Hospital admission for hyperemesis gravidarum in women at increased risk of spontaneous preterm birth

Anti-Mullerian hormone levels in spontaneous pregnancies with hyperemesis gravidarum

We investigated the serum anti-Mullerian hormone (AMH), oestrogen and progesterone levels in spontaneously conceiving pregnant women, diagnosed for hyperemesis gravidarum (HG), in the first trimester. Pregnant women admitted at Hospital between 5 and 12 gestational weeks and treated for HG were compared, in this prospective case-control study, to a control group. The serum AMH, oestradiol, and progesterone values of both groups were evaluated and compared, and potential correlations were calculated. The serum AMH values were significantly higher in the HG group than the control group (3.15 ± 1.51 ng/mL vs. 2.27 ± 1.20 ng/mL; p = 0.012). No significant difference in the two groups was about serum oestradiol and progesterone values (p = 0.264, p = 0.235). In the HG group, there was no significant correlation between AMH and oestradiol (p = 0.570). However, a significant positive correlation was determined between AMH and progesterone (p = 0.050). The area under the ROC curve (AUC) was 0.669 and the cut-off value was 2.65 ng/ml with sensitivity of 58.3% and specificity of 66.7% for AMH in pregnant women with HG. A correlation between AMH high values and unexplained HG was detected in spontaneous pregnancies in the first trimester. High AMH levels may play a role in HG etiopathogenesis, especially in pregnant women with low progesterone levels.Impact statementWhat is already known on this subject? Aetiological causes of Hyperemesis gravidarum (HG) include hormonal, immunological, genetic, and psychological issues. However, no conclusive etiopathogenesis to explain the pathophysiological mechanism of HG has been stated.What do the results of this study add? Authors focussed on investigation a possible correlation between pregnant hormones and the HG pathogenesis, prevalent in the first trimester, when hormones are produced by either the placenta or corpus luteum. High anti-Mullerian hormone (AMH) levels may play a role in HG etiopathogenesis, especially in pregnant women with low progesterone levels.What are the implications of these findings for clinical practice and/or further research? A serum AMH level of ≥2.65 mg/mL could be predictive for the development of HG in the first trimester of a spontaneous pregnancy. Basing on these findings, more selective pharmacological treatments could be administrated to these patients.

Olfactory dysfunction and oxidative stress in pregnant women with hyperemesis gravidarum

PURPOSE

This study aimed to compare the first-trimester pregnancy serum total oxidative status (TOS), total antioxidant status (TAS), and serum estradiol levels as well as the olfactory functions assessed using the brief smell identification test (BSIT) of women with healthy pregnancies and those with hyperemesis gravidarum (HG).

METHODS

In this prospective study, 60 pregnant women in the first trimester of their pregnancies were divided into two groups: 30 pregnant women with HG (study group) and 30 healthy pregnant women (control group). The following parameters were compared in the HG group and the healthy controls: TOS, TAS, serum levels of estradiol (E2), and olfactory function, which was measured using BSIT.

RESULTS

Both groups were similar in terms of age, gravida, and parity. The mean total smell score was lower in the HG group than the healthy control group (p < 0.05). TOS was significantly higher in the HG group than the control group. TAS was significantly higher in the control group than the HG group (p < 0.05).

CONCLUSION

The removal of sharp odors that will trigger the perception of odor in pregnant women with HG can contribute to the effective control of this disease; moreover, adding fetal-safe antioxidants to the treatment can contribute to the effective control of this disease.

Hospital admission for hyperemesis gravidarum in women at increased risk of spontaneous preterm birth

BACKGROUND

Progesterone administration prevents spontaneous preterm birth (sPTB) in women at increased risk. Progesterone concentration is lower in women with subsequent sPTB. Conversely, high concentrations of progesterone are implicated in the pathogenesis of hyperemesis gravidarum (HG). We hypothesized that women at increased risk of sPTB or spontaneous late miscarriage would be less likely to have a diagnosis of HG. To explore this hypothesis, we compared the incidence of HG in women at increased risk of sPTB and women with no identifiable risk factors.

METHODS

Women at increased risk of sPTB were identified from a specialist Preterm Birth Clinic (PTBC) database where criteria for PTBC attendance are previous cervical surgery, previous sPTB <34 weeks, previous spontaneous late miscarriage, incidental sonographic cervical shortening, and uterine anomaly. Hospital antenatal booking and coding records for the same time period were examined to identify HG admissions. Women with multiple gestations, trophoblastic disease, or pre-existing abnormal thyroid function were excluded. The incidence of HG among PTBC (n=394) and non-PTBC attendees (n=4762) was calculated.

RESULTS

The incidence of HG was lower in women at increased risk of sPTB (1.52%, n=6) compared with women with no identifiable risk factor for sPTB (3.33%, n=159; P=.049).

CONCLUSION

Hospital admission for HG is reduced in women with risk factors for sPTB compared with those without risk factors. Exploration of the pathogenesis of HG may improve understanding of the mechanisms underlying sPTB.