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Emmott EH. Re-examining the adaptive function of nausea and vomiting in pregnancy. Evol Med Public Health 2024; 12:97-104. [PMID: 39015511 PMCID: PMC11250205 DOI: 10.1093/emph/eoae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/29/2024] [Indexed: 07/18/2024] Open
Abstract
Nausea and vomiting in pregnancy (NVP) have been proposed to have a prophylactic function. In this review, I re-examine NVP from an evolutionary perspective in light of new research on NVP. First, current evidence suggests that the observed characteristics of NVP does not align well with a prophylactic function. Further, NVP is typically associated with high costs for pregnant women, while moderate-to-severe NVP is associated with increased risks of poorer foetal/birth outcomes. In contrast, mild NVP limited to early pregnancy may associate with improved foetal outcomes-indicating a potential evolutionary benefit. Second, researchers have recently identified growth differentiation factor 15 (GDF15) to cause NVP, with implications that low-levels of pre-conception GDF15 (associated with lower cellular stress/inflammation) may increase risks/symptoms of NVP. If so, NVP in contemporary post-industrialized populations may be more severe due to environmental mismatch, and the current symptomology of NVP in such populations should not be viewed as a typical experience of pregnancy.
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Affiliation(s)
- Emily H Emmott
- UCL Anthropology, University College London, London WC1H 0BW, UK
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2
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Porgador O, Sheiner E, Pariente G, Wainstock T. Pregnancy outcomes by hyperemesis gravidarum severity and time of diagnosis: A retrospective cohort study. Int J Gynaecol Obstet 2024. [PMID: 38940074 DOI: 10.1002/ijgo.15760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 05/19/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE With inconsistencies regarding the possible effect of hyperemesis gravidarum on the course of pregnancy, this research aimed to study the association between hyperemesis gravidarum and pregnancy outcomes, while also addressing the trimester of diagnosis and severity. METHODS A retrospective cohort study was performed, including all singleton deliveries of mothers from the largest health maintenance organization in the country, in a single tertiary hospital between 1991 and 2021. The incidence of adverse pregnancy outcomes was compared between pregnancies with and without hyperemesis gravidarum diagnosis. Multivariable generalized estimation equation binary models were used to study the association between maternal hyperemesis gravidarum, trimester of diagnosis and hyperemesis gravidarum severity and the studied outcomes. RESULTS The study population included 232 476 pregnancies, of which 3227 (1.4%) were complicated with hyperemesis gravidarum. Women with hyperemesis gravidarum were more likely to deliver preterm (adj. OR = 1.33, 95% CI: 1.18-1.50), a newborn with low birthweight (adj. OR = 1.52, 95% CI: 1.16-1.98, only if diagnosed in the second trimester), and to have a cesarean delivery (adj. OR = 1.20, 95% CI: 1.09-1.32). They were less likely to deliver small gestational age newborn (adj. OR = 0.82, 95% CI: 0.69-0.99) and their offspring to experience perinatal mortality (adj. OR = 0.54, 95% CI: 0.31-0.93, among mild cases only). A dose-response association was observed between preterm birth and hyperemesis gravidarum (adj. OR = 1.26; 95% CI: 1.11-1.44, for mild cases and adj. OR = 2.04; 95% CI: 1.31-3.19, for severe cases). CONCLUSIONS Hyperemesis gravidarum is associated with an increased risk for adverse pregnancy outcomes including mainly preterm delivery in a dose-response manner and when diagnosed during the second trimester.
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Affiliation(s)
- Omri Porgador
- Faculty of Health Sciences, Joyce & Irving Goldman Medical School at Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gali Pariente
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Nelson-Piercy C, Dean C, Shehmar M, Gadsby R, O'Hara M, Hodson K, Nana M. The Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum (Green-top Guideline No. 69). BJOG 2024; 131:e1-e30. [PMID: 38311315 DOI: 10.1111/1471-0528.17739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
An objective and validated index of nausea and vomiting such as the Pregnancy-Unique Quantification of Emesis (PUQE) and HyperEmesis Level Prediction (HELP) tools can be used to classify the severity of NVP and HG. [Grade C] Ketonuria is not an indicator of dehydration and should not be used to assess severity. [Grade A] There are safety and efficacy data for first line antiemetics such as anti (H1) histamines, phenothiazines and doxylamine/pyridoxine (Xonvea®) and they should be prescribed initially when required for NVP and HG (Appendix III). [Grade A] There is evidence that ondansetron is safe and effective. Its use as a second line antiemetic should not be discouraged if first line antiemetics are ineffective. Women can be reassured regarding a very small increase in the absolute risk of orofacial clefting with ondansetron use in the first trimester, which should be balanced with the risks of poorly managed HG. [Grade B] Metoclopramide is safe and effective and can be used alone or in combination with other antiemetics. [Grade B] Because of the risk of extrapyramidal effects metoclopramide should be used as second-line therapy. Intravenous doses should be administered by slow bolus injection over at least 3 minutes to help minimise these. [Grade C] Women should be asked about previous adverse reactions to antiemetic therapies. If adverse reactions occur, there should be prompt cessation of the medications. [GPP] Normal saline (0.9% NaCl) with additional potassium chloride in each bag, with administration guided by daily monitoring of electrolytes, is the most appropriate intravenous hydration. [Grade C] Combinations of different drugs should be used in women who do not respond to a single antiemetic. Suggested antiemetics for UK use are given in Appendix III. [GPP] Thiamine supplementation (either oral 100 mg tds or intravenous as part of vitamin B complex (Pabrinex®)) should be given to all women admitted with vomiting, or severely reduced dietary intake, especially before administration of dextrose or parenteral nutrition. [Grade D] All therapeutic measures should have been tried before considering termination of pregnancy. [Grade C].
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Ács L, Nemes B, Nagy K, Ács M, Bánhidy F, Rózsa N. Maternal factors in the origin of cleft lip/cleft palate: A population-based case-control study. Orthod Craniofac Res 2024; 27 Suppl 1:6-13. [PMID: 38010849 DOI: 10.1111/ocr.12738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES Orofacial clefts are among the most common birth defects, with an estimated worldwide incidence of around 1.5-1.7 per 1000 live-born babies. The most frequent form of orofacial clefts is cleft lip with or without cleft palate (CL ± CP). The role of environmental factors in the development of clefts is unclear in most patients, thus the aim of this study was to estimate possible maternal risk factors in the origin of CL ± CP. MATERIALS AND METHODS 1648 CL ± CP cases, 2654 matched controls and 57 231 population controls were evaluated from The Hungarian Case-Control Surveillance of Congenital Abnormalities. Maternal factors during the critical period in cases and controls were compared. Adjusted odds ratios (OR) with 95% confidence intervals (CI) were estimated in a multivariable conditional logistic regression model. RESULTS Among socio-demographic data, we have found significant differences between maternal employment. The proportion of unskilled mothers (6.5%) were higher in the CL ± CP group than in controls (3.5%). Medically recorded maternal anaemia, excessive vomiting and threatened abortion were associated with a higher risk of CL ± CP. An elevated risk was also found in various acute illnesses such as influenza (OR: 2.4, 95% CI: 3.0-5.8), acute bronchitis (OR: 4.5, 95% CI: 1.6-12.6) and urinary tract infections (OR: 3.5, 95% CI: 2.0-6.0). Maternal migraine and essential hypertension occurred more frequently in the mothers of cases than in controls. CONCLUSION The findings of this study suggest that maternal diseases and lifestyle factors during the first trimester play a significant role in the development of CL ± CP.
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Affiliation(s)
- Lili Ács
- Department of Paediatric Dentistry and Orthodontics, Semmelweis University Faculty of Dentistry, Budapest, Hungary
| | - Bálint Nemes
- Department of Paediatric Dentistry and Orthodontics, Semmelweis University Faculty of Dentistry, Budapest, Hungary
| | - Krisztián Nagy
- Department of Paediatrics, Semmelweis University School of Medicine, Budapest, Hungary
- OMFS-IMPATH KU Research Group, Leuven, Belgium
| | - Márton Ács
- Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University Faculty of Dentistry, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Ferenc Bánhidy
- Department of Obstetrics and Gynaecology, Semmelweis University School of Medicine, Budapest, Hungary
| | - Noémi Rózsa
- Department of Paediatric Dentistry and Orthodontics, Semmelweis University Faculty of Dentistry, Budapest, Hungary
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Zhang X, Zhang Y, Lv D, Xie Y, Xu H, Li F, He M, Fan Y, Li X, Jallow F, Li W, Lin X, Ye F, Deng D. Association of the Verbal Rating Scale-Measured Dysmenorrhea with Nausea and Vomiting in Pregnancy: A Retrospective Cohort Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102406. [PMID: 38331093 DOI: 10.1016/j.jogc.2024.102406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES Nausea and vomiting in pregnancy (NVP) is a common condition that reduces the quality of life by negatively affecting work and family life, physical and mental health, and economic well-being. However, its risk factors remain unclear. This study aimed to explore the association between NVP and verbal rating scale (VRS)-measured dysmenorrhea and to explore potential protective factors. METHODS This retrospective cohort study was conducted from June 2018 to December 2020 at Tongji Hospital in Wuhan. Information on baseline characteristics, pregnancy-related history, periconceptional micronutrient supplementation, and obstetric outcomes were collected. The severity of dysmenorrhea was assessed using VRS. RESULTS A total of 443 pregnant women were recruited and divided into the NVP group (n = 76) and the control group (n = 367). A significant association was observed between NVP and VRS-measured dysmenorrhea (c2=10.038, P = 0.007). After adjusting for covariates, the association between moderate/severe dysmenorrhea and NVP remained significant (OR 2.384; 95% CI 1.104-5.148, P = 0.004). First-trimester docosahexaenoic acid supplement (OR 0.443; 95% CI 0.205-0.960, P = 0.039) may be beneficial in reducing the risk of NVP. CONCLUSIONS Women with moderate to severe dysmenorrhea have a higher risk of experiencing NVP during the first trimester. Periconceptional docosahexaenoic acid supplementation may play a protective role.
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Affiliation(s)
- Xiaolei Zhang
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanling Zhang
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dan Lv
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yin Xie
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heze Xu
- Department of Obstetrics and Gynaecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fanfan Li
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mengzhou He
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yao Fan
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xufang Li
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fatoumata Jallow
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Li
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xingguang Lin
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Ye
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Ministry of Education Key Lab for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongrui Deng
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Schrager NL, Parker SE, Werler MM. The timing, duration, and severity of nausea and vomiting of pregnancy and adverse birth outcomes among controls without birth defects in the National Birth Defects Prevention Study. Birth Defects Res 2024; 116:e2334. [PMID: 38578229 DOI: 10.1002/bdr2.2334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/31/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Nausea and vomiting of pregnancy (NVP) occurs in approximately 70% of pregnant people, with varying severity and duration. Treatments include pharmacologic and herbal/natural medications. The associations between NVP and birth outcomes, including preterm birth, small for gestational age (SGA), and low birth weight are inconclusive. OBJECTIVE To determine whether NVP and reported medications are associated with adverse birth outcomes. METHODS We used data from the population-based, multisite National Birth Defects Prevention Study (1997-2011) to evaluate whether self-reported NVP according to timing, duration, and severity or its specific treatments were associated with preterm birth, SGA, and low birth weight among controls without birth defects. Odds ratios (aOR) and 95% confidence intervals (CI) were adjusted for sociodemographic, reproductive, and medical factors. For any NVP, duration, treatment use, and severity score analyses, the comparison group was participants with no reported NVP. For timing analyses, the comparison group was women with no reported NVP in the same trimester of pregnancy. RESULTS Among 6018 participants, 4339 (72.1%) reported any NVP. Among those with NVP, moderate or severe symptoms were more common than mild symptoms. Any versus no NVP was not associated with any of the outcomes of interest. NVP in months 4-6 (aOR 1.21, 95% CI: 1.00, 1.47) and 7-9 (aOR 1.57, 95% CI: 1.22, 2.01) of pregnancy were associated with an increase in the risk of preterm birth. NVP lasting one trimester in duration was associated with decrease in risk of SGA (aOR: 0.74, 95% CI: 0.58, 0.95), and NVP present in every trimester of pregnancy had a 50% increase in risk of preterm birth (aOR: 1.50, 95% CI: 1.11, 2.05). For NVP in months 7-9 and preterm birth, ORs were elevated for moderate (aOR: 1.82, 95% CI: 1.26, 2.63), and severe (aOR: 1.53, 95% CI: 1.06, 2.19) symptoms. NVP was not significantly associated with low birth weight. Our analyses of medications were limited by small numbers, but none suggested increased risk of adverse outcomes associated with use of the medication. CONCLUSION Mild NVP and NVP limited to early pregnancy appear to have no effect or a small protective effect on birth outcomes. Long-lasting NVP, severe NVP, and NVP later in pregnancy may increase risk of preterm birth and SGA.
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Affiliation(s)
- Nina L Schrager
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Samantha E Parker
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Martha M Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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Li N, Xue Z, Xu H, Yang P, Wang K, Li L, Kang H, Wang M, Deng Y, Li X, Wang Y, Zhu J, Yu P, Zhou S. Evaluation of nausea and vomiting in the first trimester on the risk of adverse birth outcomes and the contribution of genetic polymorphisms: a pilot prospective study. Arch Gynecol Obstet 2023; 308:1713-1721. [PMID: 36441230 DOI: 10.1007/s00404-022-06851-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/06/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the impact of Nausea and Vomiting in Pregnancy (NVP) on the risk of Preterm Birth (PTB) and Low Birth Weight (LBW), and explore the effect of genetic polymorphisms on the severity of NVP. METHODS A prospective study was conducted. Participants' experience of NVP prior to 12 gestational weeks were evaluated by a Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scale. 11 Single Nucleotide Polymorphisms (SNPs) loci located in growth differentiation factor 15 (GDF15) and leucine-rich repeat containing 25 (LRRC25) gene of chr19p13.11 and intergenic region of chr4q12 were genotyped, which were implicated as genetic risk factors for NVP. Logistic regression models were applied to determine the effect of NVP in the first trimester on the risk of PTB and LBW, and genetic polymorphisms on the risk of NVP. RESULTS Among 413 pregnant women, the incidence of nausea and vomiting was 85.5% (n = 353) in the first trimester, including 38.7% (n = 160) mild vomiting, 42.6% (n = 176) moderate vomiting and 4.1% (n = 17) severe vomiting. 33 were PTB, 20 were LBW. Compared with pregnant women without NVP, women with mild, moderate or severe NVP in the first trimester were not associated with the risk of PTB and LBW. Besides, the polymorphisms of 11 SNPs loci were not associated with the risk of NVP. CONCLUSIONS Our study indicated that symptoms of nausea and vomiting in the first trimester were not significantly associated with PTB and LBW, and there were also no associations between GDF15 and LRRC25 polymorphisms and NVP.
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Affiliation(s)
- Nana Li
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Sec.3 No.17, South RenMin Road, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Zhiwei Xue
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hongmei Xu
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Gynecology and Obstetrics, The People's Hospital of Leshan, Leshan, Sichuan, China
| | - Ping Yang
- Department of Obstetrics and Gynecology, Maternal and Child, Healthcare Hospital of Peng'an County, Nanchong, China
| | - Ke Wang
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Sec.3 No.17, South RenMin Road, Chengdu, Sichuan, China
| | - Lu Li
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Sec.3 No.17, South RenMin Road, Chengdu, Sichuan, China
| | - Hong Kang
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Sec.3 No.17, South RenMin Road, Chengdu, Sichuan, China
| | - Meixian Wang
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Sec.3 No.17, South RenMin Road, Chengdu, Sichuan, China
| | - Ying Deng
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Sec.3 No.17, South RenMin Road, Chengdu, Sichuan, China
| | - Xiaohong Li
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Sec.3 No.17, South RenMin Road, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yanping Wang
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Sec.3 No.17, South RenMin Road, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Jun Zhu
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Sec.3 No.17, South RenMin Road, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Ping Yu
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University, Sec.3 No.17, South RenMin Road, Chengdu, Sichuan, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
| | - Shu Zhou
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
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Moberg T, Van der Veeken L, Persad E, Hansson SR, Bruschettini M. Placenta-associated adverse pregnancy outcomes in women experiencing mild or severe hyperemesis gravidarum - a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:375. [PMID: 37226133 DOI: 10.1186/s12884-023-05691-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 05/09/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Nausea and vomiting in pregnancy (NVP) affects 50-80% of pregnant women and is correlated to the level of human chorionic gonadotropin (hCG). Hyperemesis gravidarum (HG) is a severe condition, with an incidence of 0.2-1.5%, characterized by consistent nausea, vomiting, weight loss and dehydration continuing after the second trimester. AIM The aim of this systematic review was to investigate a potential correlation between NVP or HG with adverse pregnancy outcomes and hCG levels. METHOD A systematic search in PubMed, Embase and CINAHL Complete was conducted. Studies on pregnant women with nausea in the first or second trimester, reporting either pregnancy outcomes or levels of hCG were included. The primary outcomes were preterm delivery (PTD), preeclampsia, miscarriage, and fetal growth restriction. Risk of bias was assessed using ROBINS-I. The overall certainty of evidence was assessed using GRADE. RESULTS The search resulted in 2023 potentially relevant studies; 23 were included. The evidence was uncertain for all outcomes, however women with HG had a tendency to have an increased risk for preeclampsia [odds ratio (OR) 1.18, 95% confidence of interval (CI) 1.03 to 1.35], PTD [OR 1.35, 95% CI 1.13 to 1.61], small for gestational age (SGA) [OR 1.24, 95% CI 1.13 to 1.35], and low birth weight (LBW) [OR 1.35, 95% CI 1.26 to 1.44]. Further, a higher fetal female/male ratio was observed [OR 1.36, 95% CI 1.15 to 1.60]. Meta-analyses were not performed for women with NVP; however, most of these studies indicated that women with NVP have a lower risk for PTD and LBW and a higher risk for SGA, and a higher fetal female/male ratio. CONCLUSION There may be an increased risk in women with HG and a decreased risk in women with NVP for adverse placenta-associated pregnancy outcomes, however the evidence is very uncertain. TRIAL REGISTRATION PROSPERO: CRD42021281218.
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Affiliation(s)
- Tilda Moberg
- Faculty of Medicine, Lund University, Lund, Sweden.
- Helsingborg Hospital, Helsingborg, Sweden.
| | - Lennart Van der Veeken
- Department of Obstetrics and Gynaecology, University Hospital Antwerpen, Antwerp, Belgium
| | - Emma Persad
- Department of Evidence-Based Medicine and Evaluation, Danube University Krems, Krems, Austria
- Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Stefan R Hansson
- Department of Clinical Sciences Lund, Division of Obstetrics and Gynecology, Faculty of Medicine, Lund University, Lund, Sweden
- Women's Health Clinic, Skåne University Hospital, Lund, Sweden
| | - Matteo Bruschettini
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
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Schrager NL, Parker SE, Werler MM. The association of nausea and vomiting of pregnancy, its treatments, and select birth defects: Findings from the National Birth Defect Prevention Study. Birth Defects Res 2023; 115:275-289. [PMID: 36168701 DOI: 10.1002/bdr2.2096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Nausea and vomiting of pregnancy (NVP) occurs in approximately 70% of pregnant people. Treatments include pharmacologic and herbal/natural products. Research on the associations between NVP and its treatments and birth defects is limited. METHODS We used data from the case-control National Birth Defects Prevention Study (1997-2011) to examine whether first-trimester NVP or its specific treatments were associated with 37 major birth defects. Odds ratios (aOR) and 95% confidence intervals (CIs) were adjusted for sociodemographic and reproductive factors. RESULTS Mothers of 66.6% of 28,628 cases and 69.9% of 11,083 controls reported first-trimester NVP. Compared to no NVP, mothers with NVP had ≥10% reduction in risk of cardiac and noncardiac defects overall, and of 18 specific defects. Over-the-counter antiemetic use, compared to untreated NVP, was associated with ≥10% increase in risk for nine defect groups (heterotaxy, hypoplastic left heart syndrome [HLHS], aortic stenosis, cataracts, anophthalmos/microphthalmos, biliary atresia, transverse limb deficiency, omphalocele, and gastroschisis), whereas use of prescription antiemetics increased risk ≥10% for seven defect groups (tetralogy of Fallot, HLHS, spina bifida, anopthlamos/microphthalmos, cleft palate, craniosynostosis, and diaphragmatic hernia). We observed increased risks for promethazine and tetralogy of Fallot (aOR: 1.49, 95% CI: 1.05-2.10), promethazine and craniosynostosis (1.44, 1.08-1.92), ondansetron and cleft palate (1.66, 1.18-2.31), pyridoxine and heterotaxy (3.91, 1.49-10.27), and pyridoxine and cataracts (2.57, 1.12-5.88). CONCLUSIONS NVP does not increase risks of birth defects. Our findings that some treatments for NVP increase risk of specific birth defects should be investigated further before clinical recommendations are made.
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Affiliation(s)
- Nina L Schrager
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Samantha E Parker
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Martha M Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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Morisaki N, Nagata C, Morokuma S, Nakahara K, Kato K, Sanefuji M, Shibata E, Tsuji M, Shimono M, Kawamoto T, Ohga S, Kusuhara K, Saito H, Kishi R, Yaegashi N, Hashimoto K, Mori C, Ito S, Yamagata Z, Inadera H, Kamijima M, Heike T, Iso H, Shima M, Kawai Y, Suganuma N, Kusuhara K, Katoh T. Lack of catch-up in weight gain may intermediate between pregnancies with hyperemesis gravidarum and reduced fetal growth: the Japan Environment and Children’s Study. BMC Pregnancy Childbirth 2022; 22:199. [PMID: 35279131 PMCID: PMC8917715 DOI: 10.1186/s12884-022-04542-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 03/04/2022] [Indexed: 11/12/2022] Open
Abstract
Background Women with nausea and vomiting of pregnancy (NVP) have higher birth weight infants, while those with hyperemesis gravidarum, a severe manifestation of NVP, have lower birth weight infants. We aimed to investigate the associations between maternal weight loss (a consequence of hyperemesis gravidarum), NVP, and infant birth weight. Methods This study was a secondary analysis of a nationwide birth cohort in Japan. Singleton pregnancies delivered at 28–41 weeks of gestation were included in the analysis. Women were categorized based on their weight change in the 1st trimester (as a proportion to their pre-pregnancy weight: > + 3%, > 0 to + 3%, > -3 to 0%, > -5 to -3%, ≤ -5%) and severity of NVP (no nausea, only nausea, vomiting but able to eat, vomiting and unable to eat). The effects of weight change and severity of NVP on infant birth weight and small for gestational age (SGA) were assessed using regression models. We further examined how these effects could be modified by maternal weight gain up to the 2nd trimester. Results Among 91,313 women, 5,196 (5.7%) lost ≥ 5% of their pre-pregnancy weight and 9,983 (10.9%) experienced vomiting and were unable to eat in the 1st trimester. Women with weight loss ≥ 5% in the 1st trimester had infants 66 (95% CI: 53, 78) g lighter and higher odds of SGA (aOR: 1.29; 95% CI: 1.14, 1.47) than women who gained > 3% during the same period. However, when adjusting for weight gain up to the 2nd trimester, women with weight loss ≥ 5% in the 1st trimester had infants 150 (95% CI: 135, 165) g heavier and lower odds of SGA (aOR: 0.39; 95% CI: 0.33, 0.46) than those who gained > 3% during the same period. In contrast, women with more severe NVP tended to have infants with larger birth weight and lower odds of SGA compared to women without NVP. These trends were strengthened when adjusting for weight gain up to the 2nd trimester. Conclusions Our study suggests the possibility that reduced fetal growth in pregnancies with hyperemesis gravidarum may be caused by the lack of catch-up in gestational weight gain up to the 2nd trimester. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04542-0.
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11
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Association of nausea and vomiting of pregnancy with infant growth in the first 24 months of life. Arch Gynecol Obstet 2021; 304:429-438. [PMID: 34019157 DOI: 10.1007/s00404-021-06046-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE We aimed to investigate the association of maternal nausea and vomiting during pregnancy (NVP) with infant growth in the first 24 months of life and compare the effect of fetal gender. METHODS This prospective cohort study was conducted in Zhoushan Maternal and Child Health Hospital, Zhejiang, from 2011 to 2018. 1942 pairs of singleton newborns and their mothers were selected as participants. Main outcomes were gestational weight gain (GWG), birth outcomes (birthweight and gestational age) and infant growth [weight, height, weight/height-for-age Z score (WAZ/HAZ), the weight gain during childhood]. The associations of NVP with birth outcomes and infant growth at children's age of 1, 3, 6, 12, 18, and 24 months were analyzed by multivariable regression models. RESULTS Of the 1942 women, 1395 had NVP at first trimester (T1) and among them, 210 still experienced NVP at second trimester (T2). Compared with women without NVP, women experienced severe NVP at T1 were related with lower total GWG. Mild and moderate NVP at T1 were negatively associated with lower birthweight among women with male infants. Female infants exposed to maternal NVP at T1, especially for severe degree, were showed greater weight, WAZ, height, HAZ, and weight gain after 1 year old (at age of 12, 18, 24 months). No association between maternal NVP and infant growth was observed among male infants. CONCLUSION Exposure to NVP at T1 was, respectively, associated with lower GWG. Favorable influence of NVP at T1 on infant growth was observed among female offspring.
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12
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Varela P, Deltsidou A. Hyperemesis gravidarum and neonatal outcomes: A systematic review of observational studies. Taiwan J Obstet Gynecol 2021; 60:422-432. [PMID: 33966723 DOI: 10.1016/j.tjog.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2020] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Pinelopi Varela
- General Hospital of Athens ''Alexandra'', Department of Midwifery, University of West Attica, Athens, Greece.
| | - Anna Deltsidou
- Department of Midwifery, University of West Attica, Athens, Greece
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13
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Paganin S, Herring AH, Olshan AF, Dunson DB. Centered Partition Processes: Informative Priors for Clustering (with Discussion). BAYESIAN ANALYSIS 2021; 16:301-370. [PMID: 35958029 PMCID: PMC9364237 DOI: 10.1214/20-ba1197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
There is a very rich literature proposing Bayesian approaches for clustering starting with a prior probability distribution on partitions. Most approaches assume exchangeability, leading to simple representations in terms of Exchangeable Partition Probability Functions (EPPF). Gibbs-type priors encompass a broad class of such cases, including Dirichlet and Pitman-Yor processes. Even though there have been some proposals to relax the exchangeability assumption, allowing covariate-dependence and partial exchangeability, limited consideration has been given on how to include concrete prior knowledge on the partition. For example, we are motivated by an epidemiological application, in which we wish to cluster birth defects into groups and we have prior knowledge of an initial clustering provided by experts. As a general approach for including such prior knowledge, we propose a Centered Partition (CP) process that modifies the EPPF to favor partitions close to an initial one. Some properties of the CP prior are described, a general algorithm for posterior computation is developed, and we illustrate the methodology through simulation examples and an application to the motivating epidemiology study of birth defects.
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Affiliation(s)
- Sally Paganin
- Department of Environmental Science, Policy, and Management, University of California, Berkeley
| | - Amy H Herring
- Department of Statistical Science, Duke University, Durham
| | - Andrew F Olshan
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill
| | - David B Dunson
- Department of Statistical Science, Duke University, Durham
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14
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Syn NL, Chan S, Chia EWY, Ong WX, Phua D, Cai S, Shek LPC, Chong Y, Daniel LM, Broekman BFP, Godfrey KM, Meaney MJ, Law EC. Severity of nausea and vomiting in pregnancy and early childhood neurobehavioural outcomes: The Growing Up in Singapore Towards Healthy Outcomes study. Paediatr Perinat Epidemiol 2021; 35:98-108. [PMID: 32578237 PMCID: PMC7116637 DOI: 10.1111/ppe.12703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 04/09/2020] [Accepted: 05/15/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Nausea and vomiting of pregnancy (NVP) affects 50 to 80 per cent of women. The existing literature has examined NVP from the perspective of the mother, and relatively less is known about offspring outcomes. OBJECTIVES To study the relationships of NVP with social-emotional, behavioural, and cognitive outcomes of the offspring in a multi-ethnic Asian cohort. METHODS In the Growing Up in Singapore Towards Healthy Outcomes prospective mother-offspring cohort study, mothers responded to a structured NVP questionnaire at 26-28 weeks' gestation (n = 1172) and participants with severe NVP were confirmed using medical records. Children underwent multiple neurodevelopmental assessments throughout childhood. We conducted multivariable regressions with post-estimation predictive margins to understand the associations of NVP with offspring neurobehavioural outcomes, which included 1-year Infant-Toddler Social and Emotional Assessment, 1.5-year Quantitative Checklist for Autism in Toddlers, 2-year Bayley Scales of Infant and Toddler Development, 2- and 4-year Child Behavior Checklist, and 4.5-year Kaufman Brief Intelligence Test. Analyses were adjusted for household income, birth variables, maternal mental health, and other relevant medical variables. Cohen's d effect sizes were calculated using standardised mean differences (μd ). RESULTS Mothers were categorised into no (n = 296, 25.3%), mild-moderate (n = 686, 58.5%), and severe NVP (n = 190, 16.2%), of whom 67 (5.7%) required admission. Compared to children of mothers who had no or mild-moderate NVP, children with exposure to severe NVP exhibited more externalising behaviours (μd 2.0, 95% CI 0.3, 3.6; Cohen's d = 0.33) and social communication difficulties before 2 years (μd 4.1, 95% Cl 0.1, 8.0; Cohen's d = 0.38), both externalising (μd 1.5, 95% CI 0.4, 2.6; Cohen's d = 0.43) and internalising behaviours at 2 years (μd 1.2, 95% CI 0.1, 2.2; Cohen's d = 0.35), and only internalising behaviours after 2 years (μd 1.1, 95% CI 0.4, 2.0; Cohen's d = 0.37). CONCLUSIONS Severe NVP is highly prevalent in this Asian cohort and may be adversely associated with multiple offspring neurobehavioural outcomes.
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Affiliation(s)
- Nicholas L. Syn
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Shiao‐Yng Chan
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore,Department of Obstetrics and GynaecologyNational University Health SystemSingaporeSingapore,Agency for Science, Technology and Research (A*STAR)Singapore Institute for Clinical Sciences (SICS)SingaporeSingapore
| | - Elisha Wan Ying Chia
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Wei Xin Ong
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Desiree Phua
- Agency for Science, Technology and Research (A*STAR)Singapore Institute for Clinical Sciences (SICS)SingaporeSingapore
| | - Shirong Cai
- Agency for Science, Technology and Research (A*STAR)Singapore Institute for Clinical Sciences (SICS)SingaporeSingapore
| | - Lynette P. C. Shek
- Agency for Science, Technology and Research (A*STAR)Singapore Institute for Clinical Sciences (SICS)SingaporeSingapore,Department of PaediatricsYong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore,Khoo Teck Puat‐National University Children's Medical InstituteNational University Health SystemSingaporeSingapore
| | - Yap‐Seng Chong
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore,Department of Obstetrics and GynaecologyNational University Health SystemSingaporeSingapore,Agency for Science, Technology and Research (A*STAR)Singapore Institute for Clinical Sciences (SICS)SingaporeSingapore
| | - Lourdes Mary Daniel
- Department of Child DevelopmentKK Women’s and Children’s HospitalSingaporeSingapore,Duke‐NUS Graduate Medical SchoolSingaporeSingapore
| | - Birit F. P. Broekman
- Agency for Science, Technology and Research (A*STAR)Singapore Institute for Clinical Sciences (SICS)SingaporeSingapore,Department of PsychiatryVU University Medical CentreAmsterdamNetherlands
| | - Keith M. Godfrey
- Agency for Science, Technology and Research (A*STAR)Singapore Institute for Clinical Sciences (SICS)SingaporeSingapore,MRC Lifecourse Epidemiology Unit & NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustUK
| | - Michael J. Meaney
- Agency for Science, Technology and Research (A*STAR)Singapore Institute for Clinical Sciences (SICS)SingaporeSingapore,Ludmer Centre for Neuroinformatics and Mental HealthDouglas InstituteMcGill UniversityMontrealCanada,Departments of Psychiatry and Neurology and NeurosurgeryMcGill UniversityMontrealCanada,Sackler Program for Epigenetics and PsychobiologyMcGill UniversityMontrealCanada
| | - Evelyn C. Law
- Agency for Science, Technology and Research (A*STAR)Singapore Institute for Clinical Sciences (SICS)SingaporeSingapore,Department of PaediatricsYong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore,Khoo Teck Puat‐National University Children's Medical InstituteNational University Health SystemSingaporeSingapore
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Schrager NL, Adrien N, Werler MM, Parker SE, Van Bennekom C, Mitchell AA. Trends in first-trimester nausea and vomiting of pregnancy and use of select treatments: Findings from the National Birth Defects Prevention Study. Paediatr Perinat Epidemiol 2021; 35:57-64. [PMID: 32623767 PMCID: PMC9754706 DOI: 10.1111/ppe.12705] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 05/06/2020] [Accepted: 05/31/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although nausea and vomiting of pregnancy (NVP) is common, the secular and demographic trends of NVP and its treatments are not well-studied. OBJECTIVES To describe the prevalence and patterns of first-trimester NVP and selected treatments among controls in the National Birth Defects Prevention Study (NBDPS). METHODS National Birth Defects Prevention Study is a population-based case-control study of birth defects in the United States (1997-2011). We collected self-reported data about NVP and use of commonly reported pharmacological and herbal/natural treatments (ondansetron, promethazine, pyridoxine, metoclopramide, doxylamine succinate, ginger, phosphorated carbohydrate solution, and prochlorperazine) from mothers of non-malformed control infants. We estimated the prevalence of NVP and selected treatments and examined secular and demographic trends (education, race/ethnicity, and maternal age) for such use, adjusting for study centre. RESULTS Among 10 540 mothers of controls, 7393 women (70.1%) reported first-trimester NVP, and 12.2% of those used one or more of the commonly reported treatments. Specific treatment use varied after adjustment for study centre (ondansetron: 3.4%; promethazine: 4.2%; pyridoxine: 3.2%; metoclopramide: 0.7%; doxylamine succinate: 1.7%; ginger: 1.0%; phosphorated carbohydrate solution: 0.4%; and prochlorperazine: 0.3%). Treatment use increased for each agent over the study period. Women with more years of education reported more NVP and treatment use. White (72%), Hispanic (71%), and other race (73%) women reported more NVP than Black women (67%); White women used selected NVP treatments most frequently, and Black women used them more than Hispanic women. Though women aged 25-34 years reported more NVP (72%) than younger (69%) or older (67%) women, the frequency of medication use was similar among women aged 25-34 and ≥35, and lower among women aged <25 years. CONCLUSIONS National Birth Defects Prevention Study controls reported NVP at frequencies similar to those previously reported. Of note, we observed an increase in use of selected treatments over time, and variations in NVP and treatments by study site and demographic factors.
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Affiliation(s)
- Nina L. Schrager
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Slone Epidemiology Center, Boston University, Boston, MA, USA
| | - Nedghie Adrien
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Martha M. Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Samantha E. Parker
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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16
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Poggio F, Tagliamento M, Pirrone C, Soldato D, Conte B, Molinelli C, Cosso M, Fregatti P, Del Mastro L, Lambertini M. Update on the Management of Breast Cancer during Pregnancy. Cancers (Basel) 2020; 12:cancers12123616. [PMID: 33287242 PMCID: PMC7761659 DOI: 10.3390/cancers12123616] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/29/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023] Open
Abstract
The diagnosis of breast cancer during pregnancy represents a challenging situation for the patient, her caregivers and physicians. Pregnancy adds complexity to oncological treatment planning, as many therapies can be potentially dangerous to the fetus. Therefore, a multidisciplinary approach is needed to offer a proper care for obtaining the best possible outcomes for the mother and the future child. Breast surgery is feasible throughout the pregnancy while radiotherapy should be postponed after delivery. Administration of chemotherapy is considered safe and can be given during the second and third trimesters, while it is contraindicated in the first trimester due to the high risk of fetal malformations. Endocrine therapy and targeted agents are not recommended during the whole pregnancy period; however, limited data are available on the use of the majority of new anticancer drugs in this context. The aim of the current review is to provide an update on the current state of art about the management of women diagnosed with breast cancer during pregnancy.
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Affiliation(s)
- Francesca Poggio
- Breast Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (F.P.); (L.D.M.)
| | - Marco Tagliamento
- U.O. Oncologia Medica 2, Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (M.T.); (C.P.); (D.S.); (B.C.); (C.M.)
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, 16132 Genova, Italy
| | - Chiara Pirrone
- U.O. Oncologia Medica 2, Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (M.T.); (C.P.); (D.S.); (B.C.); (C.M.)
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, 16132 Genova, Italy
| | - Davide Soldato
- U.O. Oncologia Medica 2, Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (M.T.); (C.P.); (D.S.); (B.C.); (C.M.)
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, 16132 Genova, Italy
| | - Benedetta Conte
- U.O. Oncologia Medica 2, Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (M.T.); (C.P.); (D.S.); (B.C.); (C.M.)
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, 16132 Genova, Italy
| | - Chiara Molinelli
- U.O. Oncologia Medica 2, Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (M.T.); (C.P.); (D.S.); (B.C.); (C.M.)
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, 16132 Genova, Italy
| | - Maurizio Cosso
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
| | - Piero Fregatti
- U.O.C. Clinica di Chirurgia Senologica, Department of Surgery, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
- Department of Integrated Diagnostic Surgical Sciences, School of Medicine, University of Genova, 16132 Genova, Italy
| | - Lucia Del Mastro
- Breast Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (F.P.); (L.D.M.)
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, 16132 Genova, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, 16132 Genova, Italy
- U.O.C. Clinica di Oncologia Medica, Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Correspondence:
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17
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Lindberg R, Lindqvist M, Trupp M, Vinnars MT, Nording ML. Polyunsaturated Fatty Acids and Their Metabolites in Hyperemesis Gravidarum. Nutrients 2020; 12:nu12113384. [PMID: 33158081 PMCID: PMC7694173 DOI: 10.3390/nu12113384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 12/26/2022] Open
Abstract
Polyunsaturated fatty acids (PUFAs) have been studied in relation to pregnancy. However, there is limited knowledge on PUFAs and their metabolites in relation to hyperemesis gravidarum (HG), a pregnancy complication associated with nutritional deficiencies and excessive vomiting. In order to survey the field, a systematic review of the literature was performed, which also included nausea and vomiting of pregnancy (NVP) due to its close relationship with HG. In the very few published studies found, the main subjects of the research concerned free fatty acids (four records), lipid profiles (three records), and bioactive lipids (one article about prostaglandin E2 and one about endocannabinoids). The authors of these studies concluded that, although no cause-and-effect relationship can be established, HG is linked to increased sympathetic responsiveness, thermogenic activity and metabolic rate. In addition, NVP is linked to a metabolic perturbance (which lasts throughout pregnancy). The low number of retrieved records underlines the need for more research in the area of PUFAs and HG, especially with regard to the underlying mechanism for the detected effects, potentially involving growth differentiation factor 15 (GDF15) since evidence for GDF15 regulation of lipid metabolism and the role for GDF15 and its receptor in nausea and vomiting is emerging.
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Affiliation(s)
| | - Maria Lindqvist
- Department of Nursing, Umeå University, 901 87 Umeå, Sweden;
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87 Umeå, Sweden;
| | - Miles Trupp
- Department of Clinical Sciences, Neurosciences, Umeå University, 901 87 Umeå, Sweden;
| | - Marie-Therese Vinnars
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87 Umeå, Sweden;
- Division of Obstetrics and Gynecology, Örnsköldsvik Hospital, 891 89 Örnsköldsvik, Sweden
| | - Malin L. Nording
- Department of Chemistry, Umeå University, 901 87 Umeå, Sweden;
- Correspondence:
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18
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Bhavana G, Kumar K, E A. Assessment of otolith function using vestibular evoked myogenic potential in women during pregnancy. Braz J Otorhinolaryngol 2020; 88:584-588. [PMID: 33067134 PMCID: PMC9422406 DOI: 10.1016/j.bjorl.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/01/2020] [Accepted: 08/23/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction More than 50% of pregnant women experience dizziness frequently in the first two gestational trimesters. During pregnancy, the changes in the metabolism of hormones are responsible for the ovarian cycle resulting in either peripheral or central vestibular alterations. The need for the study is to focus on the effect of changes during pregnancy on the vestibular evoked myogenic potential, an electrophysiological measure that investigates functions of the otolith structures. Objectives The aim is to investigate the vestibular evoked myogenic potential responses during the first trimester of pregnancy. Methods A total of 17 pregnant women and 17 non-pregnant women with age matched took part in this study. The cervical vestibular evoked myogenic potential were recorded from the ipsilateral sternocleridomastoid muscle and the ocular vestibular evoked myogenic potential were recorded from contralateral extraocular muscle in both groups. Results Peak to peak amplitude of cervical vestibular evoked myogenic potential and ocular vestibular evoked myogenic potential was found to be significantly reduced in the responses obtained from first-trimester pregnant women when compared to that of non-pregnant women. Conclusions Vestibular evoked myogenic potential tests exhibits a clinically significant reduced peak to peak amplitude in the first trimester of pregnancy, which indicates dysfunction in the otolith reflex pathway.
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Affiliation(s)
- G Bhavana
- Manipal Academy of Higher Education, Manipal, Kasturba Medical College, Mangalore, Department of Audiology and Speech-Language Pathology, Karnataka, India
| | - Kaushlendra Kumar
- Manipal Academy of Higher Education, Manipal, Kasturba Medical College, Mangalore, Department of Audiology and Speech-Language Pathology, Karnataka, India.
| | - Anupriya E
- Manipal Academy of Higher Education, Manipal, Kasturba Medical College, Mangalore, Department of Audiology and Speech-Language Pathology, Karnataka, India
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Ács L, Bányai D, Nemes B, Nagy K, Ács N, Bánhidy F, Rózsa N. Maternal‐related factors in the origin of isolated cleft palate—A population‐based case‐control study. Orthod Craniofac Res 2020; 23:174-180. [DOI: 10.1111/ocr.12361] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 11/24/2019] [Accepted: 12/11/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Lili Ács
- Department of Paediatric Dentistry and Orthodontics Semmelweis University Faculty of Dentistry Budapest Hungary
| | - Dorottya Bányai
- Department of Paediatric Dentistry and Orthodontics Semmelweis University Faculty of Dentistry Budapest Hungary
| | - Bálint Nemes
- Department of Paediatric Dentistry and Orthodontics Semmelweis University Faculty of Dentistry Budapest Hungary
| | - Krisztián Nagy
- 1st Department of Paediatrics Semmelweis University School of Medicine Budapest Hungary
- OMFS‐IMPATH KU Research Group Leuven Belgium
| | - Nándor Ács
- Department of Obstetrics and Gynaecology Semmelweis University School of Medicine Budapest Hungary
| | - Ferenc Bánhidy
- Department of Obstetrics and Gynaecology Semmelweis University School of Medicine Budapest Hungary
| | - Noémi Rózsa
- Department of Paediatric Dentistry and Orthodontics Semmelweis University Faculty of Dentistry Budapest Hungary
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20
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Lowe SA, Armstrong G, Beech A, Bowyer L, Grzeskowiak L, Marnoch CA, Robinson H. SOMANZ position paper on the management of nausea and vomiting in pregnancy and hyperemesis gravidarum. Aust N Z J Obstet Gynaecol 2019; 60:34-43. [PMID: 31657004 DOI: 10.1111/ajo.13084] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 09/24/2019] [Indexed: 12/27/2022]
Abstract
This is a brief summary of the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) evidence-based guideline for the management of nausea and vomiting of pregnancy (NVP) and hyperemesis gravidarum (HG). The full guideline and executive summary including auditable outcomes are freely available on the SOMANZ website [https://www.somanz.org/guidelines.asp]. The guideline includes a proposed SOMANZ definition of NVP and HG and evidence-based practical advice regarding the investigation and management of NVP, HG and associated conditions including thyroid dysfunction. A practical algorithm for assessment and management as well as an individual patient management plan and self-assessment tools are included.
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Affiliation(s)
- Sandra A Lowe
- Department of Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Georgina Armstrong
- Department of Obstetrics and Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Amanda Beech
- Department of Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Lucy Bowyer
- Department of Maternal Fetal Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Luke Grzeskowiak
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,SA Pharmacy, Flinders Medical Centre, SA Health, Adelaide, South Australia, Australia
| | | | - Helen Robinson
- Department of Medicine, Ipswich Hospital, Ipswich, Queensland, Australia
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21
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Abstract
Nausea and vomiting of pregnancy (NVP) is a common condition that affects as many as 70% of pregnant women. Although no consensus definition is available for hyperemesis gravidarum (HG), it is typically viewed as the severe form of NVP and has been reported to occur in 0.3-10.8% of pregnant women. HG can be associated with poor maternal, fetal and child outcomes. The majority of women with NVP can be managed with dietary and lifestyle changes, but more than one-third of patients experience clinically relevant symptoms that may require fluid and vitamin supplementation and/or antiemetic therapy such as, for example, combined doxylamine/pyridoxine, which is not teratogenic and may be effective in treating NVP. Ondansetron is commonly used to treat HG, but studies are urgently needed to determine whether it is safer and more effective than using first-line antiemetics. Thiamine (vitamin B1) should be introduced following protocols to prevent refeeding syndrome and Wernicke encephalopathy. Recent advances in the genetic study of NVP and HG suggest a placental component to the aetiology by implicating common variants in genes encoding placental proteins (namely GDF15 and IGFBP7) and hormone receptors (namely GFRAL and PGR). New studies on aetiology, diagnosis, management and treatment are under way. In the next decade, progress in these areas may improve maternal quality of life and limit the adverse outcomes associated with HG.
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22
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Maternal vomiting during early pregnancy and cardiovascular risk factors at school age: the Generation R Study. J Dev Orig Health Dis 2019; 11:118-126. [PMID: 31474237 PMCID: PMC7282857 DOI: 10.1017/s2040174419000114] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Evidence suggests that low birth weight and fetal exposure to extreme maternal undernutrition is associated with cardiovascular disease in adulthood. Hyperemesis gravidarum, a clinical entity characterized by severe nausea and excess vomiting leading to a suboptimal maternal nutritional status during early pregnancy, is associated with an increased risk of adverse pregnancy outcomes. Several studies also showed that different measures related to hyperemesis gravidarum, such as maternal daily vomiting or severe weight loss, are associated with increased risks of adverse fetal pregnancy outcomes. Not much is known about long-term offspring consequences of maternal hyperemesis gravidarum and related measures during pregnancy. We examined the associations of maternal daily vomiting during early pregnancy, as a measure related to hyperemesis gravidarum, with childhood cardiovascular risk factors. Methods: In a population-based prospective cohort study from early pregnancy onwards among 4,769 mothers and their children in Rotterdam, the Netherlands, we measured childhood body mass index, total fat mass percentage, android/gynoid fat mass ratio, preperitoneal fat mass area, blood pressure, lipids, and insulin levels. We used multiple regression analyses to assess the associations of maternal vomiting during early pregnancy with childhood cardiovascular outcomes. Results: Compared with the children of mothers without daily vomiting during early pregnancy, the children of mothers with daily vomiting during early pregnancy had a higher childhood total body fat mass (difference 0.12 standard deviation score [SDS]; 95% confidence interval [CI] 0.03–0.20), android/gynoid fat mass ratio (difference 0.13 SDS; 95% CI 0.04–0.23), and preperitoneal fat mass area (difference 0.10 SDS; 95% CI 0–0.20). These associations were not explained by birth characteristics but partly explained by higher infant growth. Maternal daily vomiting during early pregnancy was not associated with childhood blood pressure, lipids, and insulin levels. Conclusions: Maternal daily vomiting during early pregnancy is associated with higher childhood total body fat mass and abdominal fat mass levels, but not with other cardiovascular risk factors. Further studies are needed to replicate these findings, to explore the underlying mechanisms and to assess the long-term consequences.
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23
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Flavored electronic cigarette use, preferences, and perceptions in pregnant mothers: A correspondence analysis approach. Addict Behav 2019; 91:21-29. [PMID: 30446262 DOI: 10.1016/j.addbeh.2018.10.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/12/2018] [Accepted: 10/28/2018] [Indexed: 11/23/2022]
Abstract
Use, preferences, and perceptions of flavored electronic cigarettes (e-cigarettes) were investigated in an ethnically diverse sample of pregnant mothers (N = 100; 50% smokers, Mage = 26; 66% low income; 65% minorities) via detailed interviews. Fruit and mint were the most commonly used flavors. Pregnant women endorsed increased use of fruit flavored e-cigarettes in preconception and pregnancy, greater preferences and intentions to use sweet flavors (fruit and candy), and lowest preferences for tobacco flavors. No differences in perceptions of general, pregnancy, or fetal-related health risks emerged across flavors. Latent factor mapping (biplots) based on correspondence analyses of contingency tables revealed clustering of more-preferred fruit and candy flavors versus least-preferred tobacco flavored e-cigarettes, with other sweet flavors-mint and alcohol-clustering more closely with fruit and candy flavors, and more pungent flavors-spice, coffee, chocolate-clustering near tobacco. Correspondence analysis also revealed uncorrelated clustering of preferences and harm perceptions, with intentions showing associations with both preferences and harm perceptions. Preference for fruit and mint flavored e-cigarettes and decreased harm perceptions significantly differentiated lifetime e-cigarette users from non-users. Results highlight preferences for fruit and mint flavored e-cigarettes during preconception and pregnancy, and links between preferences for fruit and mint flavors and lifetime use of e-cigarettes. These findings also highlight the utility of correspondence analysis for elucidating clustering of flavor perceptions and preferences for novel tobacco products.
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24
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Dean CR, Shemar M, Ostrowski GAU, Painter RC. Management of severe pregnancy sickness and hyperemesis gravidarum. BMJ 2018; 363:k5000. [PMID: 30504245 DOI: 10.1136/bmj.k5000] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Caitlin R Dean
- Pregnancy Sickness Support, Dunmore Farm, Par, Cornwall, UK
- Amsterdam UMC, University of Amsterdam, Obstetrics and Gynaecology, Amsterdam, The Netherlands
| | - Manjeet Shemar
- Pregnancy Sickness Support, Dunmore Farm, Par, Cornwall, UK
- Birmingham Women's & Children's Hospital, Birmingham, UK
| | - Gillian A U Ostrowski
- Pregnancy Sickness Support, Dunmore Farm, Par, Cornwall, UK
- Bridge Lane Group Practice, Battersea, London, UK
- NHS England, London, UK
| | - Rebecca C Painter
- Amsterdam UMC, University of Amsterdam, Obstetrics and Gynaecology, Amsterdam, The Netherlands
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25
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Zambelli-Weiner A, Via C, Yuen M, Weiner DJ, Kirby RS. First trimester ondansetron exposure and risk of structural birth defects. Reprod Toxicol 2018; 83:14-20. [PMID: 30385129 DOI: 10.1016/j.reprotox.2018.10.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 08/13/2018] [Accepted: 10/26/2018] [Indexed: 11/30/2022]
Abstract
This study investigates risk of specific structural birth defects associated with ondansetron exposure during the first trimester in a large US commercially-insured population. Medical claims data were obtained from Truven Health Analytics for 864,083 mother-infant pairs from 2000 to 2014. Logistic regression was used to measure the association between first trimester exposure to ondansetron and risk of cardiac defects, orofacial clefts and other specific structural defects in offspring. First trimester exposure to ondansetron was associated with increased risk of cardiac (OR: 1.52 95% CI: 1.35-1.70) and orofacial cleft defects (OR: 1.32 95% CI: 0.76-2.28) in offspring compared to women with no antiemetic exposure during pregnancy. This analysis addresses limitations of prior studies including limited power, exposure misclassification, and generalizability to the US population. In a large, US population we found a statistically significant association between early pregnancy ondansetron exposure and specific structural birth defects in offspring.
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Affiliation(s)
- April Zambelli-Weiner
- TTi Health Research & Economics, 1231 Tech Ct, Suite 201, Westminster, MD 21157, USA.
| | - Christina Via
- TTi Health Research & Economics, 1231 Tech Ct, Suite 201, Westminster, MD 21157, USA
| | - Matt Yuen
- TTi Health Research & Economics, 1231 Tech Ct, Suite 201, Westminster, MD 21157, USA
| | - Daniel J Weiner
- TTi Health Research & Economics, 1231 Tech Ct, Suite 201, Westminster, MD 21157, USA
| | - Russell S Kirby
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B Downs Blvd, Tampa, FL 33612, USA
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26
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Colodro-Conde L, Cross SM, Lind PA, Painter JN, Gunst A, Jern P, Johansson A, Lund Maegbaek M, Munk-Olsen T, Nyholt DR, Ordoñana JR, Paternoster L, Sánchez-Romera JF, Wright MJ, Medland SE. Cohort Profile: Nausea and vomiting during pregnancy genetics consortium (NVP Genetics Consortium). Int J Epidemiol 2018; 46:e17. [PMID: 26921609 PMCID: PMC5837614 DOI: 10.1093/ije/dyv360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2015] [Indexed: 12/17/2022] Open
Affiliation(s)
- Lucía Colodro-Conde
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Department of Human Anatomy and Psychobiology, University of Murcia, and IMIB-Arrixaca, Murcia, Spain
| | - Simone M Cross
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Penelope A Lind
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Jodie N Painter
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Annika Gunst
- Department of Psychology and Speech-Language Pathology University of Turku, Turku, Finland
| | - Patrick Jern
- Department of Psychology, Åbo Akademi, University, Turku, Finland.,Department of Psychology and Speech-Language Pathology University of Turku, Turku, Finland
| | - Ada Johansson
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Department of Psychology, Åbo Akademi, University, Turku, Finland.,Department of Psychology and Speech-Language Pathology University of Turku, Turku, Finland
| | | | - Trine Munk-Olsen
- National Center for Register-based Research, Aarhus University, Aarhus Denmark
| | - Dale R Nyholt
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Juan R Ordoñana
- Department of Human Anatomy and Psychobiology, University of Murcia, and IMIB-Arrixaca, Murcia, Spain
| | - Lavinia Paternoster
- MRC Integrative Epidemiology Unit, School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Juan F Sánchez-Romera
- Department of Developmental and Educational Psychology, University of Murcia and IMIB-Arrixaca, Murcia, Spain and
| | - Margaret J Wright
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Queensland Brain Institute, University of Queensland, Brisbane, Australia
| | - Sarah E Medland
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
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27
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Petry CJ, Ong KK, Burling KA, Barker P, Goodburn SF, Perry JRB, Acerini CL, Hughes IA, Painter RC, Afink GB, Dunger DB, O'Rahilly S. Associations of vomiting and antiemetic use in pregnancy with levels of circulating GDF15 early in the second trimester: A nested case-control study. Wellcome Open Res 2018; 3:123. [PMID: 30345390 PMCID: PMC6171563 DOI: 10.12688/wellcomeopenres.14818.1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2018] [Indexed: 12/23/2022] Open
Abstract
Background: Although nausea and vomiting are very common in pregnancy, their pathogenesis is poorly understood. We tested the hypothesis that circulating growth and differentiation factor 15 (GDF15) concentrations in early pregnancy, whose gene is implicated in hyperemesis gravidarum, are associated with nausea and vomiting. Methods: Blood samples for the measurement of GDF15 and human chorionic gonadotrophin (hCG) concentrations were obtained early in the second trimester (median 15.1 (interquartile range 14.4-15.7) weeks) of pregnancy from 791 women from the Cambridge Baby Growth Study, a prospective pregnancy and birth cohort. During each trimester participants completed a questionnaire which included questions about nausea, vomiting and antiemetic use. Associations with pre-pregnancy body mass indexes (BMI) were validated in 231 pregnant NIPTeR Study participants. Results: Circulating GDF15 concentrations were higher in women reporting vomiting in the second trimester than in women reporting no pregnancy nausea or vomiting: 11,581 (10,977-12,219) (n=175) vs. 10,593 (10,066-11,147) (n=193) pg/mL, p=0.02). In women who took antiemetic drugs during pregnancy (n=11) the GDF15 levels were also raised 13,157 (10,558-16,394) pg/mL (p =0.04). Serum GFD15 concentrations were strongly positively correlated with hCG levels but were inversely correlated with maternal BMIs, a finding replicated in the NIPTeR Study. Conclusions: Week 15 serum GDF15 concentrations are positively associated with second trimester vomiting and maternal antiemetic use in pregnancy. Given GDF15's site of action in the chemoreceptor trigger zone of the brainstem and its genetic associations with hyperemesis gravidarum, these data support the concept that GDF15 may be playing a pathogenic role in pregnancy-associated vomiting.
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Affiliation(s)
- Clive J Petry
- Department of Paediatrics, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, CB2 0QQ, UK
| | - Ken K Ong
- Department of Paediatrics, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, CB2 0QQ, UK.,Medical Research Council Epidemiology Unit, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, CB2 0QQ, UK
| | - Keith A Burling
- NIHR Biomedical Research Centre Core Biochemistry Assay Lab, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, CB2 0QQ, UK
| | - Peter Barker
- NIHR Biomedical Research Centre Core Biochemistry Assay Lab, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, CB2 0QQ, UK
| | - Sandra F Goodburn
- Department of Clinical Biochemistry, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - John R B Perry
- Medical Research Council Epidemiology Unit, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, CB2 0QQ, UK
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, CB2 0QQ, UK
| | - Ieuan A Hughes
- Department of Paediatrics, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, CB2 0QQ, UK
| | - Rebecca C Painter
- Department of Gynaecology and Obstetrics, Academic Medical Center of the University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
| | - Gijs B Afink
- Reproductive Biology Laboratory, Academic Medical Center of the University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands
| | - David B Dunger
- Department of Paediatrics, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, CB2 0QQ, UK.,Metabolic Research Laboratories and MRC Metabolic Diseases Unit, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, CB2 0QQ, UK
| | - Stephen O'Rahilly
- Metabolic Research Laboratories and MRC Metabolic Diseases Unit, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, CB2 0QQ, UK
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28
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Mitsuda N, Eitoku M, Yamasaki K, Sakaguchi M, Yasumitsu-Lovell K, Maeda N, Fujieda M, Suganuma N. Nausea and vomiting during pregnancy associated with lower incidence of preterm births: the Japan Environment and Children's Study (JECS). BMC Pregnancy Childbirth 2018; 18:268. [PMID: 29945561 PMCID: PMC6020391 DOI: 10.1186/s12884-018-1911-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/21/2018] [Indexed: 11/12/2022] Open
Abstract
Background Nausea and vomiting during pregnancy (NVP) is considered to be associated with favorable fetal outcomes, such as a decreased risk for spontaneous abortion. However, the relationship between NVP and preterm births remains unknown. This study was conducted to evaluate the association between NVP and the risk of preterm births. Methods The dataset of a birth cohort study, the Japan Environment and Children’s Study (JECS), was retrospectively reviewed. Participants’ experience of NVP prior to 12 gestational weeks were evaluated by a questionnaire administered from 22 weeks of pregnancy to 1 month before delivery. NVP responses were elicited against four choices based on which the study population was divided into four subcohorts. Preterm birth was the main study outcome. Logistic regression analysis was used to quantify an association between NVP and risk of preterm birth. Results Of 96,056 women, 79,460 (82.7%) experienced some symptoms of NVP and 10,518 (10.9%) experienced severe NVP. Compared to those who did not experience NVP, women with severe NVP had lower odds for preterm birth [adjusted odds ratio (aOR) 0.84, 95% confidence interval (95% CI) 0.74–0.95]. An even lower OR was found among very preterm birth and extremely preterm birth (aOR 0.44, 95% CI 0.29–0.65). Conclusion An inverse association exists between NVP and preterm births, especially, very preterm births and extremely preterm births.
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Affiliation(s)
- Naomi Mitsuda
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
| | - Masamitsu Eitoku
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Keiko Yamasaki
- Integrated Center for Advanced Medical Technologies, Kochi Medical School, Kochi University, Kochi, Japan
| | - Masahiko Sakaguchi
- Integrated Center for Advanced Medical Technologies, Kochi Medical School, Kochi University, Kochi, Japan.,Cancer Prevention and Control Division, Kanagawa Cancer Center Research Institute, Kanagawa, Japan
| | - Kahoko Yasumitsu-Lovell
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Nagamasa Maeda
- Department of Obstetrics and Gynecology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Mikiya Fujieda
- Department of Pediatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Narufumi Suganuma
- Department of Environmental Medicine, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
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29
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Koren G, Ornoy A, Berkovitch M. Hyperemesis gravidarum-Is it a cause of abnormal fetal brain development? Reprod Toxicol 2018; 79:84-88. [PMID: 29913206 DOI: 10.1016/j.reprotox.2018.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 05/20/2018] [Accepted: 06/14/2018] [Indexed: 12/27/2022]
Abstract
Hyperemesis gravidarum (HG) is characterized by severe gestational nausea and vomiting, leading to dehydration, electrolyte imbalance and nutritional deficits. HG adversely affects the health and wellbeing of the woman. However, the detrimental impact of HG on fetal brain development has not been addressed. We evaluate herein the emerging evidence suggesting that HG interferes with human brain development, and discuss putative mechanisms. Evidence emerges from prospective developmental studies in offspring exposed in utero to HG, from studies of pregnancy outcome after in utero exposure to famine, as well as evidence on specific nutritional deficiencies affecting fetal brain development.
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Affiliation(s)
- Gideon Koren
- Motherisk Israel, Clinical Pharmacology and Toxicology Unit, Assaf Harofeh Medical Center, Zerifin; Maccabi Institute for Research and Innovation, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel; Westen University, ON, Canada; The Hebrew University, Israel.
| | - Asher Ornoy
- Westen University, ON, Canada; The Hebrew University, Israel
| | - Matitiahu Berkovitch
- Motherisk Israel, Clinical Pharmacology and Toxicology Unit, Assaf Harofeh Medical Center, Zerifin; Sackler Faculty of Medicine, Tel Aviv University, Israel; The Hebrew University, Israel
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30
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Petry CJ, Ong KK, Beardsall K, Hughes IA, Acerini CL, Dunger DB. Vomiting in pregnancy is associated with a higher risk of low birth weight: a cohort study. BMC Pregnancy Childbirth 2018; 18:133. [PMID: 29728080 PMCID: PMC5935997 DOI: 10.1186/s12884-018-1786-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 04/26/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Low birth weight has important short- and long-term health implications. Previously it has been shown that pregnancies affected by hyperemesis gravidarum in the mother are at higher risk of having low birth weight offspring. In this study we tested whether such risks are also evident with less severe nausea and vomiting in pregnancy. METHODS One thousand two hundred thirty-eight women in the prospective Cambridge Baby Growth Study filled in pregnancy questionnaires which included questions relating to adverse effects of pregnancy and drugs taken during that time. Ordinal logistic regression models, adjusted for parity, ethnicity, marital and smoking status were used to relate the risk of giving birth to low birth weight (< 2.5 kg) babies to nausea and/or vomiting in pregnancy that were not treated with anti-emetics and did not report suffering from hyperemesis gravidarum. RESULTS Only three women in the cohort reported having had hyperemesis gravidarum although a further 17 women reported taking anti-emetics during pregnancy. Of those 1218 women who did not take anti-emetics 286 (23.5%) did not experience nausea or vomiting, 467 (38.3%) experienced nausea but not vomiting and 465 experienced vomiting (38.2%). Vomiting during pregnancy was associated with higher risk of having a low birth weight baby (odds ratio 3.5 (1.2, 10.8), p = 0.03). The risk associated with vomiting was found in the first (p = 0.01) and second (p = 0.01) trimesters but not the third (p = 1.0). The higher risk was not evident in those women who only experienced nausea (odds ratio 1.0 (0.3, 4.0), p = 1.0). CONCLUSIONS Vomiting in early pregnancy, even when not perceived to be sufficiently severe to merit treatment, is associated with a higher risk of delivering a low birth weight baby. Early pregnancy vomiting might therefore be usable as a marker of higher risk of low birth weight in pregnancy. This may be of benefit in situations where routine ultrasound is not available to distinguish prematurity from fetal growth restriction, so low birth weight is used as an alternative.
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Affiliation(s)
- Clive J. Petry
- 0000000121885934grid.5335.0Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK
| | - Ken K. Ong
- 0000000121885934grid.5335.0Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK ,0000000121885934grid.5335.0Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, CB2 0QQ UK ,0000000121885934grid.5335.0The Institute of Metabolic Science, University of Cambridge, Cambridge, CB2 0QQ UK
| | - Kathryn Beardsall
- 0000000121885934grid.5335.0Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK
| | - Ieuan A. Hughes
- 0000000121885934grid.5335.0Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK
| | - Carlo L. Acerini
- 0000000121885934grid.5335.0Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK
| | - David B. Dunger
- 0000000121885934grid.5335.0Department of Paediatrics, University of Cambridge, Box 116, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK ,0000000121885934grid.5335.0The Institute of Metabolic Science, University of Cambridge, Cambridge, CB2 0QQ UK
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31
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Evaluation of nausea and vomiting in pregnancy using the Pregnancy-Unique Quantification of Emesis and Nausea scale in Korea. Obstet Gynecol Sci 2018; 61:30-37. [PMID: 29372147 PMCID: PMC5780318 DOI: 10.5468/ogs.2018.61.1.30] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/26/2017] [Accepted: 07/17/2017] [Indexed: 12/27/2022] Open
Abstract
Objective Severity of nausea and vomiting of pregnancy (NVP) is associated with adverse pregnancy outcomes and poorer quality of life (QOL). The aim of this study was to evaluate the severity of NVP and maternal well-being status using the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scale in a Korean population. Methods A total of 527 pregnant women who were receiving prenatal care at 4 hospitals were asked to participate in the study between January 2015 and June 2015. The severity of NVP was evaluated by the PUQE scale and maternal well-being status was evaluated using the visual analogue scale (VAS). Statistical analyses were performed to determine the risk factors associated with NVP and the associations between the severity of NVP and QOL. Results Among the 472 eligible pregnant women, 381 (80.7%) were suffering from NVP during pregnancy. No significant differences (P>0.05) were observed in any of the variables between the 2 study groups, with the exception of smoking, alcohol consumption, and history of NVP. NVP history was found to be the most powerful risk factor (adjusted odds ratio, 11.6; 95% confidence interval, 4.7-28.7). The correlation coefficient (r) between the VAS scores of maternal well-being status and PUQE severity was -0.25 (r2=0.062; P<0.001). Conclusion In this study, an explicit decline in maternal well-being status was observed according to severity of NVP. The PUQE scale may be of help to clinicians, healthcare providers, and researchers because of its simplicity and usefulness as a tool for NVP evaluation.
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Morales-Suárez-Varela M, Nohr EA, Olsen J, Bech BH. Potential combined effects of maternal smoking and coffee intake on foetal death within the Danish National Birth Cohort. Eur J Public Health 2017; 28:315-320. [DOI: 10.1093/eurpub/ckx222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Maria Morales-Suárez-Varela
- Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Valencia, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ellen A Nohr
- Research Unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, University of Aarhus, Aarhus, Denmark
| | - Bodil H Bech
- Section for Epidemiology, Department of Public Health, University of Aarhus, Aarhus, Denmark
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33
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Etwel F, Faught LH, Rieder MJ, Koren G. The Risk of Adverse Pregnancy Outcome After First Trimester Exposure to H1 Antihistamines: A Systematic Review and Meta-Analysis. Drug Saf 2017; 40:121-132. [PMID: 27878468 DOI: 10.1007/s40264-016-0479-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION H1 antihistamines are used for the treatment of nausea and vomiting during pregnancy as well as the symptomatic relief of asthma, urticaria, allergy, and the common cold. Although they are overall felt to be safe during pregnancy, recently several studies have challenged this assumption, as millions of women are exposed to them in the first trimester. METHODS Following the guidelines of PRISMA, a systematic review was performed to retrieve all published articles involving H1-antihistamine exposure during pregnancy. Electronic databases including PubMed and EMBASE were searched for possibly relevant articles published in any language up to December 2015. RESULTS After removing duplicate publications, and excluding animal studies and studies on drug effectiveness, 342 articles were reviewed in detail and 37 studies fulfilled the inclusion criteria for the meta-analysis. In cohort studies, the risk of major malformation in the offspring of women exposed to H1 antihistamines was not higher than that of the control population (OR 1.07; 95% CI 0.98-1.16). The Q-statistic for heterogeneity of effects was not significant (p > 0.05, I 2 < 25%) and there was no evidence of publication bias. Similar results were achieved with case-control studies (OR 1.05; 95% CI 0.90-1.23). Similarly, H1 antihistamines were not associated with more spontaneous abortions (OR 1.00; 95% CI 0.83-1.20), prematurity (OR 0.96; 95% CI 0.76-1.20), stillbirth (OR 1.23; 95% CI 0.48-3.18) or low birth weight (OR 1.20; 95% CI 0.63-2.29). CONCLUSIONS Based on our meta-analyses, which included a large number of studies, H1 antihistamines are not associated with an increased risk of major malformation or other adverse fetal outcomes. This study provides important information to both pregnant women and their healthcare providers regarding the safety and risk of H1 antihistamine use during this sensitive time.
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Affiliation(s)
- Fatma Etwel
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, Health Sciences Addition Room 222, London, ON, N6A 5C1, Canada
| | - Lauren H Faught
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, Health Sciences Addition Room 222, London, ON, N6A 5C1, Canada
| | - Michael J Rieder
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, Health Sciences Addition Room 222, London, ON, N6A 5C1, Canada
| | - Gideon Koren
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, Health Sciences Addition Room 222, London, ON, N6A 5C1, Canada.
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Hu R, Chen Y, Zhang Y, Qian Z, Liu Y, Vaughn MG, Xu S, Zheng T, Liu M, Zhang B. Association between vomiting in the first trimester and preterm birth: a retrospective birth cohort study in Wuhan, China. BMJ Open 2017; 7:e017309. [PMID: 28963301 PMCID: PMC5623485 DOI: 10.1136/bmjopen-2017-017309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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 Although vomiting in the first trimester has been reported to be associated with preterm birth (PTB), findings supporting this association remain inconsistent. Our aim was to assess the association between vomiting and PTB, as well as evaluate if the association is modified by pre-pregnancy body mass index (BMI). DESIGN A retrospective cohort study. SETTING Wuhan, a central city of China. PARTICIPANTS A total of 317 463 pregnant women who had a live, singleton newborn from 1 January 2010 to 23 May 2016 were enrolled in our study. MAIN OUTCOME MEASURE PTB was defined as gestational age <37 gestational weeks. Gestational age was calculated using reports from mothers based on the first day of their last menstrual period. An ultrasound was routinely used to determine gestational age before 12 gestational weeks. RESULTS Of the 317 463 pregnant women, 29.88% (94 857) experienced vomiting in the first trimester and 5.00% (15 889) experienced a PTB. Vomiting in the first trimester increased the risk for PTB and the multivariable adjusted OR was 1.05 (95% CI 1.02 to 1.09). In the stratified analyses, the association of vomiting in the first trimester was significant among underweight women (adjusted OR=1.08, 95% CI 1.04 to 1.17) and normal pre-pregnancy BMI women (adjusted OR=1.06, 95% CI 1.02 to 1.11), but not in overweight women (adjusted OR=1.01, 95% CI 0.90 to 1.14) and obese women (adjusted OR=0.93, 95% CI 0.73 to 1.19). CONCLUSIONS Our study indicates that vomiting in the first trimester was associated with PTB. Additionally, women with underweight and normal pre-pregnancy BMI who experienced vomiting are more likely to have a PTB.
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Affiliation(s)
- Ronghua Hu
- Health Surveillance Department, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yawen Chen
- Health Surveillance Department, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yiming Zhang
- Health Surveillance Department, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhengmin Qian
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA
| | - Yan Liu
- Health Surveillance Department, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Michael G Vaughn
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA
| | - Shunqing Xu
- Key Laboratory of Environment and Health Department, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tongzhang Zheng
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Mingzhu Liu
- Health Surveillance Department, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bin Zhang
- Health Surveillance Department, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Koren G. Safety considerations surrounding use of treatment options for nausea and vomiting in pregnancy. Expert Opin Drug Saf 2017; 16:1227-1234. [DOI: 10.1080/14740338.2017.1361403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Gideon Koren
- Western University Canada, Tel Aviv University Israel
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Korevaar TIM, de Rijke YB, Chaker L, Medici M, Jaddoe VWV, Steegers EAP, Visser TJ, Peeters RP. Stimulation of Thyroid Function by Human Chorionic Gonadotropin During Pregnancy: A Risk Factor for Thyroid Disease and a Mechanism for Known Risk Factors. Thyroid 2017; 27:440-450. [PMID: 28049387 DOI: 10.1089/thy.2016.0527] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Thyroid autoimmunity is a major risk factor for gestational thyroid disease, and recently various other risk factors have been identified, including maternal age, body mass index (BMI) and parity. Human chorionic gonadotropin (hCG) is an important determinant of gestational thyroid function, yet it is unknown to what extent differences in hCG concentration affect the risk for thyroid disease. We have recently shown that thyroperoxidase antibody positivity impairs the thyroidal response to hCG stimulation, which may suggest that this is a mechanism through which thyroid autoimmunity acts as a risk factor for thyroid disease. OBJECTIVE The purpose of this study is to determine whether hCG is a risk factor for thyroid disease entities and whether recently identified risk factors for thyroid disease may influence the thyroidal response to hCG stimulation. METHODS Human chorionic gonadotropin, thyrotropin (TSH), and free thyroxine (FT4) were measured in 5435 pregnant women participating in a prospective cohort. The association of hCG with thyroid disease entities, and the association of known risk factors with thyroidal response to hCG stimulation were studied using multivariable linear regression models. RESULTS Higher hCG concentrations were associated with a higher risk of subclinical and overt hyperthyroidism. Lower hCG concentrations were associated with a higher risk of hypothyroxinemia. In contrast, hCG concentrations were not associated with subclinical hypothyroidism. Further analyses showed that in women with hypothyroxinemia, high hCG concentrations still suppressed TSH. However, in women with subclinical hypothyroidism, high hCG concentrations were not associated with higher FT4. Higher BMI, male fetal sex, and maternal parity >2 were associated with a lower thyroidal response to hCG stimulation. CONCLUSIONS Human chorionic gonadotropin is associated with the risk of (subclinical) hyperthyroidism and hypothyroxinemia, but not with the risk of (subclinical) hypothyroidism. Women with hypothyroxinemia have a normal response to thyroidal stimulation by hCG, but this was abnormal in women with subclinical hypothyroidism. Known risk factors for thyroid dysfunction (BMI and parity), and also male fetal sex, are associated with a lower thyroidal response to hCG stimulation.
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Affiliation(s)
- Tim I M Korevaar
- 1 The Generation R Study Group, Erasmus Medical Center , Rotterdam, The Netherlands
- 2 Department of Internal Medicine, Erasmus Medical Center , Rotterdam, The Netherlands
- 3 Academic Center for Thyroid Diseases, Erasmus Medical Center , Rotterdam, The Netherlands
| | - Yolanda B de Rijke
- 4 Department of Clinical Chemistry, Erasmus Medical Center - Sophia Children's Hospital , Rotterdam, The Netherlands
| | - Layal Chaker
- 1 The Generation R Study Group, Erasmus Medical Center , Rotterdam, The Netherlands
- 2 Department of Internal Medicine, Erasmus Medical Center , Rotterdam, The Netherlands
- 3 Academic Center for Thyroid Diseases, Erasmus Medical Center , Rotterdam, The Netherlands
| | - Marco Medici
- 1 The Generation R Study Group, Erasmus Medical Center , Rotterdam, The Netherlands
- 2 Department of Internal Medicine, Erasmus Medical Center , Rotterdam, The Netherlands
- 3 Academic Center for Thyroid Diseases, Erasmus Medical Center , Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- 1 The Generation R Study Group, Erasmus Medical Center , Rotterdam, The Netherlands
- 5 Department of Pediatrics, Erasmus Medical Center - Sophia Children's Hospital , Rotterdam, The Netherlands
- 6 Department of Epidemiology, Erasmus Medical Center , Rotterdam, The Netherlands
| | - Eric A P Steegers
- 7 Department of Obstetrics and Gynecology, Erasmus Medical Center - Sophia Children's Hospital , Rotterdam, The Netherlands
| | - Theo J Visser
- 1 The Generation R Study Group, Erasmus Medical Center , Rotterdam, The Netherlands
- 2 Department of Internal Medicine, Erasmus Medical Center , Rotterdam, The Netherlands
- 3 Academic Center for Thyroid Diseases, Erasmus Medical Center , Rotterdam, The Netherlands
| | - Robin P Peeters
- 1 The Generation R Study Group, Erasmus Medical Center , Rotterdam, The Netherlands
- 2 Department of Internal Medicine, Erasmus Medical Center , Rotterdam, The Netherlands
- 3 Academic Center for Thyroid Diseases, Erasmus Medical Center , Rotterdam, The Netherlands
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Bustos M, Venkataramanan R, Caritis S. Nausea and vomiting of pregnancy - What's new? Auton Neurosci 2017; 202:62-72. [PMID: 27209471 PMCID: PMC5107351 DOI: 10.1016/j.autneu.2016.05.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 05/10/2016] [Accepted: 05/11/2016] [Indexed: 02/06/2023]
Abstract
Nausea and vomiting of pregnancy (NVP) is one of the most common disorders of pregnancy. The symptoms occur predominantly during the first trimester, although in a subgroup of patients they can continue throughout the entire pregnancy and can affect the woman's quality of life. A small percentage of women develop a severe form of NVP called hyperemesis gravidarum (HG) that if left untreated may lead to significant maternal morbidity and adverse birth outcomes. Overall, the morbidity in pregnant women with NVP is significant, although it tends to be underestimated. The pathogenesis of NVP remains unclear, but there is consensus that the disorder is multifactorial and that various genetic, endocrine and infectious factors may be involved. The treatment of NVP can be challenging as the optimal targets for therapy are not known. Currently, the therapy used depends on the severity of the disorder and it is focused on improving the symptoms while minimizing risks to mother and fetus. Therapies range from dietary changes, pharmacologic treatment or hospitalization with intravenous fluid replacement and nutrition therapy. The aims of this review are 1) to provide an overview of NVP, 2) to present possible links between the most important factors associated with the pathogenesis of NVP and 3) to discuss the effectiveness and safety of the pharmacologic and non-pharmacologic options available to treat this disorder.
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Affiliation(s)
- Martha Bustos
- School of Pharmacy, Department of Pharmaceutical Sciences, University of Pittsburgh, 716 Salk Hall, 3501 Terrace St, Pittsburgh, PA 15261, United States
| | - Raman Venkataramanan
- School of Pharmacy, Department of Pharmaceutical Sciences, University of Pittsburgh, 716 Salk Hall, 3501 Terrace St, Pittsburgh, PA 15261, United States; Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, United States
| | - Steve Caritis
- Department of Obstetrics, Gynecology and Reproductive Sciences Magee Womens Hospital, 300 Halket St., Pittsburgh, PA 15213-3180, United States; School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213, United States.
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Korevaar TIM, Steegers EAP, Chaker L, Medici M, Jaddoe VWV, Visser TJ, de Rijke YB, Peeters RP. The Risk of Preeclampsia According to High Thyroid Function in Pregnancy Differs by hCG Concentration. J Clin Endocrinol Metab 2016; 101:5037-5043. [PMID: 27648965 DOI: 10.1210/jc.2016-2397] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT During pregnancy, there is an increased demand for thyroid hormone. The pregnancy hormone human chorionic gonadotropin (hCG) is an important physiological stimulator of thyroid function. Already high-normal maternal free T4 concentrations are associated with a higher risk of preeclampsia. OBJECTIVE The objective of the investigation was to study our hypothesis that hCG concentrations can distinguish a physiological form of high thyroid function from a more pathological form of high thyroid function and that the risk of preeclampsia would differ accordingly. DESIGN TSH, free T4, hCG, or thyroperoxidase antibody concentrations were determined in pregnant women participating in a population-based prospective cohort study. SETTING The study was conducted in the general community. PARTICIPANTS A nonselected sample of 5146 pregnant women participated in the study. INTERVENTIONS There were no interventions. MAIN OUTCOME MEASURE(S) Preeclampsia was measured. RESULTS Women with high hCG-associated high thyroid function did not have a higher risk of preeclampsia than women with normal thyroid function. In contrast, women with low hCG and high thyroid function had a 3.4- to 11.1-fold higher risk of preeclampsia. These risk estimates were amplified in women with a high body mass index. Women with a low hCG and suppressed TSH (<0.10 mU/L) had a 3.2- to 8.9-fold higher risk of preeclampsia. hCG was not associated with preeclampsia, and results remained similar after exclusion of thyroperoxidase antibody-positive women. CONCLUSION This study suggests that, in contrast to women with a high hCG associated high thyroid function, women with low hCG and high thyroid function during pregnancy are at a higher risk of developing preeclampsia. The additional measurement of hCG may therefore help to distinguish a more pathological form of high thyroid function and women at a high risk of preeclampsia.
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Affiliation(s)
- Tim I M Korevaar
- The Generation R Study Group (T.I.M.K., E.A.P.S., M.M., V.W.V.J.) and Departments of Internal Medicine (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Obstetrics and Gynecology (E.A.P.S.), Pediatrics (V.W.V.J.), Epidemiology (V.W.V.J.), and Clinical Chemistry (Y.B.d.R.), Erasmus Medical Center and/or Sophia Children's Hospital, 3000 CA Rotterdam, The Netherlands; and Rotterdam Thyroid Center (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Erasmus Medical Center, 3000 DR Rotterdam, The Netherlands
| | - Eric A P Steegers
- The Generation R Study Group (T.I.M.K., E.A.P.S., M.M., V.W.V.J.) and Departments of Internal Medicine (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Obstetrics and Gynecology (E.A.P.S.), Pediatrics (V.W.V.J.), Epidemiology (V.W.V.J.), and Clinical Chemistry (Y.B.d.R.), Erasmus Medical Center and/or Sophia Children's Hospital, 3000 CA Rotterdam, The Netherlands; and Rotterdam Thyroid Center (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Erasmus Medical Center, 3000 DR Rotterdam, The Netherlands
| | - Layal Chaker
- The Generation R Study Group (T.I.M.K., E.A.P.S., M.M., V.W.V.J.) and Departments of Internal Medicine (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Obstetrics and Gynecology (E.A.P.S.), Pediatrics (V.W.V.J.), Epidemiology (V.W.V.J.), and Clinical Chemistry (Y.B.d.R.), Erasmus Medical Center and/or Sophia Children's Hospital, 3000 CA Rotterdam, The Netherlands; and Rotterdam Thyroid Center (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Erasmus Medical Center, 3000 DR Rotterdam, The Netherlands
| | - Marco Medici
- The Generation R Study Group (T.I.M.K., E.A.P.S., M.M., V.W.V.J.) and Departments of Internal Medicine (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Obstetrics and Gynecology (E.A.P.S.), Pediatrics (V.W.V.J.), Epidemiology (V.W.V.J.), and Clinical Chemistry (Y.B.d.R.), Erasmus Medical Center and/or Sophia Children's Hospital, 3000 CA Rotterdam, The Netherlands; and Rotterdam Thyroid Center (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Erasmus Medical Center, 3000 DR Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group (T.I.M.K., E.A.P.S., M.M., V.W.V.J.) and Departments of Internal Medicine (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Obstetrics and Gynecology (E.A.P.S.), Pediatrics (V.W.V.J.), Epidemiology (V.W.V.J.), and Clinical Chemistry (Y.B.d.R.), Erasmus Medical Center and/or Sophia Children's Hospital, 3000 CA Rotterdam, The Netherlands; and Rotterdam Thyroid Center (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Erasmus Medical Center, 3000 DR Rotterdam, The Netherlands
| | - Theo J Visser
- The Generation R Study Group (T.I.M.K., E.A.P.S., M.M., V.W.V.J.) and Departments of Internal Medicine (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Obstetrics and Gynecology (E.A.P.S.), Pediatrics (V.W.V.J.), Epidemiology (V.W.V.J.), and Clinical Chemistry (Y.B.d.R.), Erasmus Medical Center and/or Sophia Children's Hospital, 3000 CA Rotterdam, The Netherlands; and Rotterdam Thyroid Center (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Erasmus Medical Center, 3000 DR Rotterdam, The Netherlands
| | - Yolanda B de Rijke
- The Generation R Study Group (T.I.M.K., E.A.P.S., M.M., V.W.V.J.) and Departments of Internal Medicine (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Obstetrics and Gynecology (E.A.P.S.), Pediatrics (V.W.V.J.), Epidemiology (V.W.V.J.), and Clinical Chemistry (Y.B.d.R.), Erasmus Medical Center and/or Sophia Children's Hospital, 3000 CA Rotterdam, The Netherlands; and Rotterdam Thyroid Center (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Erasmus Medical Center, 3000 DR Rotterdam, The Netherlands
| | - Robin P Peeters
- The Generation R Study Group (T.I.M.K., E.A.P.S., M.M., V.W.V.J.) and Departments of Internal Medicine (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Obstetrics and Gynecology (E.A.P.S.), Pediatrics (V.W.V.J.), Epidemiology (V.W.V.J.), and Clinical Chemistry (Y.B.d.R.), Erasmus Medical Center and/or Sophia Children's Hospital, 3000 CA Rotterdam, The Netherlands; and Rotterdam Thyroid Center (T.I.M.K., L.C., M.M., T.J.V., R.B.P.), Erasmus Medical Center, 3000 DR Rotterdam, The Netherlands
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Bird AL, Grant CC, Bandara DK, Mohal J, Atatoa-Carr P, Wise MR, Inskip H, Miyahara M, Morton SM. Maternal health in pregnancy and associations with adverse birth outcomes: Evidence from Growing Up in New Zealand. Aust N Z J Obstet Gynaecol 2016; 57:16-24. [DOI: 10.1111/ajo.12557] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 09/12/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Amy L. Bird
- Growing Up in New Zealand; The University of Auckland; Auckland New Zealand
- Department of General Practice and Primary Health Care; The University of Auckland; Auckland New Zealand
| | - Cameron C. Grant
- Growing Up in New Zealand; The University of Auckland; Auckland New Zealand
- Centre for Longitudinal Research - He Ara ki Mua; The University of Auckland; Auckland New Zealand
- Department of Paediatrics: Child and Youth Health; The University of Auckland; Auckland New Zealand
- Starship Children's Hospital; Auckland District Health Board; Auckland New Zealand
| | - Dinusha K. Bandara
- Growing Up in New Zealand; The University of Auckland; Auckland New Zealand
| | - Jatender Mohal
- Growing Up in New Zealand; The University of Auckland; Auckland New Zealand
| | - Polly E. Atatoa-Carr
- Growing Up in New Zealand; The University of Auckland; Auckland New Zealand
- Centre for Longitudinal Research - He Ara ki Mua; The University of Auckland; Auckland New Zealand
- National Institute of Demographic and Economic Analysis; University of Waikato; Hamilton New Zealand
| | - Michelle R. Wise
- Department of Obstetrics & Gynaecology; University of Auckland; Auckland New Zealand
| | - Hazel Inskip
- MRC Lifecourse Epidemiology Unit; University of Southampton; Southampton UK
| | - Motohide Miyahara
- School of Physical Education, Sport and Exercise Sciences; University of Otago; Dunedin New Zealand
| | - Susan M.B. Morton
- Growing Up in New Zealand; The University of Auckland; Auckland New Zealand
- Centre for Longitudinal Research - He Ara ki Mua; The University of Auckland; Auckland New Zealand
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Sapra KJ, Joseph KS, Galea S, Bates LM, Louis GMB, Ananth CV. Signs and Symptoms of Early Pregnancy Loss. Reprod Sci 2016; 24:502-513. [PMID: 27342274 DOI: 10.1177/1933719116654994] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Approximately one-third of pregnancies end in loss; however, the natural history of early pregnancy loss, including signs and symptoms preceding loss, has yet to be fully described and its underlying mechanisms fully understood. We searched PubMed/MEDLINE and Embase to identify articles with prospective ascertainment of signs and symptoms, including vaginal bleeding, nausea, and vomiting, of pregnancy loss < 20 weeks gestation in spontaneous conceptions to ascertain existing literature on symptomatology of pregnancy loss. Two preconception and 16 pregnancy cohort studies that ascertained information on bleeding and/or nausea/vomiting prior to pregnancy loss ascertainment were included. Data from these studies indicated increased risk of loss with vaginal bleeding and decreased risk of loss with nausea/vomiting, though these studies were mostly comprised of pregnancies surviving into late first trimester. While such associations are biologically plausible, these study designs are subject to bias, given recruitment of women at later gestational ages and reliance on women presenting to care. Reporting symptoms to clinicians and over long periods may introduce reporting error. Data gaps remain regarding (1) relationships between signs and symptoms and losses occurring very early, prior to care entry; (2) empirical testing of whether relationships between signs and symptoms and loss differ across gestational age; (3) whether similar relationships between signs and symptoms and loss are observed in populations using assisted reproductive technologies; (4) the patterning of multiple signs and symptoms in relation to loss; and (5) how hormonal and physiologic adaptions to early pregnancy relate to symptomatology and pregnancy loss.
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Affiliation(s)
- Katherine J Sapra
- 1 Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA.,2 Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA
| | - K S Joseph
- 3 Department of Obstetrics and Gynaecology and the School of Population and Public Health, University of British Columbia, and the Children's and Women's Hospital of British Columbia, Vancouver, British Columbia, Canada
| | - Sandro Galea
- 1 Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA.,4 School of Public Health, Boston University, Boston, MA, USA
| | - Lisa M Bates
- 1 Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Germaine M Buck Louis
- 2 Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA
| | - Cande V Ananth
- 1 Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA.,5 Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Nausea and Vomiting During Pregnancy is Highly Heritable. Behav Genet 2016; 46:481-91. [PMID: 26801654 DOI: 10.1007/s10519-016-9781-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/05/2016] [Indexed: 12/27/2022]
Abstract
Nausea and vomiting during pregnancy (NVP) affects about 70 % of all expectant mothers and commonly impacts their physical health and psychosocial functioning. The aim of this study was to estimate the heritability of the presence, duration and severity of NVP. The sample consisted of 1723 women (M age = 41.78, SD = 11.67) including twins in both complete and incomplete pairs and their sisters from two cohorts participating in the NVP Genetics Consortium. The sample comprised 159 monozygotic and 140 dizygotic complete twin pairs, and 69 twin-sister pairs. We applied an extended twin design using OpenMx and Mx for secondary analysis. Individual differences in NVP were best explained by additive genetic and unique environmental effects. Heritability estimates were 73 % (95 % CIs = 57-84 %) for presence, 51 % (95 % CIs = 36-63 %) for duration and 53 % (95 % CIs = 38-65 %) for severity of NVP. The genetic correlation between duration and severity was almost perfect. Our results show that genes play an important role in different aspects of NVP and justify the importance of searching for genetic variants.
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Korevaar TIM, Muetzel R, Tiemeier H, Peeters RP. Maternal thyroid function and child IQ - Authors' reply. Lancet Diabetes Endocrinol 2016; 4:18. [PMID: 26724592 DOI: 10.1016/s2213-8587(15)00471-4] [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] [Received: 11/24/2015] [Accepted: 11/24/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Tim I M Korevaar
- The Generation R Study Group, Erasmus Medical Center, 3000 CA Rotterdam, Netherlands; Department of Internal Medicine, Erasmus Medical Center, 3000 CA Rotterdam, Netherlands; Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, Netherlands.
| | - Ryan Muetzel
- The Generation R Study Group, Erasmus Medical Center, 3000 CA Rotterdam, Netherlands; Department of Child and Adolescent Psychiatry, Erasmus Medical Center, 3000 CA Rotterdam, Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, 3000 CA Rotterdam, Netherlands; Department of Epidemiology, Erasmus Medical Center, 3000 CA Rotterdam, Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus Medical Center, 3000 CA Rotterdam, Netherlands; Rotterdam Thyroid Center, Erasmus Medical Center, 3000 CA Rotterdam, Netherlands
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Bech BH, Frydenberg M, Henriksen TB, Obel C, Olsen J. Coffee Consumption During Pregnancy and Birth Weight: Does Smoking Modify the Association? JOURNAL OF CAFFEINE RESEARCH 2015. [DOI: 10.1089/jcr.2015.0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Bodil Hammer Bech
- Section for Epidemiology, Department of Public Health, University of Aarhus, Aarhus, Denmark
| | - Morten Frydenberg
- Section for Biostatistics, Department of Public Health, University of Aarhus, Aarhus, Denmark
| | | | - Carsten Obel
- Section for General Practice/Family Medicine, Department of Public Health, University of Aarhus, Aarhus, Denmark
| | - Jørn Olsen
- Section for Epidemiology, Department of Public Health, University of Aarhus, Aarhus, Denmark
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