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Jansen LAW, Shaw V, Grooten IJ, Koot MH, Dean CR, Painter RC. Diagnostic et traitement de l’hyperémèse gravidique. CMAJ 2024; 196:E734-E743. [PMID: 38830681 PMCID: PMC11142033 DOI: 10.1503/cmaj.221502-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Affiliation(s)
- Larissa A W Jansen
- Institut de recherche sur la reproduction et le développement d'Amsterdam (Jansen, Dean, Painter), Amsterdam; Département d'obstétrique et de gynécologie (Jansen), Centre médical Érasme, Rotterdam, Pays-Bas; École des sciences infirmières et de sagesfemmes, Faculté de santé (Shaw), Université de Plymouth, R.-U.; Département d'obstétrique et de gynécologie (Grooten), Centre médical universitaire d'Amsterdam, Université d'Amsterdam; Département d'épidémiologie et de science des données (Koot), Centre médical universitaire d'Amsterdam, Université libre d'Amsterdam, Amsterdam, Pays-Bas; Soutien aux nausées gravidiques (Dean), R.-U.; Département d'obstétrique et de gynécologie (Painter), Centre médical universitaire d'Amsterdam, Université libre d'Amsterdam, Amsterdam, Pays Bas
| | - Victoria Shaw
- Institut de recherche sur la reproduction et le développement d'Amsterdam (Jansen, Dean, Painter), Amsterdam; Département d'obstétrique et de gynécologie (Jansen), Centre médical Érasme, Rotterdam, Pays-Bas; École des sciences infirmières et de sagesfemmes, Faculté de santé (Shaw), Université de Plymouth, R.-U.; Département d'obstétrique et de gynécologie (Grooten), Centre médical universitaire d'Amsterdam, Université d'Amsterdam; Département d'épidémiologie et de science des données (Koot), Centre médical universitaire d'Amsterdam, Université libre d'Amsterdam, Amsterdam, Pays-Bas; Soutien aux nausées gravidiques (Dean), R.-U.; Département d'obstétrique et de gynécologie (Painter), Centre médical universitaire d'Amsterdam, Université libre d'Amsterdam, Amsterdam, Pays Bas
| | - Iris J Grooten
- Institut de recherche sur la reproduction et le développement d'Amsterdam (Jansen, Dean, Painter), Amsterdam; Département d'obstétrique et de gynécologie (Jansen), Centre médical Érasme, Rotterdam, Pays-Bas; École des sciences infirmières et de sagesfemmes, Faculté de santé (Shaw), Université de Plymouth, R.-U.; Département d'obstétrique et de gynécologie (Grooten), Centre médical universitaire d'Amsterdam, Université d'Amsterdam; Département d'épidémiologie et de science des données (Koot), Centre médical universitaire d'Amsterdam, Université libre d'Amsterdam, Amsterdam, Pays-Bas; Soutien aux nausées gravidiques (Dean), R.-U.; Département d'obstétrique et de gynécologie (Painter), Centre médical universitaire d'Amsterdam, Université libre d'Amsterdam, Amsterdam, Pays Bas
| | - Marjette H Koot
- Institut de recherche sur la reproduction et le développement d'Amsterdam (Jansen, Dean, Painter), Amsterdam; Département d'obstétrique et de gynécologie (Jansen), Centre médical Érasme, Rotterdam, Pays-Bas; École des sciences infirmières et de sagesfemmes, Faculté de santé (Shaw), Université de Plymouth, R.-U.; Département d'obstétrique et de gynécologie (Grooten), Centre médical universitaire d'Amsterdam, Université d'Amsterdam; Département d'épidémiologie et de science des données (Koot), Centre médical universitaire d'Amsterdam, Université libre d'Amsterdam, Amsterdam, Pays-Bas; Soutien aux nausées gravidiques (Dean), R.-U.; Département d'obstétrique et de gynécologie (Painter), Centre médical universitaire d'Amsterdam, Université libre d'Amsterdam, Amsterdam, Pays Bas
| | - Caitlin R Dean
- Institut de recherche sur la reproduction et le développement d'Amsterdam (Jansen, Dean, Painter), Amsterdam; Département d'obstétrique et de gynécologie (Jansen), Centre médical Érasme, Rotterdam, Pays-Bas; École des sciences infirmières et de sagesfemmes, Faculté de santé (Shaw), Université de Plymouth, R.-U.; Département d'obstétrique et de gynécologie (Grooten), Centre médical universitaire d'Amsterdam, Université d'Amsterdam; Département d'épidémiologie et de science des données (Koot), Centre médical universitaire d'Amsterdam, Université libre d'Amsterdam, Amsterdam, Pays-Bas; Soutien aux nausées gravidiques (Dean), R.-U.; Département d'obstétrique et de gynécologie (Painter), Centre médical universitaire d'Amsterdam, Université libre d'Amsterdam, Amsterdam, Pays Bas
| | - Rebecca C Painter
- Institut de recherche sur la reproduction et le développement d'Amsterdam (Jansen, Dean, Painter), Amsterdam; Département d'obstétrique et de gynécologie (Jansen), Centre médical Érasme, Rotterdam, Pays-Bas; École des sciences infirmières et de sagesfemmes, Faculté de santé (Shaw), Université de Plymouth, R.-U.; Département d'obstétrique et de gynécologie (Grooten), Centre médical universitaire d'Amsterdam, Université d'Amsterdam; Département d'épidémiologie et de science des données (Koot), Centre médical universitaire d'Amsterdam, Université libre d'Amsterdam, Amsterdam, Pays-Bas; Soutien aux nausées gravidiques (Dean), R.-U.; Département d'obstétrique et de gynécologie (Painter), Centre médical universitaire d'Amsterdam, Université libre d'Amsterdam, Amsterdam, Pays Bas
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Nelson-Piercy C, Dean C, Shehmar M, Gadsby R, O'Hara M, Hodson K, Nana M. The Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum (Green-top Guideline No. 69). BJOG 2024; 131:e1-e30. [PMID: 38311315 DOI: 10.1111/1471-0528.17739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
An objective and validated index of nausea and vomiting such as the Pregnancy-Unique Quantification of Emesis (PUQE) and HyperEmesis Level Prediction (HELP) tools can be used to classify the severity of NVP and HG. [Grade C] Ketonuria is not an indicator of dehydration and should not be used to assess severity. [Grade A] There are safety and efficacy data for first line antiemetics such as anti (H1) histamines, phenothiazines and doxylamine/pyridoxine (Xonvea®) and they should be prescribed initially when required for NVP and HG (Appendix III). [Grade A] There is evidence that ondansetron is safe and effective. Its use as a second line antiemetic should not be discouraged if first line antiemetics are ineffective. Women can be reassured regarding a very small increase in the absolute risk of orofacial clefting with ondansetron use in the first trimester, which should be balanced with the risks of poorly managed HG. [Grade B] Metoclopramide is safe and effective and can be used alone or in combination with other antiemetics. [Grade B] Because of the risk of extrapyramidal effects metoclopramide should be used as second-line therapy. Intravenous doses should be administered by slow bolus injection over at least 3 minutes to help minimise these. [Grade C] Women should be asked about previous adverse reactions to antiemetic therapies. If adverse reactions occur, there should be prompt cessation of the medications. [GPP] Normal saline (0.9% NaCl) with additional potassium chloride in each bag, with administration guided by daily monitoring of electrolytes, is the most appropriate intravenous hydration. [Grade C] Combinations of different drugs should be used in women who do not respond to a single antiemetic. Suggested antiemetics for UK use are given in Appendix III. [GPP] Thiamine supplementation (either oral 100 mg tds or intravenous as part of vitamin B complex (Pabrinex®)) should be given to all women admitted with vomiting, or severely reduced dietary intake, especially before administration of dextrose or parenteral nutrition. [Grade D] All therapeutic measures should have been tried before considering termination of pregnancy. [Grade C].
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Lindgren L, Holmlund S, Dunge J, Nording ML, Vinnars MT, Lindqvist M. "Navigating in a maze without a map". Partners' experiences of hyperemesis gravidarum- a qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 40:100976. [PMID: 38696948 DOI: 10.1016/j.srhc.2024.100976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVE A supportive environment for women with Hyperemesis Gravidarum is crucial but not always provided. There is a lack of research regarding Hyperemesis Gravidarum, its impact on the family, and the partner's perception of supporting their spouse. Thus, this study aims to explore partners' experiences of Hyperemesis Gravidarum during their spousés pregnancy. METHODS Data were gathered through 13 individual, semi-structured, in-depth, digital interviews with partners of women who had experienced Hyperemesis Gravidarum and analysed with Qualitative Content Analysis. The partners were recruited through advertisement on a social media platform and were exclusively males, representing 8 of 21 Swedish regions. The mean age was 34, and they had, on average, 1 previous child. The mean time from the experience to the interview was 12 months. FINDINGS The main theme, "Navigating in a maze without a map", explains partners' situation as stressful and demanding when their spouse suffers from Hyperemesis Gravidarum, with insufficient support and guidance from healthcare providers. The analysis resulted in three themes: "Standing alone with a demanding responsibility", "Being in a lottery when facing healthcare", and "Climbing the mountain together." The themes display challenges within everyday life and healthcare, as well as strained relations within the family. CONCLUSION Partners experience a need to support their spouse in every aspect of daily life and advocate for adequate healthcare. Healthcare professionals must support and acknowledge the partners' struggles during the demanding situation with Hyperemesis Gravidarum.
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Affiliation(s)
| | - Sophia Holmlund
- Department of Nursing, Umeå University, Sweden; Department of Clinical Sciences, Division of Obstetrics and Gynecology, Umeå University, Sweden; Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, VIC, Bundoora, Australia
| | - Johanna Dunge
- Department of Clinical Sciences, Division of Obstetrics and Gynecology, Umeå University, Sweden
| | | | - Marie-Therese Vinnars
- Department of Clinical Sciences, Division of Obstetrics and Gynecology, Umeå University, Sweden
| | - Maria Lindqvist
- Department of Nursing, Umeå University, Sweden; Department of Clinical Sciences, Division of Obstetrics and Gynecology, Umeå University, Sweden
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Jansen LAW, Shaw V, Grooten IJ, Koot MH, Dean CR, Painter RC. Diagnosis and treatment of hyperemesis gravidarum. CMAJ 2024; 196:E477-E485. [PMID: 38621783 PMCID: PMC11019608 DOI: 10.1503/cmaj.221502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Affiliation(s)
- Larissa A W Jansen
- Amsterdam Reproduction and Development Research Institute (Jansen, Dean, Painter), Amsterdam; Department of Obstetrics and Gynecology (Jansen), Erasmus MC, Rotterdam, the Netherlands; School of Nursing and Midwifery, Faculty of Health (Shaw), University of Plymouth, UK; Department of Obstetrics and Gynecology (Grooten), Amsterdam UMC, University of Amsterdam; Department of Epidemiology & Data Science (Koot), Amsterdam UMC, Vrije Universiteit Medical Centre, Amsterdam, the Netherlands; Pregnancy Sickness Support (Dean), UK; Department of Obstetrics and Gynecology (Painter), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Victoria Shaw
- Amsterdam Reproduction and Development Research Institute (Jansen, Dean, Painter), Amsterdam; Department of Obstetrics and Gynecology (Jansen), Erasmus MC, Rotterdam, the Netherlands; School of Nursing and Midwifery, Faculty of Health (Shaw), University of Plymouth, UK; Department of Obstetrics and Gynecology (Grooten), Amsterdam UMC, University of Amsterdam; Department of Epidemiology & Data Science (Koot), Amsterdam UMC, Vrije Universiteit Medical Centre, Amsterdam, the Netherlands; Pregnancy Sickness Support (Dean), UK; Department of Obstetrics and Gynecology (Painter), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Iris J Grooten
- Amsterdam Reproduction and Development Research Institute (Jansen, Dean, Painter), Amsterdam; Department of Obstetrics and Gynecology (Jansen), Erasmus MC, Rotterdam, the Netherlands; School of Nursing and Midwifery, Faculty of Health (Shaw), University of Plymouth, UK; Department of Obstetrics and Gynecology (Grooten), Amsterdam UMC, University of Amsterdam; Department of Epidemiology & Data Science (Koot), Amsterdam UMC, Vrije Universiteit Medical Centre, Amsterdam, the Netherlands; Pregnancy Sickness Support (Dean), UK; Department of Obstetrics and Gynecology (Painter), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Marjette H Koot
- Amsterdam Reproduction and Development Research Institute (Jansen, Dean, Painter), Amsterdam; Department of Obstetrics and Gynecology (Jansen), Erasmus MC, Rotterdam, the Netherlands; School of Nursing and Midwifery, Faculty of Health (Shaw), University of Plymouth, UK; Department of Obstetrics and Gynecology (Grooten), Amsterdam UMC, University of Amsterdam; Department of Epidemiology & Data Science (Koot), Amsterdam UMC, Vrije Universiteit Medical Centre, Amsterdam, the Netherlands; Pregnancy Sickness Support (Dean), UK; Department of Obstetrics and Gynecology (Painter), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Caitlin R Dean
- Amsterdam Reproduction and Development Research Institute (Jansen, Dean, Painter), Amsterdam; Department of Obstetrics and Gynecology (Jansen), Erasmus MC, Rotterdam, the Netherlands; School of Nursing and Midwifery, Faculty of Health (Shaw), University of Plymouth, UK; Department of Obstetrics and Gynecology (Grooten), Amsterdam UMC, University of Amsterdam; Department of Epidemiology & Data Science (Koot), Amsterdam UMC, Vrije Universiteit Medical Centre, Amsterdam, the Netherlands; Pregnancy Sickness Support (Dean), UK; Department of Obstetrics and Gynecology (Painter), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Rebecca C Painter
- Amsterdam Reproduction and Development Research Institute (Jansen, Dean, Painter), Amsterdam; Department of Obstetrics and Gynecology (Jansen), Erasmus MC, Rotterdam, the Netherlands; School of Nursing and Midwifery, Faculty of Health (Shaw), University of Plymouth, UK; Department of Obstetrics and Gynecology (Grooten), Amsterdam UMC, University of Amsterdam; Department of Epidemiology & Data Science (Koot), Amsterdam UMC, Vrije Universiteit Medical Centre, Amsterdam, the Netherlands; Pregnancy Sickness Support (Dean), UK; Department of Obstetrics and Gynecology (Painter), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
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Laitinen L, Nurmi M, Koivisto M, Rautava P, Polo-Kantola P. Recalling the severity of nausea and vomiting of pregnancy - a study using Pregnancy-Unique Quantification of Emesis Questionnaire. J OBSTET GYNAECOL 2023; 43:2153025. [PMID: 36495300 DOI: 10.1080/01443615.2022.2153025] [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: 12/14/2022]
Abstract
The accuracy of the recall of the severity of nausea and vomiting of pregnancy (NVP) with Pregnancy-Unique Quantification of Emesis (PUQE) questionnaire has been questioned. We aimed to compare PUQE scores of women recalling the worst episode of NVP of their current pregnancy in different gestational weeks (gwks). Total of 2343 pregnant women (gwks 7-40) were recruited. Four groups were formed according to the gwks at reply: ≤16 gwks (n = 554), ≤20 gwks (n = 1209), >20 gwks (n = 1134) and ≥24 gwks (n = 495). PUQE scores were similar between the groups. Consequently, consistency of PUQE scores across the groups endorses the useability of the PUQE questionnaire in retrospective assessment of the overall severity of NVP in different gwks, regardless of passing of the peak NVP symptoms.Impact statementWhat is already known on this subject? Retrospective evaluation of the severity of nausea and vomiting of pregnancy (NVP) has been argued to be disposed to recall bias. Structured Pregnancy-Unique Quantification of Emesis (PUQE) questionnaire is a validated tool for assessing the severity of NVP.What do the results of this study add? When the women recalled the most severe NVP symptoms of their current pregnancy, no differences in the PUQE scores were found despite different gestational weeks at reply. Of distinct PUQE questions, women answering in early pregnancy reported longer duration of nausea than women answering in late pregnancy, but other questions were rated similarly.What the implications are of these findings for clinical practice and/or further research? Our aim was to compare the PUQE scores between the women who filled in the PUQE questionnaire in early or in late pregnancy, instructed to recall their worst symptoms in their current pregnancy. As there were no differences between the groups in total PUQE scores, our results support the application of PUQE questionnaire to assess the severity of NVP during pregnancy not only concurrent to the peak symptoms but also retrospectively.
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Affiliation(s)
- Linda Laitinen
- Department of Obstetrics and Gynecology, Hospital Nova of Central Finland, Jyväskylä, Finland.,Department of Obstetrics and Gynecology, University of Turku, Turku, Finland
| | - Miina Nurmi
- Department of Obstetrics and Gynecology, University of Turku, Turku, Finland.,Department of Public Health, University of Turku, Turku, Finland
| | - Mari Koivisto
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland.,Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, University of Turku, Turku, Finland.,Department of Obstetrics and Gynecology, Turku University Hospital, Turku, Finland
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Beck CT. Survivors' Experiences of Hyperemesis Gravidarum. JOURNAL OF INFUSION NURSING 2023; 46:338-346. [PMID: 37920107 DOI: 10.1097/nan.0000000000000520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Hyperemesis gravidarum can result in life-threatening physical and psychological maternal morbidity, including severe dehydration, weight loss, electrolyte imbalance, depression, and suicidal ideation. The reported prevalence of hyperemesis gravidarum ranges from 0.3% to 3.6%. The purpose of this qualitative study was to investigate what blogs can tell us about women's experiences of hyperemesis gravidarum. Thirty-three blogs written by hyperemesis gravidarum survivors posted on Hyperemesis Australia's website were analyzed using Krippendorff's qualitative content analysis method. Clustering was used and yielded 6 themes: (1) debilitating physical and mental health problems: digging deep to persevere, (2) heartbreaking choices, (3) lack of understanding and dismissed, (4) so much guilt surrounding their unborn infant, (5) it takes a village to support women with hyperemesis gravidarum, and (6) warriors and survivors: giving back. Infusion nurses are in a perfect position to provide support and compassionate care for women who are repeatedly coming to the hospital for rehydration treatment. Infusion nurses can validate women's physical and emotional struggles with hyperemesis gravidarum and help to no longer make women feel stigmatized.
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Affiliation(s)
- Cheryl Tatano Beck
- School of Nursing, University of Connecticut, 231 Glenbrook Rd, Storrs, CT
- Cheryl Tatano Beck, DNSc, CNM, FAAN, is a Distinguished Professor at the University of Connecticut School of Nursing. She also holds a joint appointment in the School of Medicine Department of Obstetrics and Gynecology. She is a fellow in the American Academy of Nursing and inducted into the Sigma Theta Tau International Nurse Researcher Hall of Fame. For over 35 years, her program of research has focused on postpartum depression and posttraumatic stress disorder due to traumatic childbirth. She developed the Postpartum Depression Screening Scale from her series of qualitative studies
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Lindström VS, Laitinen LM, Nurmi JMA, Koivisto MA, Polo‐Kantola P. Hyperemesis gravidarum: Associations with personal and family history of nausea. Acta Obstet Gynecol Scand 2023; 102:1176-1182. [PMID: 37431247 PMCID: PMC10407014 DOI: 10.1111/aogs.14629] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/13/2023] [Accepted: 06/18/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION The pathogenesis and risk factors for hyperemesis gravidarum, excessive nausea and vomiting of pregnancy, are not adequately recognized. In our previous study, we found that women with a personal history of nausea in different situations and a family history of nausea and vomiting of pregnancy (NVP) were more likely to have severe NVP. The present study focuses on these themes in association with hyperemesis gravidarum in a hospital setting. MATERIAL AND METHODS Women with hyperemesis gravidarum (n = 102) were recruited from among patients hospitalized due to hyperemesis gravidarum in Turku University Hospital, Finland. Our control group (Non-NVP group, n = 138) consisted of pregnant women with no NVP. Personal history of nausea in different situations was inquired about in relation to "motion sickness", "seasickness", "migraine", "other kind of headache", "after anesthesia", "during the use of contraception", and "other kinds of nausea". Relatives with NVP were divided into first-degree (mother and sisters) and second-degree (more distant) relatives. RESULTS In univariate analysis, a personal history of motion sickness, seasickness, nausea related to migraine, nausea with other headache and nausea in other situations were associated with hyperemesis gravidarum. After adjusting for age, parity, pre-pregnancy body mass index, marital status, and smoking, motion sickness (adjusted odds ratio [aOR] 5.24, 95% confidence interval [CI] 2.67-10.31, p < 0.0001), seasickness (aOR 4.82, 95% CI 2.32-10.03, p < 0.0001), nausea related to migraine (aOR 3.00, 95% CI 1.58-5.70, p < 0.001), and nausea in other situations (aOR 2.65, 95% CI 1.13-6.20, p = 0.025) remained significant. In multivariable analysis with all history of nausea variables, motion sickness (OR 2.76, 95% CI 1.29-5.89, p = 0.009) and nausea related to migraine (OR 3.10, 95% CI 1.40-6.86, p = 0.005) were associated with hyperemesis gravidarum. Having any affected relative (OR 3.51, 95%CI 1.84-6.73, p = 0.0002), especially a first-degree relative (OR 3.06, 95% CI 1.62-5.79, p = 0.0006), was also associated with hyperemesis gravidarum. Adjustment did not change the results. CONCLUSIONS Women with a personal history of nausea or a family history of NVP are more likely to suffer from hyperemesis gravidarum. These results are beneficial to better identify and help women at risk for hyperemesis gravidarum.
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Affiliation(s)
- Venla S. Lindström
- Department of Obstetrics and GynecologyTurku University Hospital and University of TurkuTurkuFinland
| | - Linda M. Laitinen
- University of TurkuTurkuFinland
- The Wellbeing Services County of Central Finland, Department of Obstetrics and GynecologyHospital Nova of Central FinlandJyväskyläFinland
| | | | | | - Päivi Polo‐Kantola
- Department of Obstetrics and GynecologyTurku University Hospital and University of TurkuTurkuFinland
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Chong Tai LI, Anand G, Singh SP. Esophagogastrectomy for Long-Segment Recurrent Esophageal Stricture Following Hyperemesis Gravidarum. Cureus 2023; 15:e42489. [PMID: 37637565 PMCID: PMC10453980 DOI: 10.7759/cureus.42489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
An esophageal stricture is an abnormal tightening of the esophageal lumen. Benign strictures are often caused by gastroesophageal reflux disease (GERD) and are more common in patients over 40 years. When caused by GERD, these strictures develop when acid from the stomach regurgitates into the esophagus, leading to inflammation, fibrosis, and eventual narrowing of the lumen. This case report aims to highlight the importance of obtaining a detailed history in discovering the underlying cause of these strictures. We present a unique case of a young female presenting with dysphagia several months after experiencing Hyperemesis gravidarum. She was found to have a long esophageal stricture that would eventually recur within a few weeks of therapeutic intervention. The pathological report confirmed benign disease, but she ultimately would require surgical intervention for her condition.
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Affiliation(s)
- Lorraine I Chong Tai
- Department of Internal Medicine, Broward Health Medical Center, Fort Lauderdale, USA
| | - Gautam Anand
- Department of Gastroenterology, Broward Health Medical Center, Fort Lauderdale, USA
| | - Satya P Singh
- Department of Gastroenterology, Broward Health Medical Center, Fort Lauderdale, USA
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Fassett MJ, Peltier MR, Lopez AH, Chiu VY, Getahun D. Hyperemesis Gravidarum: Risk of Recurrence in Subsequent Pregnancies. Reprod Sci 2023; 30:1198-1206. [PMID: 36163577 DOI: 10.1007/s43032-022-01078-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 09/02/2022] [Indexed: 10/14/2022]
Abstract
This study aimed to examine whether the recurrence risk of hyperemesis gravidarum (HG) is modified by the timing of diagnosis, the severity of illness, and interpregnancy interval. The Kaiser Permanente Southern California 1998-2020 longitudinally linked medical records were used to examine the recurrence risk of HG in the first two (n = 93,444) and first three (n = 17,492) successive pregnancies. The timing of diagnosis- and the severity of illness-specific recurrence risks were examined by estimating the adjusted relative risks (aRR). The risks of HG in the second pregnancy among patients with and without previous HG were 23.8% and 3.4%, respectively (aRR: 8.20; 95% confidence interval [CI]: 7.52, 8.94). The recurrence risk persisted regardless of the trimester at diagnosis and the gestational age of delivery in the first pregnancy. The recurrence risk was greater for patients with metabolic disturbances requiring in-hospital treatment (30.0%) than those managed on an outpatient basis (18.6%) in the first pregnancy (aRR: 10.84 95% CI: 9.66, 12.16). Although Asian/Pacific Islander (RR = 12.9) and White (RR = 8.9) patients had higher HG recurrence risk regardless of the gestational age at delivery in the first pregnancy, all patients had significant recurrence risk only if their first pregnancy was delivered after 32 weeks of gestation. African American patients had the highest recurrence rate (34.4%). HG recurrence risk was unaffected by interpregnancy interval and correlated with the number of previous pregnancies complicated by HG. There is an increased recurrence risk of HG in subsequent pregnancies that is influenced by race/ethnicity and gestational age at delivery. The number of pregnancies complicated by HG synergistically adds to the recurrence risk.
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Affiliation(s)
- Michael J Fassett
- Department of Obstetrics and Gynecology, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, CA, USA
| | - Morgan R Peltier
- Department of Psychiatry, Shore University Medical Center, Neptune, NJ, USA
| | - Adrian H Lopez
- Department of Obstetrics and Gynecology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Vicki Y Chiu
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Avenue, 2nd Floor, Pasadena, CA, 91101, USA
| | - Darios Getahun
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Avenue, 2nd Floor, Pasadena, CA, 91101, USA.
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
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Fejzo MS, MacGibbon KW, Mullin PM. Inaccuracies in "Long-term health outcomes of children born to mothers with hyperemesis gravidarum: a systematic review and meta-analysis". Am J Obstet Gynecol 2022; 227:792. [PMID: 35850201 DOI: 10.1016/j.ajog.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Marlena S Fejzo
- Division of Maternal Fetal Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.
| | | | - Patrick M Mullin
- Division of Maternal Fetal Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Nijsten K, van der Minnen LM, Dean C, Bais JMJ, Ris-Stalpers C, van Eekelen R, Bremer HA, van der Ham DP, Heidema WM, Huisjes A, Kleiverda G, Kuppens SM, van Laar JOEH, Langenveld J, van der Made F, Papatsonis D, Pelinck MJ, Pernet PJ, van Rheenen-Flach L, Rijnders RJ, Scheepers HCJ, Vogelvang T, Mol BW, Olff M, Roseboom TJ, Koot MH, Grooten IJ, Painter RC. Depression, anxiety, and post-traumatic stress disorder symptoms after hyperemesis gravidarum: a prospective cohort study. J Matern Fetal Neonatal Med 2022; 35:10055-10063. [PMID: 35726837 DOI: 10.1080/14767058.2022.2089550] [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: 10/18/2022]
Abstract
OBJECTIVE To determine the prevalence of depression, anxiety, and posttraumatic stress disorder (PTSD) years after hyperemesis gravidarum (HG) and its association with HG severity. MATERIAL AND METHODS This prospective cohort study consisted of a follow-up of 215 women admitted for HG, who were eligible to participate in a randomized controlled trial and either declined or agreed to be randomized between 2013 and 2016 in 19 hospitals in the Netherlands. Participants completed the Hospital Anxiety and Depression Scale (HADS) six weeks postpartum and during follow-up and the PTSD checklist for DSM-5 (PCL-5) during follow-up. An anxiety or depression score ≥8 is indicative of an anxiety or depression disorder and a PCL-5 ≥ 31 indicative of PTSD. Measures of HG severity were symptom severity (PUQE-24: Pregnancy Unique Quantification of Emesis), weight change, duration of admissions, readmissions, and admissions after the first trimester. RESULTS About 54/215 participants completed the HADS six weeks postpartum and 73/215 participants completed the follow-up questionnaire, on average 4.5 years later. Six weeks postpartum, 13 participants (24.1%) had an anxiety score ≥8 and 11 participants (20.4%) a depression score ≥8. During follow-up, 29 participants (39.7%) had an anxiety score ≥8, 20 participants (27.4%) a depression score ≥8, and 16 participants (21.9%) a PCL-5 ≥ 31.Multivariable logistic regression analysis showed that for every additional point of the mean PUQE-24 three weeks after inclusion, the likelihood of having an anxiety score ≥8 and PCL-5 ≥ 31 at follow-up increased with OR 1.41 (95% CI: 1.10;1.79) and OR 1.49 (95% CI: 1.06;2.10) respectively. CONCLUSION Depression, anxiety, and PTSD symptoms are common years after HG occurred.
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Affiliation(s)
- Kelly Nijsten
- Amsterdam University Medical Centers, University of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Loïs M van der Minnen
- Amsterdam University Medical Centers, University of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Caitlin Dean
- Amsterdam University Medical Centers, University of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands.,Pregnancy Sickness Support, Bodmin, UK
| | - Joke M J Bais
- Department of Obstetrics and Gynecology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Carrie Ris-Stalpers
- Laboratory of Reproductive Biology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Rik van Eekelen
- Amsterdam University Medical Centers, University of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Henk A Bremer
- Department of Obstetrics and Gynecology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - David P van der Ham
- Department of Obstetrics and Gynecology, Martini Hospital, Groningen, The Netherlands
| | - Wieteke M Heidema
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anjoke Huisjes
- Department of Obstetrics and Gynecology, Gelre Hospital, Apeldoorn, The Netherlands
| | - Gunilla Kleiverda
- Department of Obstetrics and Gynecology, Flevo Hospital, Almere, The Netherlands
| | - Simone M Kuppens
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands
| | - Judith O E H van Laar
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Josje Langenveld
- Department of Obstetrics and Gynecology, Zuyderland Hospital, Heerlen, The Netherlands
| | - Flip van der Made
- Department of Obstetrics and Gynecology, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Dimitri Papatsonis
- Department of Obstetrics and Gynecology, Amphia Hospital, Breda, The Netherlands
| | - Marie-José Pelinck
- Department of Obstetrics and Gynecology, Scheper Hospital, Emmen, The Netherlands
| | - Paula J Pernet
- Department of Obstetrics and Gynecology, Spaarne Gasthuis, Haarlem, The Netherlands
| | | | - Robbert J Rijnders
- Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Hubertina C J Scheepers
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tatjana Vogelvang
- Department of Obstetrics and Gynecology, Diakonessenhuis, Utrecht, The Netherlands
| | - Ben W Mol
- Department of Obstetrics and Gynecology, Monash University, Clayton, Australia
| | - Miranda Olff
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Tessa J Roseboom
- Amsterdam University Medical Centers, University of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Marjette H Koot
- Amsterdam University Medical Centers, University of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Iris J Grooten
- Amsterdam University Medical Centers, University of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Rebecca C Painter
- Amsterdam University Medical Centers, University of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
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Erdal H, Holst L, Heitmann K, Trovik J. Antiemetic treatment of hyperemesis gravidarum in 1,064 Norwegian women and the impact of European warning on metoclopramide: a retrospective cohort study 2002–2019. BMC Pregnancy Childbirth 2022; 22:464. [PMID: 35655181 PMCID: PMC9161510 DOI: 10.1186/s12884-022-04777-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Women suffering from severe nausea and vomiting during pregnancy, hyperemesis gravidarum, have poor quality of life and increased risk of potentially fatal maternal and fetal complications. There is increasing and reassuring knowledge about safety of antiemetics in pregnancy. In 2013, the European Medical Agency (EMA) issued a warning on metoclopramide limiting treatment to maximum five days. Metoclopramide was the most used antiemetic in pregnancy at the time the warning was implemented in the Norwegian hyperemesis guidelines (2014). We aimed at describing changes in the treatment of hyperemesis over time, including changes associated with the EMA warning. Methods Retrospective chart review of all women hospitalized for hyperemesis gravidarum with metabolic disturbances between 01/Jan/2002 and 31/Dec/2019 at a university hospital serving nearly 10% of the pregnant population in Norway. Time-series analysis described changes over time and interrupted time series analysis quantified changes in treatment and clinical outcomes related to the EMA warning. Results In total, 1,064 women (1.2% of the birthing population) were included. The use of meclizine, prochlorperazine, and ondansetron increased during 2002–2019. This led to a yearly increase in the percentage of women using any antiemetic of 1.5% (95%CI 0.6; 2.4) pre-hospital, 0.6% (95%CI 0.2; 1.1) during hospitalization, and 2.6% (95%CI 1.3; 3.8) at discharge. Overall, only 50% of the women received antiemetics pre-hospital. Following the EMA warning, prehospital use of metoclopramide dropped by 30% (95%CI 25; 36), while use of any antiemetic pre-hospital dropped by 20% (95%CI 5.7; 34). In timely association, we observed a decrease in gestational age (-3.8 days, 98.75%CI 0.6; 7.1) at first admission, as well as indication of increased rate of termination of pregnancy with an absolute increase of 4.8% (98.75%CI 0.9; 8.7) in 2014. Conclusion During 2002–2019, the overall use of antiemetics in treatment of hyperemesis increased. The EMA-warning on metoclopramide in 2013 temporarily limited pre-hospital antiemetic provision associated with hospitalization at lower gestational length and indication of an increase in termination of pregnancy.
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