Vomiting in pregnancy is associated with a higher risk of low birth weight: a cohort study

The IRIS clinic: A Protocol for a mixed-methods study evaluating the management of Hyperemesis Gravidarum

Background

Hyperemesis Gravidarum (HG) is a severe form of nausea and vomiting in pregnancy that affects 0.3-3% of women and has profound nutritional, physical and psychological consequences. Research is lacking regarding the most effective management of the condition. In response to patient feedback, a multidisciplinary HG day-case service (IRIS Clinic) was launched in 2020 at The National Maternity Hospital, Ireland. The clinic provides routine, day-case care in a comfortable space with pre-booked appointments. The MDT involves midwives, dietitians, perinatal mental health, obstetrics and pharmacy, and the nature of the clinic enables peer-to-peer support. As this clinic is the first of its kind in Ireland, we aim to assess its effectiveness and feasibility, and suggest recommendations for improvement.

Methods

This is a sequential, mixed-methods study that commenced in August 2021. The prospective arm of the study is ongoing and involves enrolling women (n = 50) who are attending the IRIS clinic. Data are collected on first admission (pre-intervention) and approximately 8 weeks' later (post-intervention) relating to symptoms of HG, well-being, food tolerances, quality of life and nutritional intake. Qualitative, semi-structured interviews will be conducted to evaluate women's experiences of attending the clinic. The retrospective arm of the study will be a chart review (n = 200) of women diagnosed with HG to describe assessments, treatments and pregnancy and birth outcomes.

Conclusion

The IRIS clinic has the potential to improve pregnancy outcomes and nutritional status among women with HG. If found to be effective and feasible, the model for this clinic could be replicated elsewhere.

Effects of auriculotherapy on nausea and vomiting in pregnant women: A randomized clinical trial

BACKGROUND

Pregnancy induces physiological changes, commonly marked by nausea and vomiting in the first trimester, posing risks for both mother and baby. This study evaluates the effects of auriculotherapy on nausea and vomiting during the first trimester of pregnancy.

MATERIALS AND METHODS

A randomized clinical trial was conducted in two primary health care centers with 56 Brazilian pregnant women who reported nausea or vomiting in the first trimester. The participants were divided into an intervention group (auriculotherapy with seeds) and a placebo group (sham auriculotherapy). The intervention was divided into three moments: pre-intervention with assessment of nausea and vomiting and application of questionnaires, and two follow-ups conducted on the fourth and seventh day of the intervention, with reassessment of nausea and vomiting.

RESULTS

Both groups experienced a decrease in nausea and vomiting over time, with no statistically significant differences between groups in the within-group analyses at various time points. The intervention group had a greater reduction in symptoms. Within the intervention group, symptoms were more common among ferrous sulfate users and those without reported dietary disturbances. In addition, a higher incidence of nausea and vomiting was associated with the use of analgesics, morning snacks, and low intake of protein, vegetables, and fruits.

CONCLUSIONS

The intervention did not affect the between-group differences in the incidence of nausea and vomiting and vomiting effort in the first trimester of pregnancy. However, a greater reduction was observed in the intervention group.

The timing, duration, and severity of nausea and vomiting of pregnancy and adverse birth outcomes among controls without birth defects in the National Birth Defects Prevention Study

BACKGROUND

Nausea and vomiting of pregnancy (NVP) occurs in approximately 70% of pregnant people, with varying severity and duration. Treatments include pharmacologic and herbal/natural medications. The associations between NVP and birth outcomes, including preterm birth, small for gestational age (SGA), and low birth weight are inconclusive.

OBJECTIVE

To determine whether NVP and reported medications are associated with adverse birth outcomes.

METHODS

We used data from the population-based, multisite National Birth Defects Prevention Study (1997-2011) to evaluate whether self-reported NVP according to timing, duration, and severity or its specific treatments were associated with preterm birth, SGA, and low birth weight among controls without birth defects. Odds ratios (aOR) and 95% confidence intervals (CI) were adjusted for sociodemographic, reproductive, and medical factors. For any NVP, duration, treatment use, and severity score analyses, the comparison group was participants with no reported NVP. For timing analyses, the comparison group was women with no reported NVP in the same trimester of pregnancy.

RESULTS

Among 6018 participants, 4339 (72.1%) reported any NVP. Among those with NVP, moderate or severe symptoms were more common than mild symptoms. Any versus no NVP was not associated with any of the outcomes of interest. NVP in months 4-6 (aOR 1.21, 95% CI: 1.00, 1.47) and 7-9 (aOR 1.57, 95% CI: 1.22, 2.01) of pregnancy were associated with an increase in the risk of preterm birth. NVP lasting one trimester in duration was associated with decrease in risk of SGA (aOR: 0.74, 95% CI: 0.58, 0.95), and NVP present in every trimester of pregnancy had a 50% increase in risk of preterm birth (aOR: 1.50, 95% CI: 1.11, 2.05). For NVP in months 7-9 and preterm birth, ORs were elevated for moderate (aOR: 1.82, 95% CI: 1.26, 2.63), and severe (aOR: 1.53, 95% CI: 1.06, 2.19) symptoms. NVP was not significantly associated with low birth weight. Our analyses of medications were limited by small numbers, but none suggested increased risk of adverse outcomes associated with use of the medication.

CONCLUSION

Mild NVP and NVP limited to early pregnancy appear to have no effect or a small protective effect on birth outcomes. Long-lasting NVP, severe NVP, and NVP later in pregnancy may increase risk of preterm birth and SGA.

Evaluation of nausea and vomiting in the first trimester on the risk of adverse birth outcomes and the contribution of genetic polymorphisms: a pilot prospective study

PURPOSE

To evaluate the impact of Nausea and Vomiting in Pregnancy (NVP) on the risk of Preterm Birth (PTB) and Low Birth Weight (LBW), and explore the effect of genetic polymorphisms on the severity of NVP.

METHODS

A prospective study was conducted. Participants' experience of NVP prior to 12 gestational weeks were evaluated by a Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scale. 11 Single Nucleotide Polymorphisms (SNPs) loci located in growth differentiation factor 15 (GDF15) and leucine-rich repeat containing 25 (LRRC25) gene of chr19p13.11 and intergenic region of chr4q12 were genotyped, which were implicated as genetic risk factors for NVP. Logistic regression models were applied to determine the effect of NVP in the first trimester on the risk of PTB and LBW, and genetic polymorphisms on the risk of NVP.

RESULTS

Among 413 pregnant women, the incidence of nausea and vomiting was 85.5% (n = 353) in the first trimester, including 38.7% (n = 160) mild vomiting, 42.6% (n = 176) moderate vomiting and 4.1% (n = 17) severe vomiting. 33 were PTB, 20 were LBW. Compared with pregnant women without NVP, women with mild, moderate or severe NVP in the first trimester were not associated with the risk of PTB and LBW. Besides, the polymorphisms of 11 SNPs loci were not associated with the risk of NVP.

CONCLUSIONS

Our study indicated that symptoms of nausea and vomiting in the first trimester were not significantly associated with PTB and LBW, and there were also no associations between GDF15 and LRRC25 polymorphisms and NVP.

Trajectory Patterns of Gestational Weight Gain

OBJECTIVE

To identify gestational weight gain trajectories and their association with demographic, obstetric, and anthropometric characteristics.

METHOD

Information of 599 pregnant women undergoing prenatal care in public health units was collected through questionnaires and medical records, resulting in 4,272 measures of body weight. Group-based trajectory models were applied to identify patterns of gestational weight gain.

RESULTS

The average gestational weight gain at 40 weeks was 14.1 kg (95%CI: 13.2, 15.0). Three different trajectory groups were identified: low (9.9%), intermediate (66.4%), and high (23.7%). Pregnant women who smoked and those classified above IOM's weight gain recommendations were more likely to be classified in the group with a high weight gain trajectory; while those with pre-pregnancy overweight or obesity, and with greater parity were more likely to be categorized in the low weight gain trajectory. After adjusting for other variables in the model, parity remained significantly associated with gestational weight gain (β: 0.88; 95%CI: 0.27, 0.73). In the multilevel model, weight gain remained different among the categories of group-based trajectory, even after adjustment for other investigated variables for intermediate (β: 2.94; 95%CI: 2.32, 3.58) and high (β: 5.88; 95%CI: 5.09, 6.66) gestational weight gain trajectory groups.

CONCLUSIONS

Behavioral, obstetric, and anthropometric characteristics determined the belonging to groups with a high or low trajectory of gestational weight gain. The findings contribute to a better understanding of patterns of gestational weight gain in middle-income women groups.

The perinatal outcomes by gestational weight gain range at 30 weeks of gestation among pre-pregnancy underweight women

AIMS

To evaluate the perinatal outcomes by gestational weight gain (GWG) range at 30 weeks of gestation among underweight pregnant women (pre-pregnancy body mass index ≤ 18.5 kg/m² ) in Japan.

METHODS

This retrospective study was conducted at a hospital in Japan from 2003 to 2020. The underweight pregnant women (UPW; n = 3643) were divided into quartile groups based on the weight gain at 30 weeks of gestation: group Q1 ≤ 5.7 kg, 5.7 kg < Q2 ≤ 7.2 kg, 7.2 kg < Q3 ≤ 8.8 kg, and 8.8 kg < Q4. Clinical characteristics and outcomes were compared using the t-test, chi-square test, and multivariable logistic regression analysis.

RESULTS

The cumulative incidences of preterm births were 7.5% (n = 70), 5.0% (n = 45), 5.4% (n = 50), and 4.9% (n = 44), and the birth rates of small for gestational age (SGA) infants were 15.7% (n = 147), 9.6% (n = 87), 6.9% (n = 64), and 5.9% (n = 53) in Q1, Q2, Q3, and Q4, respectively. Multivariable analysis revealed that Q1 was significantly associated with preterm births (adjusted odds ratio [aOR] = 1.6; 95% confidence interval [CI] = 1.0-2.3), and Q1 and Q2 were significantly associated with SGA (adj. OR = 3.0; 95% CI = 2.2-4.3; adj. OR = 1.7; 95% CI = 1.2-2.5, respectively). None of the quartile groups were significantly associated with the incidence of primary cesarean sections, gestational diabetes mellitus, and macrosomia.

CONCLUSIONS

In UPW, GWG at 30 weeks of ≤5.7 kg and ≤7.2 kg are associated with preterm birth and SGA rates, respectively.

Socio-economic and cultural determinants of mothers and fathers for low birth weight newborns in the region of Marrakech (Morocco): A case-control study

Background

Low birth weight (LBW) is defined as a birth weight less than 2500 g. It is an important predictor of early neonatal mortality, morbidity, and long-term health outcomes. The aim of this study was to identify risk factors for low birth weight in Marrakech Morocco.

Methods

A retrospective based case-control study was conducted from July 2018 to July 2019. 462 mother infant pairs (231 low birth weight babies as cases and 231 normal birth weights as controls) were included in the study. Data were collected through face to face interview using a structured and pretested questionnaire. The collected data were managed with Statistical Package for Social Science (SPSS) version 20. Bivariate and multivariate binary logistic regression were used to identify factors associated with low birth weight at p-value < 0.05 with their respective odds ratios and 95% confidence interval.

Results

The univariate analysis revealed the effect of the following determinants on the LBW: rural residence, father’s age, father’s professional activity, consanguinity, family type, mother’s low educational level, and mother’s intense physical activity. After the multivariate analysis, the risk factors identified were: rural residence (P = 0.017), father’s professional activity (temporarily working) (P = 0.000), absence of the consanguinity link (P = 0.016), and mother’s intense physical activity (P = 0.014).

Conclusion

Results show father’s professional activity (temporarily working), rural residence, absence of the consanguinity link and mother’s intense physical activity are independent predictors of low birth weight. The current findings add substantially to the growing literature on the influence of parent’s socio-demographic and cultural factors on LBW in resource-constrained settings and provide empirical data for public health interventions to reduce low birth weight.

Effect of maternal and child factors on stunting: partial least squares structural equation modeling

BACKGROUND

Stunting is affected by various factors from mother and child. Previous studies assessed only one or more influencing variables. Unfortunately, nor the significant influence of maternal and child factors nor the indicators contributing to maternal and child factors that affect the stunting incidence have ever been analyzed.

PURPOSE

This study analyzed the effect of maternal and child factors on stunting and the significant indicators that shape the maternal and child factors that impact stunting.

METHODS

This was a case-control study. Overall, 132 stunted children and 132 nonstunted children in Purbalingga Regency, Central Java Province, participated in the research. Direct interviews and medical record reviews were conducted to assess the studied variables. The research data were tested using the partial least squares structural equation with a formative model.

RESULTS

Maternal factors directly affected the occurrence of stunting (t=3.527, P<0.001) with an effect of 30.3%. Maternal factors also contributed a significant indirect effect on stunting through child factors (t=4.762, P<0.001) with an effect of 28.2%. Child factors affected the occurrence of stunting (t= 5.749, P<0.001) with an effect of 49.8%. The child factor was influenced by maternal factor with an effect of 56.7% (t=10.014, P<0.001). The moderation analysis results demonstrated that maternal and child factors were moderate predictive variables of stunting occurrence.

CONCLUSION

Child factors have more significant and direct effects on stunting than maternal factors but are greatly affected by them.

Association of nausea and vomiting of pregnancy with infant growth in the first 24 months of life

PURPOSE

We aimed to investigate the association of maternal nausea and vomiting during pregnancy (NVP) with infant growth in the first 24 months of life and compare the effect of fetal gender.

METHODS

This prospective cohort study was conducted in Zhoushan Maternal and Child Health Hospital, Zhejiang, from 2011 to 2018. 1942 pairs of singleton newborns and their mothers were selected as participants. Main outcomes were gestational weight gain (GWG), birth outcomes (birthweight and gestational age) and infant growth [weight, height, weight/height-for-age Z score (WAZ/HAZ), the weight gain during childhood]. The associations of NVP with birth outcomes and infant growth at children's age of 1, 3, 6, 12, 18, and 24 months were analyzed by multivariable regression models.

RESULTS

Of the 1942 women, 1395 had NVP at first trimester (T1) and among them, 210 still experienced NVP at second trimester (T2). Compared with women without NVP, women experienced severe NVP at T1 were related with lower total GWG. Mild and moderate NVP at T1 were negatively associated with lower birthweight among women with male infants. Female infants exposed to maternal NVP at T1, especially for severe degree, were showed greater weight, WAZ, height, HAZ, and weight gain after 1 year old (at age of 12, 18, 24 months). No association between maternal NVP and infant growth was observed among male infants.

CONCLUSION

Exposure to NVP at T1 was, respectively, associated with lower GWG. Favorable influence of NVP at T1 on infant growth was observed among female offspring.

Content validation of the nursing diagnosis Risk for disturbed maternal-fetal dyad

OBJECTIVE

To validate the content of the diagnosis Risk for disturbed maternal-fetal dyad in high-risk pregnant women.

METHOD

Nursing diagnosis content analysis study in which 48 nurses evaluated agreement regarding title, definition, class, and domain of the studied nursing diagnosis, as well as the relevance of its antecedents. The items were considered relevant when the Confidence Interval of the Content Validity Index was 0.8 or higher. When lower, the item was modified or excluded according to the experts' suggestions.

RESULTS

Out of 21 antecedents, 14 were considered relevant. The labels of five elements considered irrelevant were changed, and one item was excluded. The experts did not choose the title and definition proposed by NANDA-I, preferring instead the ones suggested in this study. The experts agreed with the class and domain proposed by the taxonomy.

CONCLUSION

Ten risk factors, four populations at risk, and six associated conditions for this nursing diagnosis were maintained; these may provide a basis for nursing practice. The phase of clinical validation is suggested to be conducted to corroborate this study's results.

The association between quality of life and complementary and alternative medicine use in pregnant women with hyperemesis gravidarum

AIM

This study investigated the association between quality of life and complementary and alternative medicine (CAM) use in pregnant women with hyperemesis gravidarum in Turkey.

METHODS

This cross-sectional descriptive study was conducted between October 2017 and July 2018 in Turkey. The sample consisted of 240 pregnant women with hyperemesis gravidarum. Data were collected using a Demographic Information Form, the Index of Nausea, Vomiting, Retching, and the 36-item Short-Form Health Survey.

RESULTS

The majority (84.2%) of participants stated that they used CAM, mostly "biologically based therapies" (97.5%). They were most satisfied with the "mental and physical treatments" (3.71 ± 1.74). Participants who did not use CAM had a higher quality of life "emotional role" than those who used CAM (p = 0.038). However, there were no statistically significant differences in the other quality of life subscale scores between the two groups.

CONCLUSION

There is limited evidence for the association between quality of life and CAM use in pregnant women with hyperemesis gravidarum in Turkey. Therefore, more evidence-based research is warranted to evaluate the association between CAM use and quality of life in pregnant women with hyperemesis gravidarum.

GDF-15 Neutralization Alleviates Platinum-Based Chemotherapy-Induced Emesis, Anorexia, and Weight Loss in Mice and Nonhuman Primates

Platinum-based cancer therapy is restricted by dose-limiting side effects and is associated with elevation of growth differentiation factor 15 (GDF-15). But whether this elevation contributes to such side effects has been unclear. Here, we explored the effects of GDF-15 blockade on platinum-based chemotherapy-induced emesis, anorexia, and weight loss in mice and/or nonhuman primate models. We found that circulating GDF-15 is higher in subjects with cancer receiving platinum-based chemotherapy and is positively associated with weight loss in colorectal cancer (NCT00609622). Further, chemotherapy agents associated with high clinical emetic score induce circulating GDF-15 and weight loss in mice. Platinum-based treatment-induced anorexia and weight loss are attenuated in GDF-15 knockout mice, while GDF-15 neutralization with the monoclonal antibody mAB1 improves survival. In nonhuman primates, mAB1 treatment attenuates anorexia and emesis. These results suggest that GDF-15 neutralization is a potential therapeutic approach to alleviate chemotherapy-induced side effects and improve the quality of life.

Risk Factors of Prolonged Nausea and Vomiting During Pregnancy

Background

Determination of the risk factors associated with prolonged nausea and vomiting during pregnancy (NVP) helps to develop prevention strategies. However, there is a lack of studies regarding risk factors of prolonged NVP. Thus, the potential risk factors of prolonged moderate and severe NVP were examined.

Methods

This is a retrospective study among pregnant women in South of China. The Pregnancy-Unique Quantification of Emesis (PUQE) scale was used to evaluate NVP. Onset before 12 weeks and persistence after 20 weeks of gestation were defined as prolonged NVP. Data on NVP and other variables were collected by standard questionnaires and medical records.

Results

A finally sample of 1739 participants were analyzed. The incidence of prolonged moderate and severe NVP was 42.1% and 1.1%, respectively. Among those with NVP, the increased risk of prolonged moderate NVP was associated with lower gestational age (OR = 0.95 per SD increase, 95% CI=0.93-0.97), being a housewife (OR = 1.30, 95% CI=1.02-1.65), pre-pregnant longer sedentary time (OR = 2.02, 95% CI=1.16-1.83), pre-pregnant lower exercise frequency (OR = 1.84, 95% CI=1.20-2.82), and history of gastrointestinal (GI) diseases (OR = 2.21, 95% CI=1.61-3.03). Persons who were a housewife (OR = 6.39, 95% CI=1.90-21.47), with pre-pregnant high frequent (always) cold drinking (OR=11.12, 95% CI=1.24-100.73), and had a history of GI diseases (OR=10.10, 95% CI=2.63-38.86) were more likely to experience prolonged severe NVP.

Conclusion

The results of the present study suggested that pregnant women unemployed, with lower gestational age, pre-pregnant longer sedentary time, less exercise, high frequent (always) cold drinking and history of GI diseases had a higher risk of prolonged NVP and should be taken more care.

Nausea, vomiting and poor appetite during pregnancy and adverse birth outcomes in rural Nepal: an observational cohort study

Background

Nausea and vomiting are experienced by a majority of pregnant women worldwide. Previous studies have yielded conflicting results regarding their impact on birth outcomes and few studies have examined this relationship in settings with limited resources. We aimed to determine the effect of nausea, vomiting and poor appetite during pregnancy on birth outcomes in rural Nepal.

Methods

Observational cohort study using data collected in two randomized, community-based trials to assess the effect of influenza immunization during pregnancy on reproductive and respiratory outcomes among pregnant women and their offspring. Pregnant women in Sarlahi District, Nepal were recruited from 2011 to 2013. Exposure was defined as nausea, vomiting or poor appetite at any point during pregnancy and by trimester; symptoms were recorded monthly throughout pregnancy. Adverse outcomes were low birth weight (LBW), preterm birth and small for gestational age (SGA). Adjusted relative risks (aRR) with 95% CIs are reported from Poisson regressions with robust variance.

Results

Among 3,623 pregnant women, the cumulative incidence of nausea, vomiting or poor appetite was 49.5% (n = 1793) throughout pregnancy and 60.6% (n = 731) in the first trimester. Significantly higher aRRs of LBW and SGA were observed among women experiencing symptoms during pregnancy as compared to symptom free women (LBW: aRR 1.20; 95% CI 1.05 1.28; SGA: aRR 1.16; 95% CI 1.05 1.28). Symptoms in the first trimester were not significantly associated with any of the outcomes. In the second trimester, we observed significantly higher aRRs for LBW and SGA (LBW: aRR 1.17; 95% CI 1.01 1.36; SGA: aRR 1.16; 95% CI 1.05 1.29) and a significantly lower aRR for preterm birth (aRR 0.75; 95% CI 0.59 0.96). In the third trimester, we observed significantly higher aRRs for LBW and SGA (LBW: aRR 1.20; 95% CI 1.01 1.43; SGA: aRR 1.14; 95% CI 1.01 1.29).

Conclusions

Symptoms of nausea, vomiting or poor appetite during pregnancy are associated with LBW, SGA and preterm birth in a setting with limited resources, especially beyond the first trimester.

Trial registration

Prospectively registered at ClinicalTrials.gov on Dec 17, 2009 (NCT01034254).

Effect of advanced maternal age on pregnancy outcomes: a single-centre data from a tertiary healthcare hospital

The aim of this study was to assess the effect of advanced maternal age on pregnancy and neonatal outcomes in patients attending a tertiary centre hospital. Between January 2013 and December 2016, the records of all patients who were referred for pregnancy follow-ups and delivery were retrospectively reviewed and were divided according to their parity and age. Patients over 35 years old were categorised as advanced maternal age; (1) 35-40 years old. (2) 40-45 years old. (3) 45 years and over. Most of the prenatal complications were found to increase in the advanced maternal age group. The caesarian section rate was found to be higher in all advanced maternal age groups. There was no significant relationship between 5 Minute Apgar scores of <7 and perinatal mortality and post-term pregnancy and parity. Globally, advanced maternal age pregnancy shows an increase as a result pregnancy complication will increase. It is important to make a appropriate follow-up for pregnancies of advance maternal age mothers. Impact statement What is already known on this subject? Advanced maternal age is a poor prognostic factor for pregnancy outcomes. But there remains no consensus opinion or a plan for the management of pregnancy in this particular risk group. What do the results of this study add? This clinical study makes a contribution to the literature for advanced maternal age and pregnancy complications. This study is one of the few studies emphasising the importance of parity in advanced maternal age and the relationship between first trimester pregnancy complications and advanced maternal age. What are the implications of these findings for clinical practice and/or further research? After the ART pregnancies increasing all around the world not only advanced age but the parity become an important role. Due to an increase in advanced maternal age pregnancies in all around the world, we think that better understanding and management of the complications to be encountered in advanced maternal age and parity pregnancies will be appropriate.

Risk factors for low birth weight in hospitals of North Wello zone, Ethiopia: A case-control study

BACKGROUND

Low birth weight at birth is an important underlying contributor for neonatal and infant mortality. It accounts for nearly half of all perinatal deaths. Identifying predictors of low birth weight is the first essential step in designing appropriate management strategies. Hence, this study aimed to identify risk factors for low birth weight in hospitals of northeastern Ethiopia.

METHODS

An institution based case-control study design was conducted from 10th April to 15th December 2016. Three hundred sixty mother-infant pairs (120 low birth weight babies as cases and 240 normal birth weights as controls) were included in the study. Data were collected by face-to-face interview. Univariable and multivariable logistic regression models were computed to examine the effect of independent variables on outcome variable using SPSS 20.0. Variables with p-value <0.05 were considered statistically significant.

RESULTS

The mean (±SD) gestational age and birth weight (±SD) were 39.2 (±1.38) weeks and 2800 (±612), grams respectively. Partner's education/being illiterate (AOR: 4.09; 95% CI 1.45, 11.50), antenatal care visit at private health institutions (AOR: 0.13; 95% CI 0.02, 0.66), having history of obstetric complications (AOR: 5.70; 95% CI 2.38, 13.63), maternal weight during pregnancy (AOR: 4.04; 95% CI 1.50, 10.84) and gravidity (AOR: 0.36; 95% CI 0.18, 0.73) were significantly associated with low birth weight. Additionally, a site for water storage and water treatment were significant environmental factors.

CONCLUSION

Maternal weight during pregnancy, paternal education, previous obstetric complication and place of antenatal follow-up were associated with low birth weight. The risk factors identified in this study are preventable. Thus, nutritional counseling, health education on improvement of lifestyle and early recognition and treatment of complications are the recommended interventions.

Combining and Using the Utrecht Method and the Analytic Hierarchy Process to Facilitate Professional and Ethical Deliberation and Decision Making in Complementary and Alternative Medicine: A Case Study among a Panel of Stakeholders

Background

In daily practice, healthcare practitioners face many challenges in ethical and professional decision making. Currently, little is known on the ethical and professional deliberations and weighing benefits against risks in daily complementary and alternative medicine (CAM) practice. The aim of this study was to combine the Utrecht method and the Analytic Hierarchy Process (AHP) in deliberations, weighing benefits against risks of using ginger for a pregnant woman suffering nausea and vomiting of pregnancy (NVP) along with other comorbidities.

Methods

A hypothetical case was constructed using the twelve tips for constructing dilemma case-based assessment. Three CAM practitioners, two physicians, three pharmacists, and two patients were recruited, and the Utrecht and the AHP methods were combined and used to deliberate and weigh benefits against risks of using ginger for the presented case.

Results

Responses from the ten panelists were obtained. Priority ratings showed significantly higher scores (p-value < 0.001) for alleviating symptoms of NVP (30.7%  ± 16.6%) compared to other potential benefits. Increasing the risk of bleeding was given significantly higher (p-value < 0.0001) weight scores (24.7%  ± 13.5%) than other potential side effects. Potential risk of spontaneous abortion and risk of impairment of fetal development were given higher (p-value < 0.001) weight scores than risk of fetal hypoglycemia. When benefits were compared against side effects and risks to the fetus and pregnancy, potential benefits were given higher (p-value < 0.001) weight scores (72.3%  ± 5.2%).

Conclusions

Considering the anticipated benefits and risks, a shared decision was made to use ginger in the case presented. The woman should also be informed of the potential side effects and risks of using ginger. The use of this combined method might promote openness and transparency in making shared decisions for healthcare providers and patients.

Associations of vomiting and antiemetic use in pregnancy with levels of circulating GDF15 early in the second trimester: A nested case-control study

Background: Although nausea and vomiting are very common in pregnancy, their pathogenesis is poorly understood. We tested the hypothesis that circulating growth and differentiation factor 15 (GDF15) concentrations in early pregnancy, whose gene is implicated in hyperemesis gravidarum, are associated with nausea and vomiting. Methods: Blood samples for the measurement of GDF15 and human chorionic gonadotrophin (hCG) concentrations were obtained early in the second trimester (median 15.1 (interquartile range 14.4-15.7) weeks) of pregnancy from 791 women from the Cambridge Baby Growth Study, a prospective pregnancy and birth cohort. During each trimester participants completed a questionnaire which included questions about nausea, vomiting and antiemetic use. Associations with pre-pregnancy body mass indexes (BMI) were validated in 231 pregnant NIPTeR Study participants. Results: Circulating GDF15 concentrations were higher in women reporting vomiting in the second trimester than in women reporting no pregnancy nausea or vomiting: 11,581 (10,977-12,219) (n=175) vs. 10,593 (10,066-11,147) (n=193) pg/mL, p=0.02). In women who took antiemetic drugs during pregnancy (n=11) the GDF15 levels were also raised 13,157 (10,558-16,394) pg/mL (p =0.04). Serum GFD15 concentrations were strongly positively correlated with hCG levels but were inversely correlated with maternal BMIs, a finding replicated in the NIPTeR Study. Conclusions: Week 15 serum GDF15 concentrations are positively associated with second trimester vomiting and maternal antiemetic use in pregnancy. Given GDF15's site of action in the chemoreceptor trigger zone of the brainstem and its genetic associations with hyperemesis gravidarum, these data support the concept that GDF15 may be playing a pathogenic role in pregnancy-associated vomiting.