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Alkhudair NA, Alrabiah Z, Almohaimeed R, Khurshid F, Alhossan A. Nausea and Vomiting of Pregnancy in Saudi Females: A Cross-Sectional Study. Saudi Pharm J 2023; 31:101821. [PMID: 37928977 PMCID: PMC10622686 DOI: 10.1016/j.jsps.2023.101821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/08/2023] [Indexed: 11/07/2023] Open
Abstract
Background Nausea and vomiting of pregnancy (NVP) is a frequently reported medical condition during pregnancy. However, no studies have evaluated its impact on women's ability to perform acts of daily living in the Saudi population. Hence, this study aimed to explore the impact of NVP on the day-to-day functions of pregnant women in Saudi Arabia. Methods This cross-sectional online survey study was conducted between March 18, 2019, and April 17, 2019. Pregnant females and new mothers were asked to complete an anonymous online questionnaire. Results A total of 591 women with NVP participated in the study. Pregnant women at the time of the survey were 233 (39.4 %), and 358 (60.6 %) were new mothers who had a child under the age of 1 year. Most participants, 556 (94.1 %), reported experiencing NVP symptoms at some time during their pregnancies. NVP symptoms were most predominant during the first trimester, as experienced by 420 (75.5 %) women. NVP severely affected daily activities in 45.4 % of participants. About 58 % of the women reported that they might never consider getting pregnant again because of NVP. Conclusions Our study found that most Saudi women suffered from NVP during their pregnancies. Additionally, NVP impacts women's daily-life functioning and their desire to become pregnant again. This warrants further studies to explore NVP socioeconomical impact on Saudi women.
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Affiliation(s)
- Nora A. Alkhudair
- Corresponding author at: Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
| | | | - Rana Almohaimeed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Fowad Khurshid
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz Alhossan
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Singh J, Kaur M, Rasane P, Kaur S, Kaur J, Sharma K, Gulati A. Nutritional management and interventions in complications of pregnancy: A systematic review. Nutr Health 2023:2601060231172545. [PMID: 37128673 DOI: 10.1177/02601060231172545] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Background: Pregnancy, also known as the "gestation period" which lasts for 37-40 weeks, has been marked as the period of "physiological stress" in a woman's life. A wide range of symptoms, from nausea to ectopic pregnancy, are usually aligned with risk factors like abortion, miscarriage, stillbirth, etc. An estimated total of 15% of total pregnant women face serious complications requiring urgent attention for safe pregnancy survival. Over the past decades, several changes in the environment and nutrition habits have increased the possibility of unfavourable changes during the gestation phase. The diagnostic factors, management and nutritional interventions are targeted and more emphasis has been laid on modifying or managing the nutritional factors in this physiologically stressed phase. Aims: This review focuses on dietary modifications and nutritional interventions for the treatment of complications of pregnancy. Nutritional management has been identified to be one of the primary necessities in addition to drug therapy. It is important to set a healthy diet pattern throughout the gestation phase or even before by incorporating key nutrients into the maternal diet. Methods: The published literature from various databases including PubMed, Google Scholar and ScienceDirect were used to establish the fact of management and treatment of complications of pregnancy. Results: The recommendations of dietary supplements have underlined the concept behind the eradication of maternal deficiencies and improving metabolic profiles. Conclusion: Therefore, the present review summarises the dietary recommendations to combat pregnancy-related complications which are necessary in order to prevent and manage the same.
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Affiliation(s)
- Jyoti Singh
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
| | - Mansehaj Kaur
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
| | - Prasad Rasane
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
| | - Sawinder Kaur
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
| | - Jaspreet Kaur
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
| | - Kartik Sharma
- International Center of Excellence in Seafood Science and Innovation (ICE-SSI), Faculty of Agro-Industry, Prince of Songkla University, Hat Yai, Thailand
| | - Amisha Gulati
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
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Adane KD, Zerga AA, Gebeyehu FB, Ayele FY. Proportion of hyperemesis gravidarum and associated factors among pregnant women admitted into the obstetrics ward at Akesta general hospital, North East Ethiopia. PLoS One 2023; 18:e0281433. [PMID: 36745599 PMCID: PMC9901745 DOI: 10.1371/journal.pone.0281433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 01/23/2023] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Hyperemesis gravidarum is a condition of intractable vomiting during pregnancy that leads to fluid and electrolyte imbalance, nutrition deficiency and weight loss often requiring hospital admission. Approximately 0.3%-10.8% of pregnant women experience nausea and vomiting during the first trimester of pregnancy. It has been associated with both maternal and fetal morbidity. There is limited evidence about the proportion of hyperemesis gravidarum and associated factors in the study area. OBJECTIVE The aim of this study was to determine the proportion of hyperemesis gravidarum and associated factors among pregnant women admitted into the obstetric ward at Akesta General Hospital, South Wollo Zone, Ethiopia. METHODS This is hospital-based cross-sectional study of 355 pregnant mothers in Akesta general hospital in northeast Ethiopia from September 1/2018- to August 30 /2020. A simple random sampling technique was used to select the patient card from the whole admission of pregnant women cards during the study period. The diagnosis of hyperemesis gravidarum include persistent vomiting not related to other causes, an objective measure of acute starvation, electrolyte abnormalities and acid-base disturbances, as well as weight loss. The data analysis was done using SPSS version 25. Bivariable and multivariable binary logistic regression analysis was conducted to identify factors associated with hyperemesis gravidarum. Adjusted odds ratio (AOR) with 95% confidence intervals (CI) was reported to show the strength of the association. Statistical significance was stated at P-value < 0.05. RESULTS The proportion of hyperemesis gravidarum was 11.3%. Women with previous history of hyperemesis gravidarum AOR (95%CI) = 10.9[2.46, 48.44], previous history of urinary tract infection AOR (95%CI) = 4.32[1.58, 11.86], previous history of gastrointestinal disease AOR (95% CI) = 4.12[1.40, 12.65], history of abortion AOR (95% CI) = 6.23[2.24, 17.52] were factors significantly associated with hyperemesis gravidarum. CONCLUSION In this study, the overall hospital proportion of hyperemesis gravidarum was high. History of gastrointestinal disease, previous history of urinary tract infection, history of hyperemesis gravidarum, and history of abortion were the major risk factors.
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Affiliation(s)
- Kassaye Demewez Adane
- School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Aregash Abebayehu Zerga
- School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Fikre Bayu Gebeyehu
- Department of Anatomy, School of Medicine, College of Medicine and Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fanos Yeshanew Ayele
- School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
- * E-mail:
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Use of Mirtazapine and Olanzapine in the Treatment of Refractory Hyperemesis Gravidarum: A Case Report and Systematic Review. Case Rep Obstet Gynecol 2022; 2022:7324627. [PMID: 36105926 PMCID: PMC9467790 DOI: 10.1155/2022/7324627] [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: 03/28/2022] [Revised: 08/09/2022] [Accepted: 08/24/2022] [Indexed: 11/18/2022] Open
Abstract
Hyperemesis gravidarum (HG) is a rare condition (1.1%) characterized by excessive vomiting, malnutrition, dehydration, and laboratorial alterations. Herein, we describe the even rarer and serious presentation of refractoriness to the usual treatment of antiemetics and parenteral nutrition, with improvement only after the use of olanzapine and mirtazapine. Two subsequent pregnancies of the same woman with HG are described, which were associated with severe weight loss, anemia, hyponatremia, hypokalemia, and mild dysfunction of liver enzymes. In the third pregnancy, the usual treatment for HG was not successful, requiring enteral nutrition and the introduction of olanzapine. In the fourth pregnancy, the patient refused to use enteral nutrition for refractory HG. Hence, the patient was started on mirtazapine at an initial dose of 15 mg/day, which was gradually increased to 30 mg/day. The patient responded well to the new regimen, as demonstrated by the decrease in symptoms, the gain of 10 kg in the pregnancy, and delivering a healthy newborn. A systematic review of literature showed 11 articles and 30 cases that successfully used mirtazapine in HG. Good clinical outcomes were seen with 4 days of the treatment and at an initial dose of 15 mg/day. However, most of these reports were from psychiatric profiles, with a predominance of depression and anxiety symptoms, and a poor description of the obstetric conditions and the disease progression itself. Pulmonary hypertension was described in one case and neonatal hyperexcitability in another. The case described in this paper reinforces the idea that mirtazapine and olanzapine can be considered in refractory HG, with good results. In the world literature, this is the second case of HG that has been successfully treated with olanzapine and the first in Latin America treated with mirtazapine.
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Yamada P, Paetow A, Chan M, Arslan A, Landberg R, Young BK. Pregnancy outcomes with differences in grain consumption: a randomized controlled trial. J Perinat Med 2022; 50:411-418. [PMID: 34981703 DOI: 10.1515/jpm-2021-0479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/13/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Contemporary obstetrics has begun to appreciate the importance of diet in pregnancy, but guidelines are not based on robust data. The hypothesis that a whole grains diet improves pregnancy outcomes is tested in this study. We compared maternal and neonatal outcomes for a pregnancy diet containing 75% of total carbohydrates as refined grains with outcomes for a diet with 75% of total carbohydrates as whole grains. METHODS This was a randomized interventional study in a clinic population over the last 4-7 months of normal pregnancy with extensive compliance measures. Besides obstetrical and neonatal outcomes, anthropometric measurements were done. In addition to food frequency questionnaires (FFQs), total plasma alkyl resorcinols, a unique quantitative measure of whole grains, were used as a measure of whole grain consumption. RESULTS The data show effective compliance and no difference in outcomes between the diets with regard to maternal weight gain, birth weights, subcutaneous fat and glucose tolerance. CONCLUSIONS Ensuring compliance to a proper pregnancy diet resulted in satisfactory weight gain and normal outcomes even when the proportion of whole grains consumed is only 25% of total carbohydrates.
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Affiliation(s)
- Pamella Yamada
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, USA
| | - Alexandra Paetow
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, USA
| | - Michael Chan
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, USA
| | - Alan Arslan
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, USA
| | - Rikard Landberg
- Division of Food and Nutrition Science, Department of Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Bruce K Young
- Department of Obstetrics and Gynecology, New York University Langone Health, New York, USA
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Şafak Öztürk C, Kaya Odabaş R, Sökmen Y, Taşpinar A. The Relationship between Nausea-Vomiting during Pregnancy and Attachment Styles, Marital Adjustment, and Ways of Coping. JOURNAL OF SEX & MARITAL THERAPY 2022; 49:65-76. [PMID: 35531669 DOI: 10.1080/0092623x.2022.2073302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The objective of this study is to examine the relationship between nausea and vomiting during pregnancy (NVP) and attachment styles in close relationships, marital adjustment, and ways of coping with stress. This study was performed in 2019 as an analytic case-control design. The study group consists of 60 pregnant women hospitalized with a nausea-vomiting/hyperemesis gravidarum diagnosis. The control group is composed of 64 pregnant women who applied for gynecology polyclinic for routine control. The participants were applied Pregnancy-Information Form, Experiences in Close Relationships Scale-Revised (ECR-R), Marital Adjustment Test (MAT), and Coping Styles Inventory (CSI). It was observed that the scores of the pregnant women in the study group from the helpless approach subscale of CSI were significantly higher than the control group and no significant difference was found between the two groups in terms of other scale scores. A negative correlation was found between the perceived severity of nausea and the seeking social support subscale of CSI in the study group. The study revealed findings that support the biopsychosocial approach to the etiology of NVP and showed that the women with NVP use a helpless approach in coping with stress and apply seeking social support as the severity of nausea decreases.
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Affiliation(s)
- Cennet Şafak Öztürk
- Department of Psychology, Faculty of Arts and Sciences, Aydın Adnan Menderes University, Aydın, Turkey
| | - Resmiye Kaya Odabaş
- Department of Midwifery, Faculty of Health Sciences, Kocaeli University, Kocaeli, Turkey
| | - Yasemin Sökmen
- Department of Midwifery, Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Turkey
| | - Ayten Taşpinar
- Department of Midwifery, Faculty of Health Sciences, Aydın Adnan Menderes University, Aydın, Turkey
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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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Suarez EA, Boggess K, Engel SM, Stürmer T, Lund JL, Funk MJ. Ondansetron use in early pregnancy and the risk of late pregnancy outcomes. Pharmacoepidemiol Drug Saf 2020; 30:114-125. [PMID: 33067868 DOI: 10.1002/pds.5151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/07/2020] [Accepted: 10/05/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND The effects of ondansetron, used off-label to treat nausea and vomiting during pregnancy, on common pregnancy complications are understudied. Modest effects of a commonly used drug could result in adverse events for large numbers of pregnant women. Therefore, our objective was to compare the risk of stillbirth, preterm birth, gestational hypertensive disorders, small for gestational age, and differences in birth weight between women prescribed ondansetron and women prescribed alternative antiemetics in early pregnancy. METHODS A cohort of pregnant women receiving a prescription for ondansetron or comparator antiemetics (metoclopramide or promethazine) during the first 20 weeks of pregnancy was identified using electronic health record data from a health care system in North Carolina, USA. Confounding by multiple covariates was controlled using stabilized inverse probability of treatment weights. Weighted hazard ratios (HR) and 95% confidence intervals (CI) accounted for competing events. RESULTS We identified 2677 eligible pregnancies with antiemetic orders, 66% for ondansetron. The small number of stillbirths (n = 15) resulted in an imprecise estimate of the association with ondansetron (HR = 1.60; 95%CI 0.51, 4.97). No association was observed for preterm birth (HR = 0.90; 95%CI 0.67, 1.20) or gestational hypertensive disorders (HR = 0.87; 95%CI 0.68, 1.12). We observed an association with small for gestational age (HR = 1.37; 95%CI 0.98, 1.90), however mean birth weight among term births was similar between groups. CONCLUSIONS Our results do not suggest that ondansetron increases the risk of preterm birth or gestational hypertensive disorders. The weak association observed between ondansetron use and small for gestational age warrants further investigation.
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Affiliation(s)
- Elizabeth A Suarez
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kim Boggess
- Division of Maternal-Fetal Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Stephanie M Engel
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Til Stürmer
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jennifer L Lund
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michele Jonsson Funk
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Aksu E, Albayrak Y, Beyazyüz E, Potas N, Durankuş F, Tenel B, Beyazyüz M. Distinct temperament and character traits in patients with hyperemesis gravidarum. Gynecol Endocrinol 2020; 36:525-529. [PMID: 31668106 DOI: 10.1080/09513590.2019.1683820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Hyperemesis gravidarum (HG) is an extreme form of vomiting during pregnancy and is characterized with excessive vomiting and nausea and ketonuria, electrolyte imbalance, dehydration and severe nurtition deficiency. The etiology of HG is considered as multifactorial. Altough there is a great interest to HG in terms of psychiatric conditions, there have been limited numbers of studies that researched personality traits in patients with HG. In present study, we aimed to compare temperament and character traits between pregnant women with and without HG by Temperament and Character Inventory. 48 pregnant women with HG and 64 healthy pregnant women were included to study. The HG groups and control group were compared in terms of temperament and character traits and anxiety levels. The temperament scores of novelty seeking, harm avoidance and reward dependence were found to be similar between groups while the score of persistence was significantly lower in HG group compared with control group (p = .021). All character scores in HG group as cooperativeness, self-directedness, and self-transcendence were significantly lower compared with control groups (respectively; p = .002, p = .018 and p = .029). The scores of STAI-1 was higher in HG group compared with control group (p = .027) whereas the score of STAI-2 was found to be similar between groups. Present study is the first to demonstrate different temperament and character traits in patients with HG. We argue that our results support the psychiatric background of HG; however further studies are needed to confirm our results.
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Affiliation(s)
- Erson Aksu
- Department of Gynecology and Obstetrics, Vatan Hospital, İstanbul Rumeli University, İstanbul, Turkey
| | - Yakup Albayrak
- Faculty of Medicine, Department of Psychiatry, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Elmas Beyazyüz
- Faculty of Medicine, Department of Psychiatry, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Nihan Potas
- Faculty of Economics and Administrative Science, Department of Healthcare Managment, Ankara Hacıbayram Veli University, Ankara, Turkey
| | - Ferit Durankuş
- Department of Pediatrics, Göztepe Education and Research Hospital, İstanbul Medeniyet University, İstanbul, Turkey
| | - Burçak Tenel
- Faculty of Medicine, Department of Psychiatry, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Murat Beyazyüz
- Faculty of Medicine, Department of Psychiatry, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
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Katarey D, Westbrook RH. Pregnancy-specific liver diseases. Best Pract Res Clin Obstet Gynaecol 2020; 68:12-22. [PMID: 32381461 DOI: 10.1016/j.bpobgyn.2020.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 03/21/2020] [Accepted: 03/26/2020] [Indexed: 12/17/2022]
Abstract
Liver disease presenting in pregnancy may be due to a pregnancy-specific liver disorder, due to previously unrecognised pre-existing liver disease, or de novo liver disorders coincidentally presenting in a pregnant woman. The pregnancy-specific liver diseases can span from mild disease with limited impact on maternal and foetal health to severe disorders that can result in significant morbidity and mortality for mother and foetus. Swift identification of these disorders is essential to allow timely and appropriate management via a multi-disciplinary approach. The pregnancy-specific conditions, including their presentation, investigations, and management are reviewed in this chapter in detail.
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Affiliation(s)
- Dev Katarey
- Royal Free Hospital, Pond Street, London, NW3 2QG, United Kingdom
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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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Bray N, Grasby KL, Lind PA, Painter JN, Colodro-Conde L, Medland SE. The psychosocial impact of nausea and vomiting during pregnancy as a predictor of postpartum depression. J Health Psychol 2019; 26:1061-1072. [PMID: 31244342 DOI: 10.1177/1359105319859048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study examined the extent to which psychosocial impact of nausea and vomiting during pregnancy predicts postpartum depression using a retrospective design. Data from a cross-sectional survey investigating women's experiences of nausea and vomiting during pregnancy were used (N = 861). Hierarchical logistic regression models revealed that the psychosocial impact of nausea and vomiting in pregnancy appears to be predictive of postpartum depression, independent of depression status before and during pregnancy. Our findings indicate that assessing the psychosocial impact of nausea and vomiting in pregnancy during antenatal care may identify women at risk of postpartum depression.
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Affiliation(s)
- Nicola Bray
- The University of Queensland, Australia.,QIMR Berghofer Medical Research Institute, Australia
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14
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Sahin E, Madendag Y, Eraslan Sahin M, Tayyar AT, Col Madendag I, Gozukucuk M, Karakukcu C, Acmaz G, Muderris II. Maternal type 1collagen N-terminal telopeptide levels in severe hyperemesis gravidarum. BMC Pregnancy Childbirth 2018; 18:502. [PMID: 30572827 PMCID: PMC6302387 DOI: 10.1186/s12884-018-2149-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 12/12/2018] [Indexed: 11/12/2022] Open
Abstract
Background Nausea and vomiting occur 50–90% during the first trimester of pregnancy. However, patients with hyperemesis gravidarum (HG) may be hospitalized at an incidence rate of 0.8–2% before the 20th week of gestational age. The symptoms generally start during the 5–6th gestational weeks, reaching the highest degree during the 9th week, and decline after the 16–20th weeks of gestation. Clinical findings are proportional to the severity of the disease and severe HG is characterized with dehydration, electrolyte imbalance, and nutritional deficiency as a result of vomiting. Methods The study population consisted of two groups of pregnant volunteers at 5–12 weeks of gestation: a severe HG group and a control group. The HG severity was scored using the Pregnancy-Unique Quantification of Emesis (and nausea) (PUQE).The serum levels of the maternal Ca, parathyroid hormone (PTH), Na, K, blood urea nitrogen(BUN), creatinine, vitamin D(25OHD3), and the maternal urine NTx levels were compared between the groups. Results In total, 40 volunteers were enrolled in this study: 20 healthy pregnant volunteers and 20 with severe HG. There were no statistically significant differences between the maternal characteristics. The first trimester weight loss of ≥5 kg was significantly higher in the severe HG group (p < 0.001), while the control group had a significantly higher sunlight exposure ratio than the severe HG group (p = 0.021). The urine NTx levels were significantly higher in the severe HG group (39.22 ± 11.68NTx/Cre) than in the control group(32.89 ± 8.33NTx/Cre) (p = 0.028).The serum Ca, PTH, Na, K, BUN, and creatinine levels were similar between the groups (p = 0.738, p = 0.886, p = 0.841, p = 0.957, p = 0.892, and p = 0.824, respectively). In the severe HG group, the serum 25OHD3 levels were significantly lower than in the control group (p < 0.001). Conclusions The data from this study indicated that severe HG is associated with increased urine NTx levels. However, large-scale studies are required to understand the clinical significance of this finding, as well as the long-term consequences of elevated urine NTx levels and the underlying mechanisms. Trial registration NCT02862496 Date of registration: 21/07/2016.
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Affiliation(s)
- E Sahin
- Department of Obstetrics and Gynecology, Health Sciences University, Sivas Sarkısla Government Hospital, Sivas, Turkey.
| | - Y Madendag
- Department of Obstetrics and Gynecology, Health Sciences University, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - M Eraslan Sahin
- Department of Obstetrics and Gynecology, Health Sciences University, Sivas Sarkısla Government Hospital, Sivas, Turkey
| | - A T Tayyar
- Department of Obstetrics and Gynecology, Health Sciences University, Zeynep Kamil Maternity and Children's Training and Research Hospital, İstanbul, Turkey
| | - I Col Madendag
- Department of Obstetrics and Gynecology, Health Sciences University, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - M Gozukucuk
- Department of Obstetrics and Gynecology, Health Sciences University, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - C Karakukcu
- Department of Biochemistry Clinic, Health Sciences University, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - G Acmaz
- Department of Obstetrics and Gynecology, Health Sciences University, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - I I Muderris
- Department of Obstetrics and Gynecology, Erciyes University Faculty of Medicine, Kayseri, Turkey
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15
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Huybrechts KF, Hernandez-Diaz S, Straub L, Gray KJ, Zhu Y, Patorno E, Desai RJ, Mogun H, Bateman BT. Association of Maternal First-Trimester Ondansetron Use With Cardiac Malformations and Oral Clefts in Offspring. JAMA 2018; 320:2429-2437. [PMID: 30561479 PMCID: PMC6669077 DOI: 10.1001/jama.2018.18307] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
IMPORTANCE Evidence for the fetal safety of ondansetron, a 5-HT3 receptor antagonist that is commonly prescribed for nausea and vomiting during pregnancy, is limited and conflicting. OBJECTIVE To evaluate the association between ondansetron exposure during pregnancy and risk of congenital malformations. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study nested in the 2000-2013 nationwide Medicaid Analytic eXtract. The cohort consisted of 1 816 414 pregnancies contributed by 1 502 895 women enrolled in Medicaid from 3 months before the last menstrual period through 1 month or longer after delivery; infants were enrolled in Medicaid for at least 3 months after birth. The final date of follow-up was December 31, 2013. Analyses were conducted between November 1, 2017, and June 30, 2018. Propensity score stratification was used to control for treatment indication and other confounders. EXPOSURES Ondansetron dispensing during the first trimester, the period of organogenesis. MAIN OUTCOMES AND MEASURES Primary outcomes were cardiac malformations and oral clefts diagnosed during the first 90 days after delivery. Secondary outcomes included congenital malformations overall and subgroups of cardiac malformations and oral clefts. RESULTS Among 1 816 414 pregnancies (mean age of mothers, 24.3 [5.8] years), 88 467 (4.9%) were exposed to ondansetron during the first trimester. Overall, 14 577 of 1 727 947 unexposed and 835 of 88 467 exposed infants were diagnosed with a cardiac malformation, for an absolute risk of 84.4 (95% CI, 83.0 to 85.7) and 94.4 (95% CI, 88.0 to 100.8) per 10 000 births respectively. The absolute risk of oral clefts was 11.1 per 10 000 births (95% CI, 10.6 to 11.6; 1921 unexposed infants) and was 14.0 per 10 000 births (95% CI, 11.6 to 16.5; 124 exposed infants). The risk of any congenital malformation was 313.5 per 10 000 births (95% CI, 310.9 to 316.1; 54 174 unexposed infants) and was 370.4 (95% CI, 358.0 to 382.9; 3277 exposed infants). The adjusted relative risk (RR) for cardiac malformations was 0.99 (95% CI, 0.93 to 1.06) and the adjusted risk difference (RD) was -0.8 (95% CI, -7.3 to 5.7 per 10 000 births). For oral clefts, the adjusted RR was 1.24 (95% CI, 1.03 to 1.48) and the RD was 2.7 (95% CI, 0.2 to 5.2 per 10 000 births). The adjusted estimate for congenital malformations overall was an RR of 1.01 (95% CI, 0.98 to 1.05) and an RD of 5.4 (95% CI, -7.3 to 18.2 per 10 000 births). CONCLUSIONS AND RELEVANCE Among offspring of mothers enrolled in Medicaid, first-trimester exposure to ondansetron was not associated with cardiac malformations or congenital malformations overall after accounting for measured confounders but was associated with a small increased risk of oral clefts.
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Affiliation(s)
- Krista F. Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Loreen Straub
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Kathryn J. Gray
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Yanmin Zhu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Rishi J. Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Helen Mogun
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Brian T. Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
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16
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Figueroa Gray M, Hsu C, Kiel L, Dublin S. Getting through the day: a pilot qualitative study of U.S. women's experiences making decisions about anti-nausea medication during pregnancy. BMC Pregnancy Childbirth 2018; 18:475. [PMID: 30514332 PMCID: PMC6280506 DOI: 10.1186/s12884-018-2093-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 11/16/2018] [Indexed: 11/13/2022] Open
Abstract
Background Nausea during pregnancy affects 80% of pregnant women and can severely affect women’s functioning and quality of life. Women often have difficulty deciding whether to take anti-nausea medications due to concern about medication risks. This paper foregrounds U.S. women’s voices as they share their experiences making decisions about anti-nausea medication use. Methods As a pilot study, we conducted two focus groups including 20 women who had filled at least one prescription for an anti-nausea medication during pregnancy. Topics included deciding about and taking anti-nausea medications. Transcripts were analyzed by two medical anthropologists using an inductive or open coding approach. Results Women in our pilot study carefully considered whether to take anti-nausea medications. Most women preferred not to take medications, in general, but were willing to do so for severe symptoms. When considering medications, they expressed concerns about risks to fetal health. They considered information from internet research, their health care provider, and the experiences of friends and family. While some women in our study decided against taking medications, many did take a prescription medication, and they reported substantial improvement in their symptoms and sense of well-being. Conclusions Women weighed various sources of evidence to assess the risks and benefits of taking anti-nausea medication and ultimately made a range of choices. More research is needed about the effectiveness and risks of anti-nausea medication, to help support women in their decision-making process, and also about the best methods to communicate scientific evidence to women. Electronic supplementary material The online version of this article (10.1186/s12884-018-2093-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Clarissa Hsu
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Linda Kiel
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Sascha Dublin
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.,University of Washington Epidemiology Department, Seattle, WA, USA
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17
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Huang L, Tian FY, Fan L, He YH, Peng D, Xie C, Tao L, Yuan SX, Jia DQ, Chen WQ. Appetite during the second and third trimesters mediates the impact of prenatal environmental tobacco smoke exposure on symmetric full-term low birth weight. J Matern Fetal Neonatal Med 2018; 33:1544-1553. [PMID: 30198354 DOI: 10.1080/14767058.2018.1522299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: To examine the relationship of prenatal environmental tobacco smoke (ETS) exposure and full-term low birth weight (FT-LBW) when taking anthropometric proportionality into consideration, and explore whether appetite mediates their association.Study design: We conducted a case-control study among pregnant women at two Women and Children's Hospitals in Guangdong, China. Information was collected through interview and medical records review. A series of logistic and linear regressions were used to examine the relationships of prenatal ETS exposure, appetite, and FT-LBW.Results: After adjusting for the potential confounders, prenatal ETS exposure was significantly negatively associated with FT-LBW (OR: 1.83, 95%CI: 1.35-2.48) and negatively correlated with maternal appetite in second and third trimester during pregnancy (β: -0.11, standard error: 0.03). Moreover, mediation analysis illustrated that maternal appetite partially mediated 12.00% of their relationship. However, subgroup analysis showed that prenatal ETS exposure was linked to higher risk of symmetric FT-LBW (OR: 2.26, 95%CI: 1.56-3.26) but not asymmetric FT-LBW. And maternal appetite explained only 6.45% of their relationship.Conclusions: Maternal prenatal ETS exposure increased risk of having symmetric FT-LBW infant, and appetite might mediate their relationship partially. This study emphasizes the importance of sample homogeneity and stresses the needs to improve the public awareness of the harmful effects of ETS.
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Affiliation(s)
- Lihua Huang
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Fu-Ying Tian
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Lijun Fan
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yan-Hui He
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ding Peng
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chuanbo Xie
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Liu Tao
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Shi-Xin Yuan
- Shenzhen Women and Children's Hospital, Shenzhen, China
| | - De-Qin Jia
- Foshan Women and Children's Hospital, Foshan, China
| | - Wei-Qing Chen
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Department of Information Management, Xinhua College, Sun Yat-sen University, Guangzhou, China
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18
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Sahin E, Madendag Y, Sahin ME, Col Madendag I, Karakukcu C, Acmaz G, Muderris II. Effect of severe hyperemesis gravidarum on maternal vascular endothelial health: evaluation of soluble adhesion molecules. J Matern Fetal Neonatal Med 2018; 33:385-389. [PMID: 29945479 DOI: 10.1080/14767058.2018.1494145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Purpose: This study aimed to clarify the effect of severe hyperemesis gravidarum (sHG) on maternal vascular endothelial health with evaluation of soluble adhesion molecules.Method: The study population consisted of two groups of pregnant participants between 18 and 35 years of age who were between 5 and 13 weeks of gestation: sHG group and a healthy control group. A group of 26 participants whose pregnancies were complicated by sHG was compared with 26 healthy participants regarding serum levels of the soluble adhesion molecules such as E-selectin, soluble intracellular cell adhesion molecule 1 (sICAM-1), and soluble vascular cell adhesion molecule one (sVCAM-1), as well as other biochemical markers. The two groups had similar baseline characteristics.Results: Maternal baseline characteristics were similar in both groups. Serum levels of E-selectin (p < .001), sICAM-1 (p < .001), and sVCAM-1 (p < .001) were higher in the sHG group compared with the control group. Higher blood urea nitrogen, creatinine, and sodium levels, serum osmolarity, and urine density (p < .001, < .001, .006, .041, and .001, respectively) were also observed in the sHG group compared with the control group.Conclusions: The findings of this study indicated that sHG could impact endothelial cell function and these changes represented hypovolemia and dehydration caused by severe vomiting. Large-scale studies are required to understand the clinical importance of this finding regarding the long-term consequences and underlying mechanisms of elevated sICAM-1, sVCAM-1, and sE-selectin synthesis.
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Affiliation(s)
- E Sahin
- Department of Obstetrics and Gynecology, Health Sciences University Sivas Sarkisla Government Hospital, Sivas, Turkey
| | - Y Madendag
- Department of Obstetrics and Gynecology, Health Sciences University Kayseri Education and Research Hospital, Kayseri, Turkey
| | - M Eraslan Sahin
- Department of Obstetrics and Gynecology, Health Sciences University Sivas Sarkisla Government Hospital, Sivas, Turkey
| | - I Col Madendag
- Department of Obstetrics and Gynecology, Health Sciences University Kayseri Education and Research Hospital, Kayseri, Turkey
| | - C Karakukcu
- Department of Biochemistry Clinic, Health Sciences University Kayseri Education and Research Hospital, Kayseri, Turkey
| | - G Acmaz
- Department of Obstetrics and Gynecology, Erciyes University Medicine Faculity, Kayseri, Turkey
| | - I I Muderris
- Department of Obstetrics and Gynecology, Erciyes University Medicine Faculity, Kayseri, Turkey
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Alame MM, Chamsy DJ, Zaraket H. Pityriasis rosea-like eruption associated with ondansetron use in pregnancy. Br J Clin Pharmacol 2018; 84:1077-1080. [PMID: 29520857 PMCID: PMC5903224 DOI: 10.1111/bcp.13560] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 02/03/2018] [Accepted: 02/11/2018] [Indexed: 12/17/2022] Open
Abstract
A 30-year-old pregnant female presented with a 2-week history of pityriasis rosea-like eruption. The rash started 2 days after the patient had started taking ondansetron 8 mg for alleviation of moderate-to-severe nausea and vomiting of pregnancy. Physical examination revealed erythematous papulosquamous lesions characterized by annular scaly margins and a dusky centre over the arms, chest, abdomen, lower back and legs. The rash did not involve the palms, sole or mucous membranes, and no lesions were observed on the lymph nodes. Ondansetron was discontinued. The rash ceased to spread and started to disappear within 2 weeks with full resolution noted after 1 month. Analysis of the case using the Naranjo adverse drug reaction probability scale indicated that ondansetron was the probable cause of the pityriasis rosea-like eruption. This is the first case report of pityriasis rosea related to ondansetron therapy.
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Affiliation(s)
- Malak M. Alame
- School of PharmacyLebanese International UniversityBeirutLebanon
| | - Dina J. Chamsy
- Department of Obstetrics and Gynecology, Faculty of MedicineAmerican University of Beirut Medical CenterBeirutLebanon
| | - Hassan Zaraket
- Department of Experimental Pathology, Immunology and Microbiology, Faculty of MedicineAmerican University of Beirut Medical CenterBeirutLebanon
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20
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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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21
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Persaud N, Meaney C, El-Emam K, Moineddin R, Thorpe K. Doxylamine-pyridoxine for nausea and vomiting of pregnancy randomized placebo controlled trial: Prespecified analyses and reanalysis. PLoS One 2018; 13:e0189978. [PMID: 29342163 PMCID: PMC5771578 DOI: 10.1371/journal.pone.0189978] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 11/28/2017] [Indexed: 11/23/2022] Open
Abstract
Background Doxylamine-pyridoxine is recommended as a first line treatment for nausea and vomiting during pregnancy and it is commonly prescribed. We re-analysed the findings of a previously reported superiority trial of doxylamine-pyridoxine for the treatment of nausea and vomiting during pregnancy using the clinical study report obtained from Health Canada. Methods and findings We re-analysed individual level data for a parallel arm randomized controlled trial that was conducted in six outpatient obstetrical practices in the United States. Pregnant women between 7 and 14 weeks of gestation with moderate nausea and vomiting of pregnancy symptoms. The active treatment was a tablet containing both doxylamine 10 mg and pyridoxine 10 mg taken between 2 and 4 times per day for 14 days depending on symptoms. The control was an identical placebo tablet taken using the same instructions. The primary outcome measure was improvement in nausea and vomiting of symptoms scores using the 13-point pregnancy unique quantification of emesis scale between baseline and 14 days using an ANCOVA. 140 participants were randomized into each group. Data for 131 active treatment participants and 125 control participants were analysed. On the final day of the trial, 101 active treatment participants and 86 control participants provided primary outcome measures. There was greater improvement in symptoms scores with doxylamine-pyridoxine compared with placebo (0.73 points; 95% CI 0.21 to 1.25) when last observation carried forward imputation was used for missing data but the difference is not statistically significant using other approaches to missing data (e.g. 0.38; 95% CI -0.08 to 0.84 using complete data). Conclusions There is a trend towards efficacy for nausea and vomiting symptoms with doxylamine-pyridoxine compared with placebo but the statistical significance of the difference depends on the method of handling missing data and the magnitude of the difference suggests that there is no clinically important benefit employing the prespecified minimal clinically important difference or “expected difference” of 3 points. Trial registration Clinical Trial NCT00614445
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Affiliation(s)
- Navindra Persaud
- Department of Family and Community Medicine and Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- * E-mail:
| | - Christopher Meaney
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Khaled El-Emam
- Department of Pediatrics, University of Ottawa, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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22
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Tan A, Lowe S, Henry A. Nausea and vomiting of pregnancy: Effects on quality of life and day-to-day function. Aust N Z J Obstet Gynaecol 2017; 58:278-290. [PMID: 28949009 DOI: 10.1111/ajo.12714] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 08/11/2017] [Indexed: 12/26/2022]
Abstract
AIMS To investigate the effect of nausea and vomiting of pregnancy (NVP) on quality of life (QoL) and activities of daily living/socioeconomic function in a contemporary Australian setting. MATERIALS AND METHODS Observational, single centre prospective cohort study using validated survey instruments in pregnant women at 9-16 weeks gestation at a tertiary metropolitan women's hospital in Sydney, Australia. QoL measured by the Short-Form Health Survey (SF-12) was compared between those with and without NVP. NVP severity scores were correlated with QoL scores, work patterns and medication use. RESULTS Of 116 participants, 72% had NVP, with no baseline (including mental health) differences between women with or without NVP. As classified by modified Pregnancy-Unique-Quantified-Emesis (PUQE) survey, 42% had mild symptoms, 55% moderate and 1% severe. SF-12 Physical Component Summary (PCS) scores were significantly lower for those with NVP (P < 0.001), but not Mental Component Summary (MCS) scores (P = 0.11). Decreasing QoL was associated with increasing NVP severity (P < 0.001), most markedly in the physical domain (P < 0.001). Only 39% of women used any NVP treatment and 15% pharmacotherapy. Most used treatments were vitamin B6 , ginger, metoclopramide and natural remedies. Significantly more women with NVP required time off work (45% vs 16%, P = 0.003). CONCLUSIONS NVP is a physically morbid disease, affecting most pregnancies. NVP has a significant detrimental impact on QoL, especially physical QoL and work function. Despite this, we found low treatment utilisation, even in those with moderate/severe symptoms. Women should be encouraged to seek assistance for NVP and further education is required to improve practitioner awareness and management.
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Affiliation(s)
- Amelia Tan
- School of Women's and Children's Health, UNSW Medicine, Sydney, NSW, Australia
| | - Sandra Lowe
- School of Women's and Children's Health, UNSW Medicine, Sydney, NSW, Australia.,Department of Obstetrics, Royal Hospital for Women, Randwick, NSW, Australia
| | - Amanda Henry
- School of Women's and Children's Health, UNSW Medicine, Sydney, NSW, Australia.,Department of Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, NSW, Australia.,Women's and Children's Health, St George Hospital, Kogarah, NSW, Australia
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23
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Boelig RC. The dilemma of hyperemesis gravidarum: more answers, and more questions. Am J Clin Nutr 2017; 106:711-712. [PMID: 28768653 DOI: 10.3945/ajcn.117.164194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Rupsa C Boelig
- Division of Maternal Fetal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
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Manning Meurer M, Chakrala K, Gowda D, Burns C, Kelly R, Schlabritz-Loutsevitch N. A case of cannabinoid hyperemesis syndrome with Heliobacter pylori and preeclampsia during pregnancy. Subst Abus 2017; 39:9-13. [PMID: 28723278 DOI: 10.1080/08897077.2017.1356790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The condition termed cannabinoid hyperemesis syndrome (CHS) was characterized a decade ago by Allen et al. and includes cyclic episodes of nausea and vomiting and the learned behavior of hot bathing in individuals with chronic cannabis abuse. During pregnancy, the differential diagnosis of this syndrome is challenging, since it can be masked by typical symptoms of early pregnancy or by hyperemesis gravidarum, a complication of early pregnancy associated with excessive nausea and vomiting. CASE DESCRIPTION The authors herein describe the case of a 21-year-old primigravida patient diagnosed with hyperemesis gravidarum at 6 weeks of gestation and with preeclampsia at 35 weeks. At 30 weeks of gestation, a drug screen was performed that was positive for cannabis; therefore, a diagnosis of CHS was made. After labor induction, the patient delivered an infant who developed normally and had a negative drug test of the umbilical cord blood. Esophagogastroduodenoscopy was performed 9 days post delivery, with biopsies taken of the duodenal, gastric, and esophageal tissues. Moderate chronic gastritis with lymphoid aggregates and slight acute inflammation were noticed, whereas no malignancy, dysplasia, or goblet cell metaplasia was detected. A number of Helicobacter-like organisms were identified by H. pylori immunostaining. CONCLUSION Presented here is the first case reporting an association of chronic cannabis use with H. pylori colonization and preeclampsia in pregnancy, which brings to light the possible involvement of a cannabinoid-related pathway in the link between pregnancy-specific complications and bacterial colonization.
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Affiliation(s)
- Madeline Manning Meurer
- a Department of Obstetrics and Gynecology , Texas Tech University Health Sciences Center at the Permian Basin , Odessa , Texas , USA
| | - Kalyan Chakrala
- b Department of Internal Medicine , Texas Tech University Health Sciences Center at the Permian Basin , Odessa , Texas , USA
| | - Dinesh Gowda
- c Department of Pediatrics , Texas Tech University Health Sciences Center at the Permian Basin , Odessa , Texas , USA
| | - Charles Burns
- d Department of Pathology , Medical Center Hospital , Odessa , Texas , USA
| | - Randall Kelly
- a Department of Obstetrics and Gynecology , Texas Tech University Health Sciences Center at the Permian Basin , Odessa , Texas , USA
| | - Natalia Schlabritz-Loutsevitch
- a Department of Obstetrics and Gynecology , Texas Tech University Health Sciences Center at the Permian Basin , Odessa , Texas , USA
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Dochez V, Dimet J, David-Gruselle A, Le Thuaut A, Ducarme G. French family physician experience concerning the outpatient care for women suffering from nausea and vomiting in pregnancy. J Gynecol Obstet Hum Reprod 2017. [PMID: 28643666 DOI: 10.1016/j.jogoh.2017.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To explore thoughts and attitudes among French family physicians on the outpatient care for women suffering from nausea and vomiting in pregnancy (NVP). DESIGN AND SETTING A retrospective study was conducted among family physicians who had taken care of pregnant women who gave birth in our hospital in 1 year. PATIENTS AND METHODS Fifty-nine French family physicians responded to a questionnaire assessing their experience about outpatient care for women suffering from NVP. Analysis were done according to the physicians' age, as the annual demographics data analysis from the French Medical Council. RESULTS More than 89% of family physicians asked systematically the question concerning NVP (53/59), which were estimated as a frequent symptom (n=44, 74.6%). The intensity of NVP was assessed as mild in 28.8% (n=17), moderate in 62.7% (n=37), severe in 6.8% (n=4) and unbearable in 1.7% (n=1). Physicians younger than 40 years questionned less frequently about NVP compared to those older than 40 or older than 60 years (66.7% vs. 90.5% vs. 95.5%, respectively; P=0.04). Severe and unbearable NVP were significantly estimated more frequent among younger physicians (33.3% vs. 6.8%; P=0.03). Treatments (sick leave, diet, drugs, homeopathy, acupuncture or psychotherapy) did not differ between groups. DISCUSSION AND CONCLUSION Outpatient care for women suffering from NVP may vary according to the physician. French family physicians played a key role in NVP. Younger family physician considered NVP as a frequent symptom which needed active management in severe forms.
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Affiliation(s)
- V Dochez
- Department of obstetrics and gynecology, centre hospitalier departemental, Les Oudairies, 85000 La-Roche-sur-Yon, France; Department of obstetrics and gynecology, centre hospitalier universitaire, 44000 Nantes, France
| | - J Dimet
- Clinical research center, centre hospitalier departemental, Les Oudairies, La-Roche-sur-Yon, France
| | | | - A Le Thuaut
- Clinical research center, centre hospitalier departemental, Les Oudairies, La-Roche-sur-Yon, France
| | - G Ducarme
- Department of obstetrics and gynecology, centre hospitalier departemental, Les Oudairies, 85000 La-Roche-sur-Yon, France.
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Abstract
BACKGROUND In the United States, hyperemesis gravidarum is the most common cause of hospitalization during the first half of pregnancy and is second only to preterm labor for hospitalizations in pregnancy overall. In approximately 0.3-3% of pregnancies, hyperemesis gravidarum is prevalent and this percentage varies on account of different diagnostic criteria and ethnic variation in study populations. Despite extensive research in this field, the mechanism of the disease is largely unknown. Although cases of mortality are rare, hyperemesis gravidarum has been associated with both maternal and fetal morbidity. The current mainstay of treatment relies heavily on supportive measures until improvement of symptoms as part of the natural course of hyperemesis gravidarum, which occurs with progression of gestational age. However, studies have reported that severe, refractory disease manifestations have led to serious adverse outcomes and to termination of pregnancies. SUMMARY Despite extensive research in the field, the pathogenesis of hyperemesis gravidarum remains unknown. Recent literature points to a genetic predisposition in addition to previously studied factors such as infectious, psychiatric, and hormonal contributions. Maternal morbidity is common and includes psychological effects, financial burden, clinical complications from nutritional deficiencies, gastrointestinal trauma, and in rare cases, neurological damage. The effect of hyperemesis gravidarum on neonatal health is still debated in literature with conflicting results regarding outcomes of birth weight and prematurity. Available therapy options remain largely unchanged in the past several decades and focus on parenteral antiemetic medications, electrolyte repletion, and nutritional support. Most studies of therapeutic options do not consist of randomized control studies and cross-study analysis is difficult due to considerable variation of diagnostic criteria. Key Messages: Hyperemesis gravidarum carries a significant burden on maternal health and US health care. Most published research on pathogenesis is observational and suggests multifactorial associations with hyperemesis gravidarum. Precise, strictly defined criteria for clinical diagnosis are likely to benefit meta-analyses of further research studies regarding pathogenesis as well as therapeutic options.
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Affiliation(s)
- Viktoriya London
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Medical Center, Brooklyn, NY, USA
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Abstract
The American College of Obstetricians and Gynecologists recommends early treatment of nausea and vomiting of pregnancy to stop progression to hyperemesis gravidarum. Nausea and vomiting and hyperemesis gravidarum typically occur during the first trimester, the sensitive time for exposure to teratogens because organogenesis is occurring in the embryo. An efficacious treatment used widely across the United States for both nausea and vomiting of pregnancy and hyperemesis gravidarum is ondansetron. Recent studies have provided conflicting findings on the safety of ondansetron during pregnancy. There are numerous limitations in the current literature on ondansetron safety including exposure to the medication is not limited to sensitive windows of organogenesis, there is a lack of information on dosing and compliance, self-reports of exposure are commonly used, an inadequate accounting exists for other factors that may explain the relationship between ondansetron exposure and the adverse outcome, and there exists a lack of biologic plausibility by which ondansetron might cause harm. It is the authors' opinion that current data do not support a reluctance to treat women with ondansetron in clinical practice.
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Zhao B, Li M, Ren C, Liu XY, Mei D. Aggravated nausea and vomiting induced by fat emulsion for hyperemesis gravidarum: A case report. J Clin Pharm Ther 2017; 42:618-620. [PMID: 28474354 DOI: 10.1111/jcpt.12545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 04/03/2017] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Total parental nutrition (TPN) for hyperemesis gravidarum (HG) is generally effective and well-tolerated. We report a case of aggravated nausea and vomiting caused by fat emulsion. CASE DESCRIPTION A 40-year-old pregnant woman through IVF was admitted to the hospital at 11-week gestation and diagnosed with HG. During TPN treatment, the patient suffered from aggravated nausea and vomiting. We identified fat emulsion as the most likely culprit using challenge, dechallenge and rechallenge. WHAT IS NEW AND CONCLUSION This is the first report of fat emulsion aggravating nausea and vomiting in such situation.
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Affiliation(s)
- B Zhao
- Department of Pharmacy, Peking Union Medical College Hospital, Beijing, China
| | - M Li
- Department of Pharmacy, Peking Union Medical College Hospital, Beijing, China.,Department of Pharmacy, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - C Ren
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - X Y Liu
- College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - D Mei
- Department of Pharmacy, Peking Union Medical College Hospital, Beijing, China
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Helicobacter pylori infection: a predictor of vomiting severity in pregnancy and adverse birth outcome. Am J Obstet Gynecol 2017; 216:512.e1-512.e9. [PMID: 28188774 PMCID: PMC5426529 DOI: 10.1016/j.ajog.2017.01.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/09/2016] [Accepted: 01/31/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Nausea and occasional vomiting in early pregnancy is common. Why some women experience severe nausea and occasional vomiting in early pregnancy is unknown. Causes are multifactorial and only symptomatic treatment options are available, although adverse birth outcomes have been described. Helicobacter pylori infection has been implicated in the cause of nausea and occasional vomiting in early pregnancy. OBJECTIVE The purpose of this study was to investigate the association of H pylori with vomiting severity in pregnancy and its effect on birth outcome. STUDY DESIGN We assembled a population-based prospective cohort of pregnant women in The Netherlands. Enrolment took place between 2002 and 2006. H pylori serology was determined in mid gestation. Women reported whether they experienced vomiting in early, mid, and late gestation. Maternal weight was measured in the same time periods. Birth outcomes were obtained from medical records. Main outcome measures were vomiting frequency (no, occasional, daily) and duration (early, mid, late gestation), maternal weight gain, birthweight, small for gestational age, and prematurity. Data were analyzed with the use of multivariate regression. RESULTS We included 5549 Women, of whom 1932 (34.8%) reported occasional vomiting and 601 (10.8%) reported daily vomiting. Women who were H pylori-positive (n=2363) were more likely to report daily vomiting (adjusted odds ratio, 1.44; 95% confidence interval, 1.16-1.78). H pylori-positivity was associated with a reduction of total weight gain in women with daily vomiting (adjusted difference, -2.1 kg; 95% confidence interval, -2.7 to -1.5); infants born to women with H pylori and daily vomiting had slightly reduced birthweight (addjusted difference -60g; 95% confidence interval, -109 - -12) and an increased risk of being small for gestational age (adjusted odds ratio, 1.49; 95% confidence interval, 1.04-2.14). H pylori and daily vomiting did not significantly affect prematurity rate. CONCLUSION This study suggests that H pylori is an independent risk factor for vomiting in pregnancy. In women with daily vomiting, H pylori is also associated with low maternal weight gain, reduced birth weight, and small for gestational age. Because effective treatments for severe nausea and occasional vomiting in early pregnancy are currently lacking, the effect of H pylori eradication therapy on nausea and occasional vomiting in early pregnancy symptom severity should be the target of future studies.
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Taylor LG, Bird ST, Sahin L, Tassinari MS, Greene P, Reichman ME, Andrade SE, Haffenreffer K, Toh S. Antiemetic use among pregnant women in the United States: the escalating use of ondansetron. Pharmacoepidemiol Drug Saf 2017; 26:592-596. [DOI: 10.1002/pds.4185] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/29/2016] [Accepted: 01/23/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Lockwood G. Taylor
- Center for Drug Evaluation and Research; US Food and Drug Administration; Silver Spring MD USA
| | - Steven T. Bird
- Center for Drug Evaluation and Research; US Food and Drug Administration; Silver Spring MD USA
| | - Leyla Sahin
- Center for Drug Evaluation and Research; US Food and Drug Administration; Silver Spring MD USA
| | - Melissa S. Tassinari
- Center for Drug Evaluation and Research; US Food and Drug Administration; Silver Spring MD USA
| | - Patty Greene
- Center for Drug Evaluation and Research; US Food and Drug Administration; Silver Spring MD USA
| | - Marsha E. Reichman
- Center for Drug Evaluation and Research; US Food and Drug Administration; Silver Spring MD USA
| | - Susan E. Andrade
- Meyers Primary Care Institute (Fallon Community Health Plan, Reliant Medical Group, and University of Massachusetts Medical School); Worcester MA USA
| | - Katherine Haffenreffer
- Department of Population Medicine; Harvard Medical School and Harvard Pilgrim Health Care Institute; Boston MA USA
| | - Sengwee Toh
- Department of Population Medicine; Harvard Medical School and Harvard Pilgrim Health Care Institute; Boston MA USA
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Associations between Nausea, Vomiting, Fatigue and Health-Related Quality of Life of Women in Early Pregnancy: The Generation R Study. PLoS One 2016; 11:e0166133. [PMID: 27814390 PMCID: PMC5096665 DOI: 10.1371/journal.pone.0166133] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 10/24/2016] [Indexed: 12/16/2022] Open
Abstract
The objective of this study was to evaluate the independent associations between nausea, vomiting, fatigue and health-related quality of life of women in early pregnancy in the Generation R study, which is a prospective mother and child cohort. Analyses were based on 5079 women in early pregnancy in the Rotterdam area, the Netherlands. The information on nausea, vomiting and fatigue in the previous three months was measured in the questionnaire at enrollment, as well as potential confounders (i.e., maternal/gestational age, ethnic background, educational level, parity, marital status, body mass index, tobacco and alcohol use, chronic/infectious conditions, uro-genital conditions/symptoms, sleep quality, headache, anxiety, and depression). Health-related quality of life was assessed by the 12-item Short Form Health Survey and physical and mental component summary scores were calculated. Multivariate regression models were performed to evaluate the independent associations of the presence of nausea, vomiting and fatigue with health-related quality of life, adjusting for potential confounders. 33.6% of women experienced daily presence of nausea, 9.6% for vomiting and 44.4% for fatigue. Comparing with women who never reported nausea, vomiting and fatigue, women with daily presence of at least one of these symptoms had significantly lower scores of physical component summary and mental component summary, after adjusting for potential confounders. Our study shows how common nausea, vomiting and fatigue are among women in early pregnancy and how much each of these symptoms negatively impact on health-related quality of life. We call for awareness of this issue from health care professionals, pregnant women and their families.
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Dragoman MV, Grossman D, Kapp N, Huong NM, Habib N, Dung DL, Tamang A. Two prophylactic medication approaches in addition to a pain control regimen for early medical abortion < 63 days' gestation with mifepristone and misoprostol: study protocol for a randomized, controlled trial. Reprod Health 2016; 13:132. [PMID: 27733165 PMCID: PMC5062865 DOI: 10.1186/s12978-016-0246-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 10/03/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Pain is often cited as one of the worst features of medical abortion. Further, inadequate pain management may motivate some women to seek unnecessary clinical care. There is a need to identify effective methods for pain control in this setting. METHODS/DESIGN We propose a randomized, placebo-controlled trial. 576 participants (288 nulliparous; 288 parous) from study sites in Nepal, South Africa and Vietnam will be randomly allocated to one of three treatments: (1) ibuprofen 400 mg PO and metoclopramide 10 mg PO; (2) tramadol 50 mg PO and a placebo; or (3) two placebo pills, to be taken immediately before misoprostol and repeated once four hours later. All women will be provided with supplementary analgesia for use as needed during the medical abortion. We hypothesize that women receiving prophylactic analgesia will report lower maximal pain scores in the first 8 h following misoprostol administration compared to women receiving placebos for medical abortion through 63 days' gestation. Our primary objective is to determine whether prophylactic administration of ibuprofen and metoclopramide or tramadol provides superior pain relief compared to analgesia administration after pain begins, measured during the first eight hours after misoprostol administration. Secondary objectives include identifying covariates associated with higher reported pain scores; determining any impact of the study medicines on medical abortion success; and, qualitatively exploring women's physical experiences of medical abortion, especially related to pain, and how can they be improved. Data sources include medical records, participant symptom diaries and interview data obtained on the day of enrollment, during the medical abortion, and at follow-up. Participants will be contacted via telephone on day 3 and return for follow-up will occur approximately 14 days after mifepristone, concluding study participation. A subset of 42 women will also be invited to undergo in-depth qualitative interviews following study completion. DISCUSSION Although pain is one of the most common side effects encountered with medical abortion, little is known about optimal pain management for this process. This multi-arm trial design offers an efficient approach to evaluating two prophylactic pain management regimens compared to use of pain medication as needed. TRIAL REGISTRATION ACTRN12613000017729 (Prospectively registered 8/1/2013).
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Affiliation(s)
- Monica V. Dragoman
- Department of Reproductive Health and Research, WHO, UNFP/UNDP/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
- Ibis Reproductive Health, Oakland, CA USA
| | - Nathalie Kapp
- Department of Reproductive Health and Research, WHO, UNFP/UNDP/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Nguyen My Huong
- Department of Reproductive Health and Research, WHO, UNFP/UNDP/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Ndema Habib
- Department of Reproductive Health and Research, WHO, UNFP/UNDP/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Duong Lan Dung
- National Hospital for Obstetrics and Gynecology, Hanoi, Viet Nam
| | - Anand Tamang
- Center for Environment Health and Population Activities, Kathmandu, Nepal
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Acinetobacter ursingii Bacteremia From a Peripherally Inserted Central Catheter in a Woman With Hyperemesis Gravidarum. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2016. [DOI: 10.1097/ipc.0000000000000374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Grooten IJ, Roseboom TJ, Painter RC. Barriers and Challenges in Hyperemesis Gravidarum Research. Nutr Metab Insights 2016; 8:33-9. [PMID: 26917969 PMCID: PMC4755698 DOI: 10.4137/nmi.s29523] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/30/2015] [Accepted: 12/03/2015] [Indexed: 12/27/2022] Open
Abstract
Nausea and occasional vomiting in early pregnancy (NVP) are common. When vomiting is severe or protracted, it is referred to as hyperemesis gravidarum (HG). HG affects up to 3% of pregnancies and is characterized by weight loss, dehydration, electrolyte imbalance, and the need for hospital admission. HG has significant consequences for maternal well-being, is associated with adverse birth outcomes, and leads to major health care costs. Treatment options are symptomatic, hampered by the lack of evidence-based options including studies on nutritional interventions. One of the reasons for this lack of evidence is the use of a broad range of definitions and outcome measures. An internationally accepted definition and the formulation of core outcomes would facilitate meta-analysis of trial results and implementation of evidence in guidelines to ultimately improve patient care.
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Affiliation(s)
- Iris J Grooten
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Tessa J Roseboom
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Rebecca C Painter
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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Heitmann K, Solheimsnes A, Havnen GC, Nordeng H, Holst L. Treatment of nausea and vomiting during pregnancy —a cross-sectional study among 712 Norwegian women. Eur J Clin Pharmacol 2016; 72:593-604. [DOI: 10.1007/s00228-016-2012-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 01/12/2016] [Indexed: 02/08/2023]
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Heitmann K, Svendsen HC, Sporsheim IH, Holst L. Nausea in pregnancy: attitudes among pregnant women and general practitioners on treatment and pregnancy care. Scand J Prim Health Care 2016; 34:13-20. [PMID: 26854395 PMCID: PMC4911029 DOI: 10.3109/02813432.2015.1132894] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Nausea and vomiting during pregnancy (NVP) is very common, and may have great impact on a woman's life. The aim of this study was to explore thoughts and attitudes among Norwegian pregnant women and GPs on treatment of NVP and pregnancy care. DESIGN Focus-group study. SETTING AND SUBJECTS Separate focus-group discussions were conducted with pregnant women and GPs. RESULTS Two focus-group discussions were conducted with pregnant women and two with GPs. The GPs thought it was important to normalize NVP symptoms. However, the women felt their distress due to NVP was trivialized by the GPs. The women were sceptical towards the use of medicines while pregnant, and avoidance was sought despite being ill. The GPs appeared uncertain with respect to medical treatment of NVP, which was stated to be considered only after progression to quite severe symptoms. Sick leave seemed to be an important part of the treatment regime applied by the GPs. The women had good experiences with graded sick leave. CONCLUSION This Norwegian study identifies attitudes among GPs and pregnant women that may act as obstacles to appropriate care for women with NVP. The pregnant women and the GPs seemed to talk at cross-purposes; GPs' normalization of the symptoms made the women feel that their distress due to NVP was trivialized by the GPs. Our results indicate that pregnant women with NVP requiring medical treatment probably need comprehensive and reassuring information about treatment options before considering using any medicines. KEY POINTS Nausea and vomiting during pregnancy (NVP) is very common, and considered to be of clinical significance for 35% of women. While the GPs agreed on the importance of normalizing the symptoms, the women felt their distress was trivialized, and missed being properly evaluated. Both the GPs and the women showed a reluctant attitude to medical treatment of NVP. The GPs gave the impression of considering medical treatment only after progression of symptoms to becoming quite severe.
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Affiliation(s)
- Kristine Heitmann
- CONTACT Kristine Heitmann Department of Global Public Health and Primary Caree, University of Bergen, Post Box 7804, N-5018 Bergen, Norway
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Fischer T, Grab D, Grubert T, Hantschmann P, Kainer F, Kästner R, Kentenich C, Klockenbusch W, Lammert F, Louwen F, Mylonas I, Pildner von Steinburg S, Rath W, Schäfer-Graf UM, Schleußner E, Schmitz R, Steitz HO, Verlohren S. Maternale Erkrankungen in der Schwangerschaft. FACHARZTWISSEN GEBURTSMEDIZIN 2016. [PMCID: PMC7158353 DOI: 10.1016/b978-3-437-23752-2.00017-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Treatment of nausea in pregnancy: a cross-sectional multinational web-based study of pregnant women and new mothers. BMC Pregnancy Childbirth 2015; 15:321. [PMID: 26628289 PMCID: PMC4667480 DOI: 10.1186/s12884-015-0746-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 11/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The factors related to the treatment of nausea during pregnancy have not yet been investigated in several countries simultaneously. The present study aimed to describe differences in self-reported nausea during pregnancy and the patterns of use for both conventional and herbal medicines across countries. The factors related to nausea and its treatment and the relationships between different self-reported co-morbidities and nausea were also investigated. METHODS This cross-sectional study used data collected by a web-based questionnaire distributed between October 2011 and February 2012 in several countries within five regions: Western, Northern, and Eastern Europe, North America, and Australia. Women who were pregnant or had a child less than one year old were eligible to participate. RESULTS A total of 9113 women were included in the study, whereof 6701 (73.5%) had experienced nausea during pregnancy. Among respondents with nausea, conventional medicines were used by 1201 (17.9%) women and herbal medicines by 556 (8.3%) women. The extent of self-reported nausea and its treatment varied by country. Education, working status, and folic acid use were significantly associated with the use of conventional medicines against nausea. Respondents who had nausea also had a high burden of co-morbidity. CONCLUSION The prevalence of nausea was high across all participating countries but its treatment varied, possibly due to cultural differences and differences in attitudes towards medicines. A high degree of co-morbidity was found among respondents with nausea.
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