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Abouzaid M, Howidi N, Badran Z, Mohammed G, Mousa NA. The potential role of the gingival crevicular fluid biomarkers in the prediction of pregnancy complications. Front Med (Lausanne) 2023; 10:1168625. [PMID: 37342498 PMCID: PMC10277493 DOI: 10.3389/fmed.2023.1168625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/18/2023] [Indexed: 06/23/2023] Open
Abstract
Early and minimally invasive methods are required to predict the risk of multiple adverse pregnancy outcomes. A potential technique with growing interest utilizes the gingival crevicular fluid (GCF), a physiological serum exudate found in the healthy gingival sulcus and in the periodontal pocket in inflammatory conditions. Analysis of biomarkers in the GCF is a minimally invasive method that can be feasible and cost-effective. The potential use of GCF biomarkers along with other clinical indicators in early pregnancy may provide reliable predictors of several adverse pregnancy outcomes, therefore, reducing both maternal and fetal morbidities. Various studies have reported that increased or decreased concentrations of different biomarkers in GCF are associated with a high risk of developing pregnancy complications. In particular, such associations have been commonly demonstrated with gestational diabetes, pre-eclampsia, and pre-term birth. However, limited evidence is available regarding other pregnancy complications such as preterm premature rupture of membranes, recurrent miscarriage, small for gestational age, and hyperemesis gravidarum. In this review, we discuss the reported association between individual GCF biomarkers and common pregnancy complications. Future research is required to provide more solid evidence of the predictive value of those biomarkers in estimating women's risk for each disorder.
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Affiliation(s)
- Maryam Abouzaid
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Nourhan Howidi
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Zahi Badran
- Periodontology Unit, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Ghada Mohammed
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Noha A. Mousa
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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Liu C, Zhao G, Qiao D, Wang L, He Y, Zhao M, Fan Y, Jiang E. Emerging Progress in Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum: Challenges and Opportunities. Front Med (Lausanne) 2022; 8:809270. [PMID: 35083256 PMCID: PMC8785858 DOI: 10.3389/fmed.2021.809270] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/17/2021] [Indexed: 12/16/2022] Open
Abstract
Nausea and vomiting of pregnancy (NVP) is a common condition that affects up to 70% of pregnant women. Hyperemesis gravidarum (HG) is considered the serious form of NVP, which is reported in 0.3–10.8% of pregnant women. NVP has a relatively benign course, but HG can be linked with some poor maternal, fetal, and offspring outcomes. The exact causes of NVP and HG are unknown, but various factors have been hypothesized to be associated with pathogenesis. With the advance of precision medicine and molecular biology, some genetic factors such as growth/differentiation factor 15 (GDF15) have become therapeutic targets. In our review, we summarize the historical hypotheses of the pathogenesis of NVP and HG including hormonal factors, Helicobacter pylori, gastrointestinal dysmotility, placenta-related factors, psychosocial factors, and new factors identified by genetics. We also highlight some approaches to the management of NVP and HG, including pharmacological treatment, complementary treatment, and some supporting treatments. Looking to the future, progress in understanding NVP and HG may reduce the adverse outcomes and improve the maternal quality of life during pregnancy.
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Affiliation(s)
- Chuan Liu
- School of Medicine, Henan University, Kaifeng, China
| | - Guo Zhao
- School of Medicine, Henan University, Kaifeng, China
| | - Danni Qiao
- School of Medicine, Henan University, Kaifeng, China
| | - Lintao Wang
- Department of Neurology, The First Affiliated Hospital of Henan University, Kaifeng, China
| | - Yeling He
- School of Medicine, Henan University, Kaifeng, China
| | - Mingge Zhao
- School of Life Sciences, Henan University, Kaifeng, China
| | - Yuanyuan Fan
- School of Life Sciences, Henan University, Kaifeng, China
| | - Enshe Jiang
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, China.,Henan International Joint Laboratory for Nuclear Protein Regulation, Henan University, Kaifeng, China
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Ng QX, Venkatanarayanan N, De Deyn MLZQ, Ho CYX, Mo Y, Yeo WS. A meta-analysis of the association between Helicobacter pylori (H. pylori) infection and hyperemesis gravidarum. Helicobacter 2018; 23. [PMID: 29178407 DOI: 10.1111/hel.12455] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hyperemesis gravidarum remains a common, distressing, and significant yet poorly understood disorder during pregnancy. The association between maternal Helicobacter pylori (H. pylori) infection and hyperemesis gravidarum has been increasingly recognized and investigated. This study thus aimed to provide an updated review and meta-analysis of the topic. METHODS Using the search terms (H. pyloriOR Helicobacter ORHelicobacter pyloriOR infection) AND (pregnancy OR emesis OR hyperemesis gravidarum OR nausea OR vomiting), a preliminary search on the PubMed, Ovid, Web of Science, Google Scholar, and WanFang database yielded 372 papers published in English between January 1st, 1960 and June 1st, 2017. RESULTS A total of 38 cross-sectional and case-control studies, with a total of 10 289 patients were eligible for review. Meta-analysis revealed a significant association between H. pylori infection and hyperemesis gravidarum during pregnancy, with a pooled odds ratio of 1.348 (95% CI: 1.156-1.539, P < .001). Subgroup analysis found that serologic and stool antigen tests were comparable methods of detecting H. pylori as they yielded similar odds ratios. LIMITATIONS Although the studies did not have high heterogeneity (I2 = 28%), publication bias was observed, and interstudy discrepancies in the diagnostic criteria adopted for hyperemesis gravidarum limit the reliability of findings. Also, 15 of the included studies were from the same country (Turkey), which could limit the generalizability of current findings. The prevalence of H. pylori infection varies throughout the world, and there may also be pathogenic differences as most strains of H. pylori in East Asia carry the cytotoxin-associated gene A gene. CONCLUSION H. pylori infection was associated with an increased likelihood of hyperemesis gravidarum during pregnancy. Given the high prevalence of H. pylori infections worldwide, detecting H. pylori infection and the eradication of maternal H. pylori infection could be part of maternal hyperemesis gravidarum management. Further confirmation with robust longitudinal studies and mechanistic investigations are needed.
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Affiliation(s)
- Qin Xiang Ng
- KK Women's and Children's Hospital, Singapore City, Singapore.,MOH Holdings, Singapore City, Singapore
| | | | | | | | - Yin Mo
- National University Hospital, National University Health System, Singapore City, Singapore
| | - Wee-Song Yeo
- National University Hospital, National University Health System, Singapore City, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
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Konikoff T, Avraham T, Ophir E, Bornstein J. Hyperemesis gravidarum in northern Israel: a retrospective epidemiological study. Isr J Health Policy Res 2016; 5:39. [PMID: 27733901 PMCID: PMC5045651 DOI: 10.1186/s13584-016-0100-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 08/12/2016] [Indexed: 12/27/2022] Open
Abstract
Background Hyperemesis gravidarum (HG) is characterized by severe intractable nausea and vomiting in pregnancy leading to electrolyte imbalance, ketonuria, and weight loss. The cause is unknown. This study sought to investigate the prevalence and characteristics of HG in the Western Galilee in two ethnic populations and to estimate its economic burden. Methods Data on ethnicity, age, gestational age, number of pregnancies, and length of hospitalization were collected from the medical files of all women with HG admitted to the Galilee Medical Center in 2010–2013. Findings were compared between Arabs and Jews. Prevalence was assessed relative to total number of births. Economic burden was assessed by cost of hospitalization and work days lost. Results The cohort included 184 women, 124 Arabic (67.4 %) and 60 Jewish (32.6 %). There were 13,630 births at the medical center during the study period, for a calculated prevalence of HG of 1.2 %. There was no difference in the relative proportions of Arabs and Jews between the cohort and the total women giving birth at our center. Mean patient age was 27.2 years, gestational age 9.3 weeks, parity 2.35. Mean age was significantly higher in the Jewish group. There were no significant between-group differences in the other clinical parameters. Mean number of hospitalization days was 2.24 days, and of additional rest days prescribed, 4.62. The calculated annual cost of HG was 452,943.42 NIS (120,144.14 USD), crudely extrapolated to a nationwide cost of 15–20 million NIS (5,300,000 USD). Conclusion The prevalence and characteristics of HG are similar in the Arabic and Jewish populations of northern Israel. Mean gestational age at admission for HG was lower in our study than earlier ones, probably owing to the universal health care provided by law in Israel. HG prevalence was twice that reported previously in southern Israel but still within the range observed in other world regions. The socioeconomic differences between Arabs and Jews in the Galilee are smaller than elsewhere in Israel, suggesting a multifactorial etiology of HG. HG poses a major economic burden which should be considered when planning health policies. Further studies of this issue are warranted.
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Affiliation(s)
- Tom Konikoff
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel ; Department of Internal Medicine D, Rabin Medical Center Beilinson Hospital, Petach Tikva, 4941492 Israel
| | - Tehila Avraham
- Department of Statistical Studies, Hebrew University, Jerusalem, Israel
| | - Ella Ophir
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel ; Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
| | - Jacob Bornstein
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel ; Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
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Helicobacter pylori Infection Is Associated with an Increased Risk of Hyperemesis Gravidarum: A Meta-Analysis. Gastroenterol Res Pract 2015; 2015:278905. [PMID: 25861257 PMCID: PMC4378596 DOI: 10.1155/2015/278905] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/13/2015] [Accepted: 02/22/2015] [Indexed: 02/07/2023] Open
Abstract
Background. Several studies have shown a possible involvement of Helicobacter pylori (H. pylori) infection in individuals with hyperemesis gravidarum (HG), but the relationship remains controversial. This meta-analysis was performed to validate and strengthen the association between HG and H. pylori infection. Methods. PubMed, Embase, and Web of Science databases up to March 20, 2014, were searched to select studies on the prevalence of H. pylori infection between pregnant women with HG and the normal pregnant control subjects. Results. Of the HG cases, 1289 (69.6%) were H. pylori-positive; however, 1045 (46.2%) were H. pylori-positive in control group. Compared to the non-HG normal pregnant controls, infection rate of H. pylori was significantly higher in pregnant women with HG (OR = 3.34, 95% CI: 2.32–4.81, P < 0.001). Subgroup analysis indicated that H. pylori infection was a risk factor of HG in Asia, Africa, and Oceania, especially in Africa (OR = 12.38, 95% CI: 7.12–21.54, P < 0.001). Conclusions. H. pylori should be considered one of the risk factors of HG, especially in the developing countries. H. pylori eradication could be considered to relieve the symptoms of HG in some intractable cases.
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Diagnostic markers for hyperemesis gravidarum: a systematic review and metaanalysis. Am J Obstet Gynecol 2014; 211:150.e1-15. [PMID: 24530975 DOI: 10.1016/j.ajog.2014.02.012] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/14/2014] [Accepted: 02/11/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Currently, there is no consensus on the definition of hyperemesis gravidarum (HG; protracted vomiting in pregnancy) and no single widely used set of diagnostic criteria for HG. The various definitions rely on symptoms, sometimes in combination with laboratory tests. Through a systematic review, we aimed to summarize available evidence on the diagnostic value of biomarkers for HG. This could assist diagnosis and may shed light on the, as yet, not understood cause of the disorder. STUDY DESIGN We searched Medline and Embase for articles about diagnostic biomarkers for either the presence or severity of HG or nausea and vomiting of pregnancy. We defined HG as any combination of nausea, vomiting, dehydration, weight loss, or hospitalization for nausea and/or vomiting in pregnancy, in the absence of any other obvious cause for these complaints. RESULTS We found 81 articles on 9 biomarkers. Although 65% of all studies included only HG cases with ketonuria, we did not find an association between ketonuria and presence or severity of HG in 5 studies reporting on this association. Metaanalysis, with the use of the hierarchical summary receiver operating characteristics model, yielded an odds ratio of 3.2 (95% confidence interval, 2.0-5.1) of Heliobacter pylori for HG, as compared with asymptomatic control subjects (sensitivity, 73%; specificity, 55%). Studies on human chorionic gonadotropin and thyroid hormones, leptin, estradiol, progesterone, and white blood count showed inconsistent associations with HG; lymphocytes tended to be higher in women with HG. CONCLUSION We did not find support for the use of ketonuria in the diagnosis of HG. H pylori serology might be useful in specific patients.
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7
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Cardaropoli S, Rolfo A, Todros T. Helicobacter pylori and pregnancy-related disorders. World J Gastroenterol 2014; 20:654-664. [PMID: 24574739 PMCID: PMC3921475 DOI: 10.3748/wjg.v20.i3.654] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 11/18/2013] [Accepted: 01/02/2014] [Indexed: 02/06/2023] Open
Abstract
Helicobacter pylori (H. pylori) infection is investigated in gastric diseases even during pregnancy. In particular, this Gram-negative bacterium seems to be associated with hyperemesis gravidarum, a severe form of nausea and vomiting during pregnancy. During the last decade, the relationship among H. pylori and several extra-gastric diseases strongly emerged in literature. The correlation among H. pylori infection and pregnancy-related disorders was mainly focused on iron deficiency anemia, thrombocytopenia, fetal malformations, miscarriage, pre-eclampsia and fetal growth restriction. H. pylori infection may have a role in the pathogenesis of various pregnancy-related disorders through different mechanisms: depletion of micronutrients (iron and vitamin B12) in maternal anemia and fetal neural tube defects; local or systemic induction of pro-inflammatory cytokines release and oxidative stress in gastrointestinal disorders and pre-eclampsia; cross-reaction between specific anti-H. pylori antibodies and antigens localized in placental tissue and endothelial cells (pre-eclampsia, fetal growth restriction, miscarriage). Since H. pylori infection is most likely acquired before pregnancy, it is widely believed that hormonal and immunological changes occurring during pregnancy could activate latent H. pylori with a negative impact not only on maternal health (nutritional deficiency, organ injury, death), but also on the fetus (insufficient growth, malformation, death) and sometime consequences can be observed later in life. Another important issue addressed by investigators was to determine whether it is possible to transmit H. pylori infection from mother to child and whether maternal anti-H. pylori antibodies could prevent infant’s infection. Studies on novel diagnostic and therapeutic methods for H. pylori are no less important, since these are particularly sensitive topics in pregnancy conditions. It could be interesting to study the possible correlation between H. pylori infection and other pregnancy-related diseases of unknown etiology, such as gestational diabetes mellitus, obstetric cholestasis and spontaneous preterm delivery. Since H. pylori infection is treatable, the demonstration of its causative role in pregnancy-related disorders will have important social-economic implications.
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8
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Association of Helicobacter pylori positivity with the symptoms in patients with hyperemesis gravidarum. Arch Gynecol Obstet 2013; 288:1279-83. [DOI: 10.1007/s00404-013-2869-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 04/23/2013] [Indexed: 10/26/2022]
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9
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Guven MA, Ertas IE, Coskun A, Ciragil P. Serologic and stool antigen assay of Helicobacter pylori infection in hyperemesis gravidarum: which test is useful during early pregnancy? Taiwan J Obstet Gynecol 2011; 50:37-41. [PMID: 21482373 DOI: 10.1016/j.tjog.2009.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2009] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To investigate the relationship between Helicobacter pylori infection and hyperemesis gravidarum (HG) during early pregnancy by using serologic and stool antigen tests in developing South Anatolia region of Turkey. MATERIALS AND METHODS A prospective cross-sectional study was performed on 40 pregnant women with HG and 40 asymptomatic controls without gastric problems at 7-12 weeks of gestation. The sociodemographic characteristics were recorded. The presence of H pylori was analyzed in the sera of the study-group patients by serology-specific IgG test in serum and by a stool antigen test in fecal samples. RESULTS The rates of serology-specific H pylori IgG positivity were 80% (32 of 40) in patients with HG and 35% (14 of 40) in control group. The difference between the two groups was significant [odds ratio: 6.9 (confidence interval: 2.2-22.1); p<0.01]. The rates of H pylori stool antigen test positivity were 87.5% (35 of 40) in patients with HG and 62.5% (25 of 40) in control groups. The difference between the two groups was significant (odds ratio: 4.5, confidence interval: 1.09-18.5); p=0.028. CONCLUSION Both serology-specific IgG and stool antigen tests seem to be good screening methods to identify H pylori in our pregnant patient population with HG during early pregnancy.
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Affiliation(s)
- Melih Atahan Guven
- Department of Obstetrics and Gynecology, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.
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10
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Mansour GM, Nashaat EH. Role of Helicobacter pylori in the pathogenesis of hyperemesis gravidarum. Arch Gynecol Obstet 2010; 284:843-7. [PMID: 21079980 DOI: 10.1007/s00404-010-1759-8] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 10/29/2010] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the role of Helicobacter pylori (H. pylori) in the pathogenesis of hyperemesis gravidarum (HG) and the value of adding a non teratogenic regimen for its treatment in intractable cases. METHODS Eighty hyperemesis gravidarum cases were recruited from Ain Shams University out patient clinics. A complete history was taken including history of medical disorders and chronic medications intake as non steroidal anti-inflammatory drugs. After general and local examination, ultrasound was done for all cases to exclude obstetric causes of hyperemesis. Eighty normal pregnant women acted as control. Serum test for H. pylori IgG antibody titre was done for all patients and controls. RESULTS Seventy-one cases among the 80 HG cases and twenty-four out of the 80 controls were H. pylori positive. Eight HG cases developed severe intractable vomiting. Three of them developed attacks of hematemesis. Gastroscopy done for the eight cases revealed antral gastritis and duodenitis. Gastric and duodenal erosions were found in two cases. The eight patients received a non teratogenic regimen for treatment. Attacks of vomiting decreased and pregnancy continued till delivery of healthy newborns. CONCLUSION Screening for H. pylori should be added to the investigations of hyperemesis gravidarum cases. Non teratogenic treatment can be considered in intractable cases.
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Affiliation(s)
- Ghada M Mansour
- Department of Obstetrics and Gynecology, Ain Shams University, 5th El Gahez street, Seventh area, Nasr city, Cairo, Egypt.
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Jueckstock JK, Kaestner R, Mylonas I. Managing hyperemesis gravidarum: a multimodal challenge. BMC Med 2010; 8:46. [PMID: 20633258 PMCID: PMC2913953 DOI: 10.1186/1741-7015-8-46] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 07/15/2010] [Indexed: 12/18/2022] Open
Abstract
Up to 90% of pregnant women experience nausea and vomiting. When prolonged or severe, this is known as hyperemesis gravidarum (HG), which can, in individual cases, be life threatening. In this article the aetiology, diagnosis and treatment strategies will be presented based on a selective literature review. Treatment strategies range from outpatient dietary advice and antiemetic drugs to hospitalization and intravenous (IV) fluid replacement in persistent or severe cases. Alternative methods, such as acupuncture, are not yet evidence based but sometimes have a therapeutic effect.In most cases, the condition is self limiting and subsides by around 20 weeks gestation. More severe forms require medical intervention once other organic causes of nausea and vomiting have been excluded. In addition, a psychosomatic approach is often helpful.In view of its potential complexity, general practitioners and obstetricians should be well informed about HG and therapy should be multimodal.
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Affiliation(s)
- J K Jueckstock
- First Department of Obstetrics and Gynaecology, Campus Innenstadt, Ludwig-Maximilians-University, Maistrasse 11, 80337 Munich, Germany
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Helicobacter pylori infection and Hyperemesis gravidarum. An institution-based case–control study. Eur J Epidemiol 2008; 23:491-8. [DOI: 10.1007/s10654-008-9261-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Accepted: 04/23/2008] [Indexed: 01/01/2023]
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Phayphet M, Rafat C, Andreux F, Parraga E, Rondeau E, Hertig A. Hyperemesis gravidarum: une cause rare d'encéphalopathie de Wernicke. Presse Med 2007; 36:1759-61. [PMID: 17572049 DOI: 10.1016/j.lpm.2007.05.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Accepted: 12/21/2006] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Wernicke encephalopathy - most often observed in alcoholic patients - is due to severe thiamine deficiency. CASE We report here the case of a 30-year-old woman who presented with hyperemesis and vomiting during the first trimester of pregnancy (hyperemesis gravidarum). Hyperemesis can lead to severe, symptomatic thiamine deficiency and to severe dehydration with prerenal azotemia. DISCUSSION Wernicke encephalopathy is a rare complication of hyperemesis gravidarum. It should be diagnosed as early as possible to prevent long-term complications.
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Gill SK, Einarson A. The safety of drugs for the treatment of nausea and vomiting of pregnancy. Expert Opin Drug Saf 2007; 6:685-94. [DOI: 10.1517/14740338.6.6.685] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Golberg D, Szilagyi A, Graves L. Hyperemesis gravidarum and Helicobacter pylori infection: a systematic review. Obstet Gynecol 2007; 110:695-703. [PMID: 17766620 DOI: 10.1097/01.aog.0000278571.93861.26] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To systematically review studies examining the relationship between hyperemesis gravidarum and Helicobacter pylori (H pylori) infection. DATA SOURCES A 1966 to January 2007 search using MEDLINE/PubMed, EMBASE, and Web of Science included MeSH terms: "Helicobacter pylori," "Helicobacter infections," "hyperemesis gravidarum," and the text words "nausea," "vomit," "pregnancy," and "Helicobacter." References of selected papers were examined for additional relevant studies. METHODS OF STUDY SELECTION We evaluated studies investigating a relationship between hyperemesis gravidarum and H pylori infection. Studies were included in which the diagnosis of hyperemesis gravidarum was made at or before entry into the study, and H pylori diagnosis was made by serum antibody sample, gastric biopsy, saliva test, or stool sample. The search produced 169 titles; 22 were reviewed in further detail. TABULATION, INTEGRATION, AND RESULTS Fourteen case-control studies met established criteria, involving 1,732 participants and controls tested for H pylori infection. Studies were evaluated according to patient demographics and study methodology (case definition, exclusion criteria, H pylori testing). An estimate of the odds ratios with 95% confidence intervals was calculated by using a random effects model for dichotomous variables with review article software. Ten studies showed a significant association between hyperemesis gravidarum and H pylori infection. Odds ratios varied from 0.55 to 109.33; three results were less than 1.0. Tests for heterogeneity applied to several subgroups were considerable with values above 75% for all groups. CONCLUSION An association between hyperemesis gravidarum and H pylori infection is suggested by this systematic review. However, the considerable heterogeneity among studies highlights study limitations.
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Affiliation(s)
- Deborah Golberg
- Department of Family Medicine, SMBD Jewish General Hospital, McGill University, Montreal, Canada.
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Aytac S, Türkay C, Kanbay M. Helicobacter pylori stool antigen assay in hyperemesis gravidarum: a risk factor for hyperemesis gravidarum or not? Dig Dis Sci 2007; 52:2840-3. [PMID: 17431779 DOI: 10.1007/s10620-006-9709-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Accepted: 11/27/2006] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To test the hypothesis that Helicobacter pylori (H. pylori) infection may cause hyperemesis gravidarum (HG). MATERIALS AND METHODS A prospective-comparative study was performed on 107 pregnant patients from October 2002 to December 2003 in a university-based prenatal care clinic. Blood and stool samples were obtained from 52 patients diagnosed as HG and 55 matched asymptomatic pregnant women. H. pylori stool antigen (HpSA) status of the participants was evaluated using a commercially available enzyme immunoassay-based kit. RESULTS The overall prevalence of HpSA positivity appeared as 41.1%. Twenty-two of 52 (42.3%) HG patients and 22 of 55 (40.0%) control subjects were positive for HpSA. The difference was not significant (p>.05). CONCLUSION HG seemed to be not associated with H. pylori infection, as indicated by specific stool antigen assay.
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Affiliation(s)
- Sirin Aytac
- Department of Gastroenterology, Güven Hospital, Ankara, Turkey
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Sinan Karadeniz R, Ozdegirmenci O, Metin Altay M, Solaroglu A, Dilbaz S, Hızel N, Haberal A. Helicobacter pylori seropositivity and stool antigen in patients with hyperemesis gravidarum. Infect Dis Obstet Gynecol 2007; 2006:73073. [PMID: 17093356 PMCID: PMC1522059 DOI: 10.1155/idog/2006/73073] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The objective of this paper is to investigate whether Helicobacter pylori is an etiologic factor in hyperemesis gravidarum. Thirty one patients with hyperemesis gravidarum and twenty nine pregnant
controls without hyperemesis gravidarum were included in this
prospective study. All pregnant women were examined both for
Helicobacter pylori serum immunoglobulin G antibodies
(HpIgG Ab), showing chronic infection, and Helicobacter pylori
stool antigens (HpSA), showing active gastrointestinal colonization. Chi-square
and Student t tests were used accordingly for statistical analysis.
Helicobacter pylori seropositivity was
67.7% in the patients with hyperemesis gravidarum and
79.3% in the control group (χ2 = 1.02, P = .31). HpSA was detected in 22.6% of patients with hyperemesis
gravidarum, whereas 6.9% of patients in the control group. The difference was not statistically
significant (χ2 = 2.89, P = .08). In this study, no relation was found between Helicobacter pylori and
hyperemesis gravidarum. The low social status of women in both groups could be one of the reasons for the high prevalence of Hp infection.
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Affiliation(s)
- R. Sinan Karadeniz
- Turkish Ministry of Health, Ankara Etlik Maternity and Women's Health Teaching Hospital, TR-06010 Etlik, Ankara, Turkey
| | - Ozlem Ozdegirmenci
- Turkish Ministry of Health, Ankara Etlik Maternity and Women's Health Teaching Hospital, TR-06010 Etlik, Ankara, Turkey
- *Ozlem Ozdegirmenci:
| | - M. Metin Altay
- Turkish Ministry of Health, Ankara Etlik Maternity and Women's Health Teaching Hospital, TR-06010 Etlik, Ankara, Turkey
| | - Ayse Solaroglu
- Turkish Ministry of Health, Ankara Etlik Maternity and Women's Health Teaching Hospital, TR-06010 Etlik, Ankara, Turkey
| | - Serdar Dilbaz
- Turkish Ministry of Health, Ankara Etlik Maternity and Women's Health Teaching Hospital, TR-06010 Etlik, Ankara, Turkey
| | - Nedret Hızel
- Turkish Ministry of Health, Ankara Etlik Maternity and Women's Health Teaching Hospital, TR-06010 Etlik, Ankara, Turkey
| | - Ali Haberal
- Turkish Ministry of Health, Ankara Etlik Maternity and Women's Health Teaching Hospital, TR-06010 Etlik, Ankara, Turkey
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18
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Woods SDS, Chee JBL, Sinclair CF, Tremayne AB, Clooney JN. Helicobacter status does not relate to postanesthetic nausea. Helicobacter 2005; 10:443-4. [PMID: 16181355 DOI: 10.1111/j.1523-5378.2005.00352.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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19
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Abstract
BACKGROUND Hyperemesis gravidarum (HG) is reported in 0.5-2% of all pregnancies. The purpose of this research was to evaluate the relationship of maternal HG, neonatal birth weight, and birth outcomes. METHODS This is a prospective cohort study of 45 patients diagnosed, by Fairweather's criteria, with HG compared with 306 non-HG control pregnant patients with singleton pregnancies. Sociodemographic and clinical data were obtained from the pregnant patients. Neonatal data were also collected, including indicators of neonatal wellness. RESULTS Significantly higher incidences of being nonwhite (33% vs 16%; p < .05) and of attaining post-high school education (60% vs 38%) were noted in the HG group, relative to controls. Mothers in the control group experienced greater gestational weight gain, 14.9 +/- 0.3 kg (mean +/- SEM) relative to mothers in the HG group (10.6 +/- 1.3 kg). Infants from HG pregnancies manifested significantly lower birth weight (3.23 +/- 0.09 kg vs 3.52 +/- 0.03 kg), younger gestational age (38.4 +/- 0.3 weeks vs 39.7 +/- 0.1 weeks), and a greater length of hospital stay (2.9 +/- 0.5 days vs 1.8 +/- 0.1 day), relative to infants from the control group. After undergoing multivariate analysis, HG was a significant predictor of decreased gestational age and increased hospital length of stay. CONCLUSIONS Infants born of women who had HG are more likely to experience decreased gestational age and increased length of hospital stay. Efficacy of early and aggressive treatment of HG, including nutrition support, in minimizing these outcomes needs to be studied.
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Affiliation(s)
- James D Paauw
- Spectrum Health Nutrition Support Service, Grand Rapids, MI 49503, USA
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20
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Fukui O, Shimoya K, Shimizu T, Fukuda H, Wasada K, Murata Y. Helicobacter pylori infection and platelet counts during pregnancy. Int J Gynaecol Obstet 2005; 89:26-30. [PMID: 15777894 DOI: 10.1016/j.ijgo.2005.01.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2004] [Accepted: 01/10/2005] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate whether there is any correlation between Helicobacter pylori infection and platelet counts during pregnancy. METHODS One hundred and twenty pregnant women without any complications were evaluated. Platelet counts were determined during pregnancy and postpartum. H. pylori infection was assessed by the detection of serum antibodies at the 3rd day postpartum. Statistically significant differences of platelet count between H. pylori-positive and -negative patients were determined. RESULTS H. pylori infection was found in 29 of 120 (24.2%). Platelet counts in the 3rd trimester were 22.7+/-4.7 x 10(3)/microl in H. pylori-positive group and 22.8+/-5.6 x 10(3)/microl in negative group (p=0.98). Platelet count in the 3rd trimester in positive and negative patients were 93+/-17% and 94+/-20%, respectively, of that of the 1st trimester (p=0.92). The incidence of hyperemesis gravidarum in both groups was not significant (p=0.28). CONCLUSION A correlation between H. pylori infection and thrombocytopenia during pregnancy was not found in this study.
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Affiliation(s)
- O Fukui
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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21
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Verberg MFG, Gillott DJ, Al-Fardan N, Grudzinskas JG. Hyperemesis gravidarum, a literature review. Hum Reprod Update 2005; 11:527-39. [PMID: 16006438 DOI: 10.1093/humupd/dmi021] [Citation(s) in RCA: 236] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Hyperemesis gravidarum (HG) is a condition causing severe nausea and vomiting in early pregnancy often resulting in hospital admission. The incidence of HG is approximately 0.5% of live births, said to be higher in multiple pregnancies, hydatidiform mole and other conditions associated with increased pregnancy hormone levels. Both the aetiology and pathogenesis of HG remain unknown. We conducted a literature review (1966-now) to summarize the current evidence on the aetiology and pathogenesis of HG. The potential role of pregnancy-related hormones such as progesterone, estrogen and HCG has been widely studied; however, various other hormones such as leptin, placental growth hormone, prolactin, thyroid and adrenal cortical hormones have been implicated in the aetiology of HG. In addition to endocrinological hypotheses, the rationale and evidence considering infectious, immunological, psychological, metabolic and anatomical causes for HG have been analysed here. Many studies suffer from the low number of patients included, the variable definition used for HG and varying assay methodology used in studies of hormone measurement. This review highlights the need for more extensive studies addressing the pathogenesis and aetiology of HG.
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Affiliation(s)
- M F G Verberg
- Academic Unit of Reproductive Physiology, Obstetrics and Gynaecology, St. Bartholomew's Hospital, West Smithfield, London, UK
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22
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Abstract
This article is a review of the incidence, characteristics, risk factors, proposed causes, outcomes, treatment and nursing management of nausea and vomiting of pregnancy. Despite the fact that it affects most pregnant women to some degree, it is poorly understood and often poorly treated. Specific suggestions for therapeutic interventions are outlined.
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Affiliation(s)
- Mitzi Davis
- College of Nursing, The University of Tennessee, Knoxville, TN 37996, USA.
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23
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24
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Weyermann M, Brenner H, Adler G, Yasar Z, Handke-Vesely A, Grab D, Kreienberg R, Rothenbacher D. Helicobacter pylori infection and the occurrence and severity of gastrointestinal symptoms during pregnancy. Am J Obstet Gynecol 2003; 189:526-31. [PMID: 14520229 DOI: 10.1067/s0002-9378(03)00486-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE We investigated the possible role of Helicobacter pylori infection in the occurrence and severity of gastrointestinal symptoms during pregnancy in a large group of mothers after delivery. STUDY DESIGN Between November 2000 and November 2001, mothers were recruited after delivery at the Department of Gynecology and Obstetrics at the University of Ulm. Present H pylori infection was determined by (13)C-urea breath test. Associations between gastrointestinal symptoms during pregnancy (sickness, vomiting, increased saliva production, heartburn) and H pylori infection were quantified by crude and adjusted odds ratios with 95% CI. RESULTS Twenty-three percent of the 898 mothers had a current H pylori infection. Eighty-four percent of the mothers reported at least one of the evaluated gastrointestinal symptoms, and 30% of the mothers reported at least one physician visit because of the severity of these symptoms. None of the analyzed gastrointestinal symptoms showed an association to a current H pylori infection after an adjustment for the covariates, even after a virulence marker of H pylori infection was taken into account. CONCLUSION This study does not support an involvement of H pylori infection in the generation of gastrointestinal symptoms during pregnancy.
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Affiliation(s)
- Maria Weyermann
- Department of Epidemiology, German Centre for Research on Aging, University of Ulm, Germany
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25
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Tratamiento con sonda de yeyunostomía en hiperemesis gravídica refractaria. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2002. [DOI: 10.1016/s0210-573x(02)77161-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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