worse physical QoL (first admission adjusted OR (AOR) 1.09; 95% CI 1.03 to 1.16; readmissions AOR 1.13; 95% CI 1.02 to 1.25) and women with ketonuria of +++ (first admission AOR 16.00; 95% CI 1.44 to 177.82) fell into higher PUQE score category. On discharge day, women with better physical QoL had lower PUQE score category (first admission AOR 0.94; 95% CI 0.91 to 0.98; readmissions AOR 0.93; 95% CI 0.90 to 0.97). The results between physical QoL and continuous PUQE scores were similar. Concerning readmissions, better mental QoL was associated with lower PUQE score category at discharge (AOR 0.93; 95% CI 0.89 to 0.97). As for continuous PUQE score, worse mental QoL was associated with higher score at admission (readmissions, p=0.007) and better mental QoL with lower score at discharge (readmissions, p=0.007).

CONCLUSIONS

PUQE scores reflected alleviation of NVP severity in women hospitalised due to HG. Further, the decrease in PUQE score was associated with improved physical QoL and partly also with improved mental QoL. We therefore suggest PUQE as a complementary instrument for inpatient setting.

Hematological Parameters to Predict the Severity of Hyperemesis Gravidarum and Ketonuria

OBJECTIVE

 Hyperemesis gravidarum (HG) is a pregnancy complication that can progress with persistent nausea and vomiting. The aim of the present study is to evaluate the relationship between hematological parameters and HG.

METHOD

 A total of 532 pregnant women with HG who were admitted to the Department of Obstetrics and Gynecology between March 2019 and February 2021, and 534 healthy pregnant women with characteristics similar to those of the case group were included in the study. The hematological parameters of both groups were compared. In addition, the hematological parametersof patients with HG according to the severity of ketonuria were compared.

RESULTS

 The mean age of the HG group (n = 532) was 26.3 ±  4.1 years, and that of the control group (n = 534) was 25.9 ±  4.8 years. Among patients with HG, 46% (n = 249) had ketone (+), 33% (n = 174), ketone (++), and 21% (n = 109), ketone (++ + ). The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were higher in the HG group than in the control group: 3.8 (2.8-5.8)/3.2 (2.6-4.0); p < 0.001; and 135.2 ±  30.4/108.9 ±  62.2; p < 0.001 respectively. The neutrophil count, NLR, and PLR were higher in the group with ketone (++ + ) than in the groups with ketone (+) or ketone (++): 7.6 ±  1.9/5.5 ±  2.4; p < 0.001; 3.8(2.8-4.6)/2.9(2.3-3.6); p < 0.001; and 149.9 ±  48.0/135.9 ±  65.7; p < 0.001 respectively. The mean corpuscular hemoglobin (MCH) level, the NLR, and the PLR were identified as independent predictors of the presence of HG and the level of ketone positivity in HG patients.

CONCLUSION

 The NLR and PLR were high in patients with HG, suggesting the its inflammatory activity. They may be important markers associated with the presence and severity of HG.

Anxiety, depression and marital satisfaction in women with hyperemesis gravidarum: A comparative cross-sectional study in Hospital Tengku Ampuan Rahimah, Klang, Malaysia

INTRODUCTION

Hyperemesis Gravidarum (HG) is a severe form of vomiting that occurs among pregnant mothers. Due to the nature of HG, pregnant mothers may feel fatigued and burdened by it and questions have been raised about the emergence of psychiatric illness during this period of vulnerability.

METHODS

A comparative cross-sectional study using Hospital Anxiety and Depression Scale (HADS), M.I.N.I (MINI International Neuropsychiatric Interview) and ENRICH- EMS (Evaluation and Nurturing Relationship Issues, Communication and Happiness - Marital Satisfaction Scale) were performed in a group of 112 pregnant women.

RESULTS

There were no differences in the prevalence rate of any anxiety disorder among the patient with HG vs comparative group (9% vs 3%, P > 0.05) and depressive disorder in women with HG vs comparative group (16% vs 8%, P > 0.05) respectively. There were associations between HG and gravida, past history of miscarriage, and gestational diabetes (P < 0.05). After adjustment, only past history of gestational diabetes was associated with HG as a protective factor (AOR 0.034 95% CI 0.002-0.181; P = 0.0014). We found that women in the HG group tended to score statistically significantly higher than the comparison group for depressive symptoms in the HADS Depression subscale (P = 0.041).

DISCUSSION

We found no convincing association between HG and anxiety disorder, depressive disorder, and marital satisfaction, but women with HG statistically significantly reported more depressive symptoms than women who were not diagnosed with HG. Psychiatric evaluation should be considered for women with HG.

Weight loss among pregnant women hospitalized because of hyperemesis gravidarum: Is there a lack of nutrition intervention?

BACKGROUND

Nutrition therapy is a key component in the management of hyperemesis gravidarum (HG). The aim of this study was to describe sociodemographic, anthropometric, and nutrition aspects of pregnant women hospitalized because of HG and raise a discussion about the nutrition care provided.

MATERIALS AND METHODS

This is a retrospective descriptive study that includes 26 pregnant women with confirmed diagnosis of HG who were hospitalized because of this condition in a tertiary hospital. Data of interest were collected from official medical records and analyzed to obtain measures of central tendency and dispersion, as well as frequencies.

RESULTS

The studied individuals had a mean age of 25.7 years and a low level of education, and 65% of them were single mothers. They registered a low weight gain (2.8 kg) during pregnancy and in the course of their hospitalization, during which they lost an average of 1.7 kg, showing a decline in nutrition status during this period. Although the average intake of oral diet (OD) was 55% during hospital stay and only 5% of the studied population met caloric needs through OD, the prescription of complementary medical nutrition therapy (oral supplements, enteral or parenteral nutrition) was scarcely observed in this sample.

CONCLUSION

Despite the negative impact that HG can impose on the mother's nutrition status and the known benefits that complementary nutrition therapies can provide, few nutrition interventions have been carried out to improve this situation. That indicates an urgent need for implementation or reviewing of nutrition assistance protocols for HG patients.

Effectiveness of Acupuncture in the Treatment of Hyperemesis Gravidarum: A Systematic Review and Meta-Analysis

Background

Hyperemesis gravidarum (HG) is a common gastrointestinal disease afflicting gravidas. It usually results in hospital admission in early pregnancy.

Objective

Through a meta-analysis, this study intended to explore acupuncture's clinical efficacy in treating HG.

Materials and Methods

A comprehensive search of PubMed, the Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biological Medical (CBM), Wanfang Database, and China Science and Technology Journal (VIP) for published clinical randomized controlled trials (RCTs) of acupuncture for treating HG was conducted from the date of database creation to 20th January 2021. We also searched grey literature in four databases: Chinese Cochrane Center, Chinese Clinical Trial Registry, GreyNet International, and Open Grey from their inception to 20th January 2021. Two authors independently screened the literature, extracted data, and evaluated the quality of the literature with Cochrane Handbook 5.1.0 and Review Manager 5.2 software. Review Manager 5.2 and STATA 12.0 software were applied to analyze data. Heterogeneity analysis was performed by the Cochran Chi-square test and I ² statistic. Egger's tests together with funnel plots were used to identify publication bias.

Results

A total of 16 trials covering 1043 gravidas were included. Compared with the conventional treatment, acupuncture had a significantly higher effective rate (OR: 8.11, 95% CI: 5.29∼12.43; P < 0.00001), a higher conversion rate of urine ketone (RR: 1.36, 95% CI: 1.15∼1.60; P=0.0003), an improvement rate of nausea and vomiting (OR: 26.44, 95% CI: 3.54∼197.31; P=0.001), and a relatively higher improvement rate of food intake (RR: 1.17, 95% CI: 1.01∼1.36; P=0.04). Acupuncture also shortened hospitalization time and manifested with a lower pregnancy termination rate and fewer adverse events. Nevertheless, no statistical variation in the improvement of nausea intensity, vomiting episodes, and lassitude symptom, recurrence rate, and serum potassium was observed.

Conclusion

Our study suggested that acupuncture was effective in treating HG. However, as the potential inferior quality and underlying publication bias were found in the included studies, there is a need for more superior-quality RCTs to examine their effectiveness and safety. PROSPERO registration number: CRD42021232187.

Hyperemesis gravidarum and neonatal outcomes: A systematic review of observational studies

Hyperemesis gravidarum (HG) is associated with adverse somatic and psychological effects. The impact of HG on neonatal outcomes is debatable given that disagreeing research results have appeared. The objective of this study was to systematically review, according to the PRISMA guidelines, and synthesize the available evidence from observational studies on the relationship between HG and neonatal outcomes. The PubMed, Scopus, and Science Direct databases were systematically reviewed, with the last search carried out in April 2020. The quality of the studies was estimated using the Newcastle-Ottawa Scale (NOS) for non-randomized studies. The databases search yielded 516 studies 15 of which (n = 112.372 HG cases) matched eligibility criteria while the majority of the studies were of moderate quality (n = 12). We observed heterogeneity among the studies regarding the definition of HG and characteristics of the samples. The results of this systematic review suggest that it is still uncertain whether HG has an adverse impact on neonatal outcomes, fact that requires more studies to be conducted.

Hyperparathyroidism presenting as hyperemesis and acute pancreatitis in pregnancy: A case report

RATIONALE

Nausea and vomiting are common in the early period of pregnancy and rarely seen as an overture to pancreatitis.

PATIENT CONCERNS

Here, we describe a 31-year-old pregnant woman who presented with progressive nausea and vomiting followed by severe epigastric pain. Biochemical data and sonographic features confirmed the occurrence of acute pancreatitis. Accompanying electrolyte abnormalities included hypercalcemia and hypokalemia. Her condition stabilized following medical treatment, but hypercalcemia persisted despite intravenous fluids and furosemide administration.

DIAGNOSES

A diagnosis of primary hyperparathyroidism was made based on the elevated parathyroid hormone level and urinary calcium-to-creatinine clearance ratio.

INTERVENTIONS

Localization study with neck ultrasonography indicated left inferior parathyroid adenoma. She underwent parathyroidectomy successfully and made an uneventful recovery.

OUTCOMES

At 37 weeks of gestation, she had a serum calcium level of 8.8 mg/dL and normal parathyroid hormone of 28.55 pg/mL. A healthy baby weighing 3180 g was delivered smoothly with no clinical nor biochemical evidence of hypocalcemia.

LESSONS

Although primary hyperparathyroidism during pregnancy is usually asymptomatic, patients may present with atypical manifestations such as hyperemesis and pancreatitis. Proper diagnosis and timely intervention are crucial to minimizing potential hazards to both mother and fetus.

Micronutrients in Multiple Pregnancies-The Knowns and Unknowns: A Systematic Review

Maternal diet and nutritional status are of key importance with regard to the short- and long-term health outcomes of both the mother and the fetus. Multiple pregnancies are a special phenomenon in the context of nutrition. The presence of more than one fetus may lead to increased metabolic requirements and a faster depletion of maternal macro- and micro- nutrient reserves than in a singleton pregnancy. The aim of this systematic review was to gather available knowledge on the supply and needs of mothers with multiple pregnancies in terms of micronutrients and the epidemiology of deficiencies in that population. It was constructed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). The authors conducted a systematic literature search with the use of three databases: PubMed/MEDLINE, Scopus and Embase. The last search was run on the 18 October 2020 and identified 1379 articles. Finally, 12 articles and 1 series of publications met the inclusion criteria. Based on the retrieved studies, it may be concluded that women with multiple pregnancies might be at risk of vitamin D and iron deficiencies. With regard to other microelements, the evidence is either inconsistent, scarce or absent. Further in-depth prospective and population studies are necessary to determine if nutritional recommendations addressed to pregnant women require adjustments in cases of multiple gestations.

The incidence of postoperative nausea and vomiting after caesarean section in patients with hyperemesis gravidarum: a retrospective cohort study

BACKGROUND

Postoperative nausea and vomiting is one of the most common anaesthetic complications of caesarean section. This study examined the association between hyperemesis gravidarum during pregnancy and nausea and vomiting after caesarean section.

METHODS

A single-centre, retrospective cohort study, using electronic databases of patients with and without hyperemesis gravidarum, undergoing caesarean section from 2015 to 2019. The incidence and severity of postoperative nausea and vomiting were established by a review of the documentation of administration of postoperative anti-emetics within the 24-h period after surgery, and examined using univariable, multivariable binary and ordered logistic regression models.

RESULTS

Data were compared for 76 patients with hyperemesis gravidarum and 315 patients without the condition. The incidence of postoperative nausea and vomiting in the hyperemesis group versus the non-hyperemesis group was 43.4% vs 29.6%, respectively. The odds of experiencing postoperative nausea and vomiting was 1.95 times higher in women with hyperemesis gravidarum than in those without (aOR 1.95, 95% CI 1.13 to 3.36, P=0.016). The odds of having more severe postoperative nausea and vomiting were greater in the hyperemesis gravidarum group (aOR 1.91, 95% CI 1.14 to 3.20, P=0.014).

CONCLUSION

Patients with hyperemesis gravidarum are more likely to develop nausea and vomiting after caesarean section, and this is likely to be of greater severity than in those without the condition. This finding should assist the effective provision of intra-operative and postoperative anti-emetics for patients with hyperemesis gravidarum undergoing caesarean section.

Eating Disorders During Gestation: Implications for Mother's Health, Fetal Outcomes, and Epigenetic Changes

Introduction: Eating disorders (EDs) have increased globally in women of childbearing age, related to the concern for body shape promoted in industrialized countries. Pregnancy may exacerbate a previous ED or conversely may be a chance for improving eating patterns due to the mother's concern for the unborn baby. EDs may impact pregnancy evolution and increase the risk of adverse outcomes such as miscarriage, preterm delivery, poor fetal growth, or malformations, but the knowledge on this topic is limited. Methods: We performed a systematic review of studies on humans in order to clarify the mechanisms underpinning the adverse pregnancy outcomes in patients with EDs. Results: Although unfavorable fetal development could be multifactorial, maternal malnutrition, altered hormonal pathways, low pre-pregnancy body mass index, and poor gestational weight gain, combined with maternal psychopathology and stress, may impair the evolution of pregnancy. Environmental factors such as malnutrition or substance of abuse may also induce epigenetic changes in the fetal epigenome, which mark lifelong health concerns in offspring. Conclusions: The precocious detection of dysfunctional eating behaviors in the pre-pregnancy period and an early multidisciplinary approach comprised of nutritional support, psychotherapeutic techniques, and the use of psychotropics if necessary, would prevent lifelong morbidity for both mother and fetus. Further prospective studies with large sample sizes are needed in order to design a structured intervention during every stage of pregnancy and in the postpartum period.