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Bayram F, Ozgen G, Karasın SS, Ozgen L. The predictive value of HALP score and systemic immune inflammation (SII) index in hyperemesis gravidarum. J Obstet Gynaecol Res 2023. [PMID: 37211347 DOI: 10.1111/jog.15666] [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: 11/15/2022] [Accepted: 04/24/2023] [Indexed: 05/23/2023]
Abstract
AIM Hyperemesis gravidarum (HG) is one of the most common serious diseases in early pregnancy. This study aimed to investigate the clinical significance of hemoglobin, albumin, lymphocyte, and platelet (HALP) score and systemic immune inflammation (SII) index in the presence and severity of HG. METHODS This retrospective case-control study was conducted in a training and educational university hospital between January 2019 and July 2022. A total of 521 pregnant women, of whom 360 were diagnosed with HG at 6-14 weeks of gestation and 161 were low-risk pregnancies, were included in the study. Patients' demographic characteristics and laboratory parameters were recorded. Patients with HG were divided into three categories: mild (n = 160), moderate (n = 116), and severe (n = 84), according to disease severity. The modified PUQE scoring was used to determine the severity of HG. RESULTS The mean age of the patients was 27.6 (16-40) years. We divided the pregnant women into the control group and HG group. The HALP score was significantly lower in the HG group (average, 2.8 ± 1.3), whereas the SII index was found to be significantly higher (average, 895.8 ± 458.1). A negative correlation was found between the increase in the severity of HG and HALP score. The HALP score was the lower in severe HG (mean, 2.16 ± 0.81) and was significantly different from other HG categories (p < 0.01). Moreover, a positive correlation was noted between increased HG severity and SII index levels. The SII index was higher in the severe HG group and was significantly different from the others (1001.2 ± 437.2) (p < 0.01). CONCLUSIONS The HALP score and SII index can be useful, cost-effective, and easily accessible objective biomarkers to predict the presence and severity of HG.
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Affiliation(s)
- Feyza Bayram
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Educational and Research Hospital, Bursa, Turkey
| | - Gulten Ozgen
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Educational and Research Hospital, Bursa, Turkey
| | - Süleyman Serkan Karasın
- Department of Obstetrics and Gynecology, Bursa Yuksek Ihtisas Educational and Research Hospital, Bursa, Turkey
| | - Levent Ozgen
- Department of Obstetrics and Gynecology, Uludag University, Bursa, Turkey
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Dal Y, Akkuş F, Karagün Ş, Çolak H, Coşkun A. Are serum delta neutrophil index and other inflammatory marker levels different in hyperemesis gravidarum? J Obstet Gynaecol Res 2023; 49:828-834. [PMID: 36627732 DOI: 10.1111/jog.15542] [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: 10/07/2022] [Accepted: 12/26/2022] [Indexed: 01/12/2023]
Abstract
AIM Hyperemesis gravidarum (HEG) is a condition characterized by nausea and vomiting, fluid electrolyte and acid-base imbalance, dehydration, weight loss, and ketonuria in early pregnancy. The relationship of HEG with inflammation has been studied in many studies. This study aimed to investigate the role of serum delta neutrophil index (DNI), a new inflammatory marker, and other inflammatory markers in demonstrating the disease's presence and severity in HEG patients. MATERIAL AND METHOD This retrospective study was conducted by accessing the electronic data of 79 pregnant women diagnosed with HEG in a tertiary center between 2017 and 2022 and 100 healthy pregnant women. The demographic characteristics of the study and control groups, as well as the hematological parameters in the complete blood count and the levels of inflammatory markers, were recorded. RESULTS There was no significant difference between the groups regarding hematological parameters, DNI, platelet-lymphocyte ratio, monocyte-lymphocyte ratio, and systemic inflammation index (p > 0.05). Neutrophil count and neutrophil-lymphocyte ratio (NLR) were higher in the HEG group compared to the control group (p < 0.05). CONCLUSION This is the first study to determine the relationship between HEG and serum DNI, a new inflammatory marker. We found that serum DNI values in HEG patients were not different from normal pregnancies and did not reflect the presence and severity of the disease. We also found that inflammatory markers other than the NLR were not different from normal pregnancies in HEG patients.
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Affiliation(s)
- Yusuf Dal
- Department of Obstetrics and Gynecology, Perinatology Department, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Fatih Akkuş
- Department of Obstetrics and Gynecology, Perinatology Department, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Şebnem Karagün
- Department of Obstetrics and Gynecology, Perinatology Department, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Hatun Çolak
- Department of Obstetrics and Gynecology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Ayhan Coşkun
- Department of Obstetrics and Gynecology, Perinatology Department, Mersin University Faculty of Medicine, Mersin, Turkey
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Maternal serum ischemia-modified albumin (IMA), total-sulphydryl concentrations, and some subclinic inflammatory markers in hyperemesis gravidarum (HG). Taiwan J Obstet Gynecol 2023; 62:101-106. [PMID: 36720519 DOI: 10.1016/j.tjog.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE This study investigates the relationship between Ischemia Modified Albumin and Total-Sulphydryl levels with some subclinical inflammatory markers in patients with hyperemesis gravidarum. MATERIALS AND METHODS A total of 258 pregnant women, 137 with hyperemesis gravidarum and 121 low-risk pregnancies, were included in this case-control study. The patients were divided into three groups according to the severity of hyperemesis gravidarum as mild (n = 53), moderate (n = 41) and severe (n = 43). RESULTS Serum Ischemia Modified Albumin levels were statistically different from the control group (P < 0.001). Among the subgroups, the highest Ischemia Modified Albumin value was observed in the severe hyperemesis gravidarum group, and the highest Total-Sulphydryl level was observed in the mild hyperemesis gravidarum group (P < 0.001). Serum potassium levels were higher in the control group (P < 0.001). While a negative correlation was observed between Ischemia Modified Albumin and Total-Sulphydryl, a positive correlation was observed in Platelet crit, C-reactive protein, and ketonuria. As the severity of the disease increases, Ischemia Modified Albumin, which is an oxidative stress factor, increases, and Total-Sulphydryl levels decrease (p < 0.001). Logistic regression analysis revealed that a one-unit increase in Ischemia Modified Albumin resulted in a statistically significant 1.9-fold increase in the risk of Severe hyperemesis gravidarum (OR 1.92, 95% CI 1.008-1.956; P = 0.01) CONCLUSION: This study shows that there is a condition in the pathophysiology of hyperemesis gravidarum, with an increase in Ischemia Modified Albumin and a decrease in Total-Sulphydryl levels, and oxidative stress occurs. It was important to detect increased Ischemia Modified Albumin and decreased antioxidant values in relation to the inflammatory factors that were effective in the severe hyperemesis gravidarum group.
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Guo J, Zheng A, He J, Ai M, Gan Y, Zhang Q, Chen L, Liang S, Yu X, Kuang L. The prevalence of and factors associated with antenatal depression among all pregnant women first attending antenatal care: a cross-sectional study in a comprehensive teaching hospital. BMC Pregnancy Childbirth 2021; 21:713. [PMID: 34702205 PMCID: PMC8545620 DOI: 10.1186/s12884-021-04090-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 08/29/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Antenatal depression has become a common and serious problem, significantly affecting maternal and fetal health. However, evaluation and intervention methods for pregnant women in obstetric clinics are inadequate. This study aimed to determine the prevalence of and risk factors for depression among all pregnant women at their first attending antenatal care in the obstetrics clinic, a comprehensive teaching hospital, southwest of China. METHODS From June to December 2019, 5780 pregnant women completed online psychological assessments, and data from 5728 of the women were analyzed. The women were categorized into two groups according to the presence or absence of depression. Depression was assessed by the Patient Health Questionnaire-9 (PHQ-9), with a cutoff point of 10 for depression. Anxiety and somatic symptoms were measured by the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-15 (PHQ-15), respectively. Univariate analysis and binary logistic regression analysis were used to determine the association among antenatal depression, anxiety, somatic symptoms and participants' characteristics. RESULTS The prevalence of antenatal depression among all the pregnant women at their first attending antenatal care was 16.3%, higher in the first trimester (18.1%). Anxiety symptoms (Mild anxiety AOR = 2.937; 95% CI: 2.448-3.524) and somatic symptoms (Mild somatic symptoms AOR = 3.938; 95% CI: 2.888-3.368) were major risk factors for antenatal depression among women and the risk increased more with the anxiety level or somatic symptoms level. Gestational weeks (second trimester AOR = 0.611; 95% CI: 0.483-0.773; third trimester AOR = 0.337; 95% CI: 0.228-0.498) and urban residence (AOR = 0.786; 95% CI: 0.652-0.947) were protective factors for antenatal depression among women. CONCLUSIONS About one in six pregnant women would experience depression, and special attention should be paid to some risk factors (i.e., early pregnancy, anxiety symptoms, somatic symptoms, rural residence). Online psychological assessments might be a time-saving and convenient screening method for pregnant women in obstetric clinics.
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Affiliation(s)
- Jiamei Guo
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Anhai Zheng
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Jinglan He
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Ming Ai
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Yao Gan
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Qi Zhang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Lulu Chen
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Sisi Liang
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Xiaoyu Yu
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Li Kuang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China.
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Soysal C, Işıkalan MM, Bıyık İ, Erten Ö, İnce O. The relationship between inflammation markers and ketonuria in hyperemesis gravidarum. J Obstet Gynaecol Res 2021; 47:3078-3083. [PMID: 34107554 DOI: 10.1111/jog.14857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/08/2021] [Accepted: 05/08/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Hyperemesis gravidarum is an illness that starts in early pregnancy and manifests itself with oral intake problems, electrolyte imbalance, ketonuria, and weight loss. Inflammation is closely associated with the hyperemesis gravidarum, and inflammatory indicators have been studied to understand its pathophysiology. This study investigates the relationship of ketonuria levels with inflammatory markers platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and neutrophil-to-lymphocyte ratio (NLR) for hyperemesis gravidarum patients. MATERIAL AND METHODS This retrospective case control study was conducted at Kütahya Medical Sciences University Tertiary Research and Training Hospital between December 2019 and December 2020. A total of 173 pregnancies, 82 of them with hyperemesis gravidarum and 91 of them low-risk pregnancies were included in the study. The patients' demographic profiles and laboratory parameters were recorded. The patients were divided into hyperemesis gravidarum and control groups and the groups were compared for the levels of inflammation markers. For the hyperemesis gravidarum group, the relationship between ketonuria levels and the inflammation severity was investigated. RESULTS MLR, NLR, PLR levels were higher in the hyperemesis gravidarum group than the control group in a statistically significant way (p < 0.001 for all of the comparisons). The hyperemesis gravidarum group was subdivided into four groups based on their ketonuria levels, and their MLR, NLR, PLR levels were compared. The differences between the groups were statistically significant (p < 0.001) and the indicators increased with the ketonuria levels. Finally, ketonuria levels had a positive and significant correlation with MLR (rho =0.67, p < 0.001), PLR (rho =0.67, p < 0.001), and NLR (rho =0.8, p < 0.001). CONCLUSION Hyperemesis gravidarum patients have higher levels of hematologic inflammation indicators than healthy pregnant patients. For these patients, the levels of the indicators increase with ketonuria levels.
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Affiliation(s)
- Cenk Soysal
- Department of Gynecology and Obstetrics, Kütahya Health Sciences University, Kutahya, Turkey
| | - Mehmet Murat Işıkalan
- Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Unit, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - İsmail Bıyık
- Department of Gynecology and Obstetrics, Kütahya Health Sciences University, Kutahya, Turkey
| | - Özlem Erten
- Department of Gynecology and Obstetrics, Kütahya Health Sciences University, Kutahya, Turkey
| | - Onur İnce
- Department of Gynecology and Obstetrics, Kütahya Health Sciences University, Kutahya, Turkey
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Koren G, Cohen R. Measuring the severity of nausea and vomiting of pregnancy; a 20-year perspective on the use of the pregnancy-unique quantification of emesis (PUQE). J OBSTET GYNAECOL 2020; 41:335-339. [PMID: 32811235 DOI: 10.1080/01443615.2020.1787968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Nausea and vomiting of pregnancy (NVP) is the most common medical condition in pregnancy, affecting up to 80% of expectant women. Measuring the severity of the condition over time is important for management decisions, as well as for research into different therapeutic modalities. Twenty years ago we described and validated the Pregnancy Unique Quantification of Emesis scale (PUQE), as a clinical and research tool. PUQE has become widely used for both ends, and has been incorporated in numerous practice guidelines worldwide. In this review we describe the inception of the tool, its rational, and its wide range of use worldwide.
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Affiliation(s)
- Gideon Koren
- The Motherisk Israel Program, Shamir Medical Center, Zerifin, Israel.,Adelson Faculty of Medicine, Ariel University, Ariel, Israel
| | - Rana Cohen
- The Motherisk Israel Program, Shamir Medical Center, Zerifin, Israel
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Kan E, Emektar E, Corbacioglu K, Safak T, Sariaydin T, Cevik Y. Evaluation of relationship between inflammatory markers and hyperemesis gravidarum in patients admitted to emergency department. Am J Emerg Med 2020; 38:292-295. [DOI: 10.1016/j.ajem.2019.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 02/02/2023] Open
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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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Bulanık M, Sağsöz N, Sayan CD, Yeral Mİ, Kısa Ü. Comparison of Serum Ykl-40 and Ischemia Modified Albulmin Levels Between Pregnant Women with Hyperemesis Gravidarum and Normal Pregnant Women. Med Arch 2019; 73:97-100. [PMID: 31391695 PMCID: PMC6643323 DOI: 10.5455/medarh.2019.73.97-100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 04/02/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The etiopathogenesis of HG is still unclear. AIM The aim of this study was to investigate the levels of YKL-40 protein as an inflammatory marker and evaluate the levels of IMA as an oxidative marker in hyperemesis gravidarum women. MATERIALS AND METHODS Totally 35 patients with hyperemesis gravidarum and 35 healthy pregnants were included in the study. Singleton pregnancies between 6+0 week and 13+6 weeks of gestation, with normal fetal anatomy were included in the study. Complete blood count, complete urine analyze, biochemical tests and thyroid function tests were done. RESULTS There was no significant difference between groups for demographical features (age, gravidity, gestational age, body mass index). Also, there was no statistically significant difference between groups for IMA levels (p>0.05). The median level of YKL-40 was higher in pregnants with hyperemesis gravidarum than normal pregnants but the difference was not statistically significance (p>0.05). CONCLUSION Further comprehensive studies with more number of patients are needed to show the efficacy of YKL-40 and IMA levels for predicting hyperemesis gravidarum and even monitoring of the treatment.
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Affiliation(s)
- Murat Bulanık
- Department of Obstetrics and Gynecology, Zonguldak Devrek State Hospital, Turkey
| | - Nevin Sağsöz
- Department of Obstetrics and Gynecology, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey
| | - Cemile Dayangan Sayan
- Department of Obstetrics and Gynecology, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey
| | - Mahmut İlkin Yeral
- Department of Obstetrics and Gynecology, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey
| | - Üçler Kısa
- Department of Biochemistry, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey
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Tayfur C, Burcu DC, Gulten O, Betul D, Tugberk G, Onur O, Engin K, Orcun O. Association between platelet to lymphocyte ratio, plateletcrit and the presence and severity of hyperemesis gravidarum. J Obstet Gynaecol Res 2017; 43:498-504. [DOI: 10.1111/jog.13228] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/23/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Cift Tayfur
- Department of Obstetrics and Gynecology; Bursa Yuksek Ihtisas Research and Training Hospital; Bursa Turkey
| | - Dincgez Cakmak Burcu
- Department of Obstetrics and Gynecology; Bursa Yuksek Ihtisas Research and Training Hospital; Bursa Turkey
| | - Ozgen Gulten
- Department of Obstetrics and Gynecology; Bursa Yuksek Ihtisas Research and Training Hospital; Bursa Turkey
| | - Dundar Betul
- Department of Obstetrics and Gynecology; Bursa Yuksek Ihtisas Research and Training Hospital; Bursa Turkey
| | - Guclu Tugberk
- Department of Obstetrics and Gynecology; Bursa Yuksek Ihtisas Research and Training Hospital; Bursa Turkey
| | - Ozdenoglu Onur
- Department of Obstetrics and Gynecology; Bursa Yuksek Ihtisas Research and Training Hospital; Bursa Turkey
| | - Korkmazer Engin
- Department of Obstetrics and Gynecology; Bursa Yuksek Ihtisas Research and Training Hospital; Bursa Turkey
| | - Ozdemir Orcun
- Department of Obstetrics and Gynecology; Bursa Yuksek Ihtisas Research and Training Hospital; Bursa Turkey
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