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Peng Z, Liu J, Liu B, Zhou J, Zhang L, Zhang Y. Psychological interventions to pregnancy-related complications in patients with post-traumatic stress disorder: a scoping review. BMC Psychiatry 2024; 24:478. [PMID: 38937748 PMCID: PMC11212442 DOI: 10.1186/s12888-024-05926-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 06/21/2024] [Indexed: 06/29/2024] Open
Abstract
OBJECTIVE This scoping review sought to investigate the association between pregnancy-related complications and post-traumatic stress disorder (PTSD) among postpartum women, then summarize effective psychological interventions for pregnancy-related PTSD or sub-PTSD. METHOD Publications in English and Chinese were searched in PubMed, Embase, Cochrane, ISI Web of Science, China National Knowledge Infrastructure (CNKI), and WanFang databases using the subject headings of "Stress Disorders, Post-Traumatic", "Pregnant Women", and "psychotherapy". To ensure that as many relevant studies are incorporated as possible, free terms such as prenatal, postnatal, perinatal and gestation were also used. Intervention studies and related cases published by July 1st, 2023, were also searched. RESULTS Twenty-one articles (including 3,901 mothers) were included in this review. Evidence showed that typical psychological interventions exhibited great effect, and family support programs, peer support, online yoga, and music therapy were also effective in reducing risk and improving the psychological well-being of the studied population. CONCLUSION Fetal abnormalities, miscarriage, premature birth, infants with low birth weights, hypertension, pre-eclampsia, HELLP syndrome, and hyperemesis gravidarum are associated with an increased risk of PTSD. Moreover, high-risk pregnant women may benefit from psychological interventions such as cognitive behavioral therapy (CBT). It may also be feasible and well-accepted for music therapy and exposure therapy to lessen the intensity of PTSD in mothers.
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Affiliation(s)
- Zhuo Peng
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Jin Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Bangshan Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Jiansong Zhou
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Li Zhang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.
| | - Yan Zhang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
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Auger N, Padda B, Bégin P, Brousseau É, Côté-Corriveau G. Hyperemesis gravidarum and the risk of offspring morbidity: a longitudinal cohort study. Eur J Pediatr 2024:10.1007/s00431-024-05647-8. [PMID: 38884821 DOI: 10.1007/s00431-024-05647-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/07/2024] [Accepted: 06/05/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE Hyperemesis gravidarum has the potential to affect the long-term health of offspring. We examined whether maternal hyperemesis gravidarum was associated with the risk of hospitalization for childhood morbidity. METHODS We conducted a longitudinal cohort study of 1,189,000 children born in Quebec, Canada, between April 2006 and March 2021. The main exposure measure was maternal hyperemesis gravidarum requiring hospitalization in the first or second trimester. The outcome was any pediatric admission between birth and 16 years of age, with follow-up ending in March 2022. We used Cox regression models adjusted for maternal and socioeconomic factors to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between maternal hyperemesis gravidarum and childhood hospitalization. RESULTS Among 1,189,000 children, 6904 (0.6%) were exposed to maternal hyperemesis gravidarum. Hospitalization rates at age 16 years were higher for children exposed to hyperemesis gravidarum than unexposed children (47.6 vs 43.9 per 100 children). Relative to no exposure, hyperemesis gravidarum was associated with a 1.21 times greater risk of any hospitalization before 16 years (95% CI 1.17-1.26). Hyperemesis gravidarum was associated with hospitalization for neurologic (HR 1.50, 95% CI 1.32-1.71), developmental (HR 1.51, 95% CI 1.29-1.76), digestive (HR 1.40, 95% CI 1.30-1.52), and allergic disorders (HR 1.39, 95% CI 1.24-1.56). When contrasted with preeclampsia, hyperemesis gravidarum was a stronger risk factor for these outcomes. CONCLUSIONS Maternal hyperemesis gravidarum is associated with an increased risk of childhood hospitalization, especially for neurologic, developmental, digestive, and atopic disorders. WHAT IS KNOWN • Hyperemesis gravidarum is associated with neurodevelopmental disorders in offspring. • However, the effect of hyperemesis gravidarum on other childhood morbidity is unclear. WHAT IS NEW • In this longitudinal cohort study of 1.2 million children, maternal hyperemesis gravidarum was associated with a greater risk of hospitalization before age 16 years. • Exposure to hyperemesis gravidarum was associated with developmental, neurologic, atopic, and digestive morbidity in childhood.
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Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, QC, Canada.
- Institut national de santé publique du Québec, Montreal, QC, Canada.
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada.
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
| | - Banmeet Padda
- University of Montreal Hospital Research Centre, Montreal, QC, Canada
| | - Philippe Bégin
- University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Sainte-Justine University Hospital Research Centre, Montreal, QC, Canada
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Montreal, Montreal, QC, Canada
| | - Émilie Brousseau
- University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Institut national de santé publique du Québec, Montreal, QC, Canada
| | - Gabriel Côté-Corriveau
- Institut national de santé publique du Québec, Montreal, QC, Canada
- Sainte-Justine University Hospital Research Centre, Montreal, QC, Canada
- Department of Pediatrics, University of Montreal, Montreal, QC, Canada
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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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Ostenfeld A, Futtrup TB, Løkkegaard ECL, Westergaard HB. Reorganising and improving quality of care for hyperemesis gravidarum in a Danish hospital: a quality improvement project. BMJ Open Qual 2023; 12:e002035. [PMID: 37463782 PMCID: PMC10357691 DOI: 10.1136/bmjoq-2022-002035] [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: 09/06/2022] [Accepted: 06/11/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Hyperemesis gravidarum (HG) is a pregnancy complication comprising severe nausea and vomiting in pregnancy. It is associated with adverse outcomes for both mother and child. Treatment consists primarily of antiemetics and intravenous fluids; however, support from healthcare professionals is also important. LOCAL PROBLEM At the department of obstetrics at Nordsjællands Hospital, an increasing workload caused challenges regarding patient care and organisation for patients with HG, and exploring possibilities of reorganising HG care to release midwife resources was warranted. METHODS Through input from staff and patients, possible improvements were identified. Plan-do-study-act cycles were conducted with staff and patients, resulting in adjustments in care and organisation and thus use of resources. The specific, measurable, attainable, realistic and timely aims included patient satisfaction and number of follow-ups conducted via phone. INTERVENTIONS HG care was relocated to the department of gynaecology, where it was managed primarily by nurses. Staff and patients were actively involved in the process. RESULTS HG care was successfully relocated without compromising patient satisfaction. Additionally, an option of patient-administered home treatment for selected patients was established. CONCLUSION This quality improvement project describes the relocation and set-up of hospital care provided to patients with HG, resulting in high patient satisfaction. This project might serve as an inspiration to other departments of obstetrics and gynaecology.
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Affiliation(s)
- Anne Ostenfeld
- Department of Obstetrics and Gynaecology, Nordsjællands Hospital, Hillerod, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Ellen Christine Leth Løkkegaard
- Department of Obstetrics and Gynaecology, Nordsjællands Hospital, Hillerod, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Brix Westergaard
- Department of Obstetrics and Gynaecology, Nordsjællands Hospital, Hillerod, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Asrade L, Misikir D, Alemu H, Belachew A, Almaw H. Determinants of hyperemesis gravidarum among pregnant women attending antenatal care at public and private hospitals in Bahir Dar City, North-West Ethiopia, 2022: a multicenter unmatched case control study. BMC Womens Health 2023; 23:225. [PMID: 37138281 PMCID: PMC10157961 DOI: 10.1186/s12905-023-02386-0] [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: 11/01/2022] [Accepted: 04/21/2023] [Indexed: 05/05/2023] Open
Abstract
INTRODUCTION Hyperemesis gravidarum is a severe form of nausea and vomiting during pregnancy characterized by more than 5% weight loss and ketonuria. Although there are cases in Ethiopia, there is still insufficient information regarding the determinant factors of hyperemesis gravidarum.This finding helps to decrease maternal as well as fetal complications of hyperemesis gravidarum by early identification of pregnant mothers who are at high risk. This study aimed to assess determinants of hyperemesis gravidarum among pregnant women attending antenatal care at public and private hospitals in Bahir Dar, North-West Ethiopia, 2022. METHOD A multicenter, facility-based, unmatched case-control study was conducted on 444 pregnant women (148 cases and 296 controls) from January 1 to May 30. Women with a documented diagnosis of hyperemesis gravidarum on the patient chart were considered as cases, and women who attended antenatal care service without hyperemesis gravidarum were assigned as controls. Cases were selected using a consecutive sampling technique, whereas controls were selected using systematic random sampling technique. Data were collected using an interviewer-administered structured questionnaire. The data were entered into EPI-Data version 3 and exported into SPSS version 23 for analysis. Multivariable logistic regression was performed to identify determinants of hyperemesis gravidarum at a p-value of less than 0.05. An adjusted odds ratio with a 95% confidence interval was used to determine the direction of association. RESULTS Living in urban (AOR = 2.717, 95% CI : 1.693,4.502), primigravida (AOR = 6.185, 95% CI: 3.135, 12.202), first& second trimester of pregnancy (AOR = 9.301, 95% CI: 2.877,30.067) & (AOR = 4.785, 95% CI: 1.449,15.805) respectively, family history of hyperemesis gravidarum (AOR = 2.929, 95% CI: 1.268,6.765), helicobacter pylori (AOR = 4.881, 95% CI: 2.053, 11.606) & Depression (AOR = 2.195, 95% CI: 1.004,4.797) were found to be determinants of hyperemesis gravidarum. CONCLUSION Living in an urban area, primigravida woman, being in the first and second trimester, having family history of hyperemesis gravidarum, Helicobacter pylori infection, and having depression were the determinants of hyperemesis gravidarum. Primigravid women, those living in urban areas, and women who have a family history of hyperemesis gravidarum should have psychological support and early treatment initiation if they develop nausea and vomiting during pregnancy. Routing screening for Helicobacter pylori infection and mental health care for a mother with depression at the time of preconception care may decreases hyperemesis gravidarum significantly during pregnancy.
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Affiliation(s)
- Lakachew Asrade
- College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Daniel Misikir
- College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Hiwotemariam Alemu
- College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Amare Belachew
- College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Hunegnaw Almaw
- College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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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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Reissland N, Matthewson J, Einbeck J. Association between Hyperemesis Gravidarum in pregnancy on postnatal ability of infants to attend to a play task with their mother. Infant Behav Dev 2023; 71:101823. [PMID: 36764111 DOI: 10.1016/j.infbeh.2023.101823] [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: 07/25/2021] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023]
Abstract
Research indicates a higher prevalence of attention deficits in children exposed to HG in utero compared to controls with some claiming that the deficit is due to prenatal effects of malnutrition in HG mothers and others that it is due to maternal mental health after birth. The current study examines the effect of hyperemesis gravidarum (HG) diagnosis during pregnancy on infant attention controlling for maternal stress, depression anxiety and attachment. Thirty-eight infants mean age 4 months were videotaped with their mothers (19 mothers with a hyperemesis diagnosis and 19 controls) during play with a soft toy and looking at a picture book. Infant attention was operationalized as gaze direction towards the play activity, mother, and 'distracted' (indicated by looking away from play or mother). Mothers completed stress, depression, anxiety, and attachment questionnaires. HG exposed infants attended for significantly less time during play with a book or soft toy compared to controls. Maternal stress, depression, anxiety, and attachment did not differ in HG mothers and controls. Infant ability to attend to the toy, book, mother or being distracted did not relate to maternal postnatal attachment, or mental health. These results suggest that the prenatal environment, especially exposure to HG might be associated with reduced infant attention abilities independent of maternal postnatal health.
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Affiliation(s)
- Nadja Reissland
- Dept of Psychology, Durham University, Durham, United Kingdom.
| | | | - Jochen Einbeck
- Dept of Mathematical Sciences, Durham University, Durham, United Kingdom; Durham Research Methods Centre, Durham, United Kingdom
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Jia L, Li W, Liu Y, Wang L. Psychologic Sequelae in Early Pregnancy Complications. Int J Womens Health 2023; 15:51-57. [PMID: 36643713 PMCID: PMC9838123 DOI: 10.2147/ijwh.s382677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/06/2022] [Indexed: 01/11/2023] Open
Abstract
Early pregnancy complications, including miscarriage, ectopic pregnancies, and hyperemesis gravidarum, are common discomforts accounting for about 15% to 20% of all pregnancies. A proportion of women with early pregnancy complications will experience short- and long-term psychologic sequelae in the aftermath of pregnancy complications, including anxiety, depression, and post-traumatic stress disorder (PTSD) which are the most commonly reported psychologic reactions. This review will focus on the course and impact of these psychologic sequelae in early pregnancy complications, and the noninvasive interventions to improve mental health are also briefly discussed.
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Affiliation(s)
- Lili Jia
- Department of Gynaecology and Obstetrics, Binhai County People’s Hospital, Yancheng City, People’s Republic of China
| | - Wenfei Li
- Department of Gynaecology and Obstetrics, Binhai County People’s Hospital, Yancheng City, People’s Republic of China
| | - Yue Liu
- Department of Gynaecology and Obstetrics, Binhai County People’s Hospital, Yancheng City, People’s Republic of China
| | - Longqin Wang
- Department of Emergency, Binhai County People’s Hospital, Yancheng City, People’s Republic of China,Correspondence: Longqin Wang, Department of Emergency, Binhai County People’s Hospital, 248 Fudong Middle Road, Yancheng City, 224599, People’s Republic of China, Email
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Dean CR, Nijsten K, Spijker R, O'Hara M, Roseboom TJ, Painter RC. Systematic evidence map of evidence addressing the top 10 priority research questions for hyperemesis gravidarum. BMJ Open 2022; 12:e052687. [PMID: 36691124 PMCID: PMC9454001 DOI: 10.1136/bmjopen-2021-052687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/20/2022] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Knowledge gaps regarding hyperemesis gravidarum (HG) are substantial. We aimed to systematically identify and map recent evidence addressing the top 10 priority questions for HG, as published in 2021 in a James Lind Alliance Priority Setting Partnership. DESIGN Systematic evidence map. METHODS We searched MEDLINE and EMBASE on 12 January 2021 and CINAHL on 22 February 2021 with search terms hyperemesis gravidarum, pernicious vomiting in pregnancy and their synonyms. Results were limited to 2009 onwards. Two reviewers independently screened titles and abstracts to assess whether the studies addressed a top 10 priority questions for HG. Differences were discussed until consensus was reached. Publications were allocated to one or more top 10 research questions. Study design was noted, as was patient or public involvement. Two reviewers extracted data synchronously and both cross-checked 10%. Extracted data were imported into EPPI-Reviewer software to create an evidence map. OUTCOME MEASURES The number and design of studies in the search yield, displayed per the published 10 priority questions. RESULTS Searches returned 4338 results for screening; 406 publications were included in the evidence map. 136 publications addressed multiple questions. Numerous studies address the immediate and long-term outcomes or possible markers for HG (question 8 and 9, respectively 164 and 82 studies). Very few studies seek a possible cure for HG (question 1, 8 studies), preventative treatment (question 4, 2 studies) or how to achieve nutritional requirements of pregnancy (question 10, 17 studies). Case reports/series were most numerous with 125 (30.7%) included. Few qualitative studies (9, 2.2%) were identified. 25 (6.1%) systematic reviews addressed eight questions, or aspects of them. 31 (7.6%) studies included patient involvement. CONCLUSIONS There are significant gaps and overlap in the current HG literature addressing priority questions. Researchers and funders should direct their efforts at addressing the gaps in the top 10 questions.
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Affiliation(s)
- Caitlin Rosa Dean
- Obstetrics and Gynaecology, Amsterdam UMC Location AMC, Amsterdam, Netherlands
- Pregnancy Sickness Support, 19G Normandy Way, Bodmin, UK
| | - Kelly Nijsten
- Obstetrics and Gynaecology, Amsterdam UMC Location AMC, Amsterdam, Netherlands
| | - René Spijker
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
| | | | - Tessa J Roseboom
- Obstetrics and Gynaecology, Amsterdam UMC Location AMC, Amsterdam, Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
| | - Rebecca C Painter
- Obstetrics and Gynaecology, Amsterdam UMC Location AMC, Amsterdam, Netherlands
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Yamada F, Kataoka Y, Minatani M, Hada A, Wakamatsu M, Kitamura T. The NVP QOL Questionnaire: Psychometric properties of the self-report measure of health-related quality of life for nausea and vomiting during pregnancy. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2022; 1:e21. [PMID: 38868696 PMCID: PMC11114323 DOI: 10.1002/pcn5.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/10/2022] [Accepted: 05/24/2022] [Indexed: 06/14/2024]
Abstract
Aim The Nausea and Vomiting of Pregnancy Quality of Life (NVP QOL) Questionnaire is a self-report measure of health-related QOL for nausea and vomiting during pregnancy. This study determines the best fitting factor structure for the NVP QOL Questionnaire and explores its measurement invariance in terms of observation time and parity. Methods A test-retest study of pregnant women was conducted at Gestational Weeks (GWs) 10-13 (T1: N = 381) and 1 week later (T2: n = 128) at one hospital and five clinics with the NVP QOL and the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE). Exploratory and confirmatory factor analyses were performed to compare different factor structure models and evaluate measurement invariance of the best fitting model between two time points and between primiparas and multiparas. Concurrent validity of the NVP QOL was clarified by correlations with the PUQE, Sheehan Disability Scale, and other scales. Results The one-factor model had the best fit. This factor structure model was acceptable up to the factor invariance level for two time points and up to the factor mean level for primiparas versus multiparas. Correlations between NVP QOL, PUQE, and Sheehan Disability Scale scores were strong. Women with higher NVP QOL scores were more likely to lose weight, have lower daily fluid intake, have reduced fluid and food intake since pregnancy began, and receive outpatient or inpatient treatment. Conclusion The one-factor structure and measurement invariance of the NVP QOL at different times and parities were demonstrated, suggesting that the NVP QOL can be used to evaluate primiparas and multiparas in a longitudinal study.
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Affiliation(s)
- Fukiko Yamada
- Kitamura Institute of Mental Health TokyoTokyoJapan
- Department of Women's Health and MidwiferySt. Luke's International UniversityTokyoJapan
| | - Yaeko Kataoka
- Department of Women's Health and MidwiferySt. Luke's International UniversityTokyoJapan
| | - Mariko Minatani
- Kitamura Institute of Mental Health TokyoTokyoJapan
- Life Value Creation UnitNTT DATA Institute of Management Consulting Inc.TokyoJapan
| | - Ayako Hada
- Kitamura Institute of Mental Health TokyoTokyoJapan
- Department of Community Mental Health and Law, National Center of Neurology and PsychiatryNational Institute of Mental HealthTokyoJapan
| | - Mikiyo Wakamatsu
- Department of Reproductive Health Care Nursing, School of Health Sciences, Faculty of MedicineKagoshima UniversityKagoshimaJapan
| | - Toshinori Kitamura
- Kitamura Institute of Mental Health TokyoTokyoJapan
- Kitamura KOKORO Clinic Mental HealthTokyoJapan
- T. and F. Kitamura Foundation for Studies and Skill Advancement in Mental HealthTokyoJapan
- Department of Psychiatry, Graduate School of MedicineNagoya UniversityNagoyaJapan
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Morrison MA, Chung Y, Heneghan MA. Managing hepatic complications of pregnancy: practical strategies for clinicians. BMJ Open Gastroenterol 2022; 9:e000624. [PMID: 35292523 PMCID: PMC8928321 DOI: 10.1136/bmjgast-2021-000624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/12/2022] [Indexed: 12/17/2022] Open
Abstract
Liver disorders specific to pregnancy are rare but can have potentially serious consequences for mother and fetus. Pregnancy-related liver disorders are the most common cause of liver disease in otherwise healthy pregnant women and pose a challenge to physicians because of the need to take into account both maternal and fetal health. A good knowledge of these disorders is necessary as prompt diagnosis and appropriate management results in improved maternal and fetal outcomes. This review will focus on pregnancy-specific disorders and will aim to serve as a guide for physicians in their diagnosis, management and subsequent monitoring.
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Affiliation(s)
| | - Yooyun Chung
- Institute of Liver Studies, King's College Hospital, London, UK
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12
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Readmissions due to hyperemesis gravidarum: a nation-wide Finnish register study. Arch Gynecol Obstet 2022; 306:1519-1529. [PMID: 35226159 PMCID: PMC9519664 DOI: 10.1007/s00404-022-06448-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/09/2022] [Indexed: 01/17/2023]
Abstract
Purpose To evaluate the burden of illness caused by hyperemesis gravidarum (HG) and association of readmissions due to HG with maternal, environmental and pregnancy-related factors, and different pregnancy outcomes. Methods Data of women with HG diagnosis in Finland, 2005–2017, were retrieved from health-care registers. Associations between readmissions due to HG and age, gravidity, parity, pre-pregnancy body mass index (BMI), smoking, marital status, socioeconomic status, municipality population, assisted reproductive technology (ART), and number and sex of fetuses were analyzed in pregnancies resulting in delivery. Admissions and readmissions due to HG in deliveries, gestational trophoblastic disease, ectopic pregnancies, miscarriages and pregnancy terminations were calculated. Results 10,381 pregnancies with HG diagnosis were identified: 9518 live births, 31 stillbirths, 8 cases of gestational trophoblastic disease, 16 ectopic pregnancies, 299 miscarriages, and 509 pregnancy terminations. Both outpatients and inpatients were included. Readmission occurred in 60% of pregnancies, inpatient readmission in 17%. Parity of ≥ 5, multiple gestation and female sex of fetus were associated with higher odds of readmission, maternal age 36–40 years, BMI ≥ 35 kg/m2, smoking and ART with lower odds of readmission. Of the 9549 pregnancies resulting in delivery, 33% involved at least one outpatient visit or inpatient episode after the first trimester, and 8% in the third trimester. Conclusion The majority of women suffering from HG needed repeated medical care, often persisting after the first trimester. Our results provide practical information allowing clinicians to prepare for symptom duration beyond the first trimester and emphasize the importance of planning for eventual long-term treatment.
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Abstract
Hyperemesis gravidarum (HG) is a condition at the extreme end of the pregnancy sickness spectrum, estimated to affect 1-2 % of pregnant women. This narrative review provides an overview of the current literature concerning the nutritional implications and management of HG. HG can persist throughout pregnancy, causing malnutrition, dehydration, electrolyte imbalance and unintended weight loss, requiring hospital admission in most cases. In addition to its negative effect on maternal, physical and psychological wellbeing, HG can negatively impact fetal growth and may have adverse consequences on the health of the offspring. HG care and research have been hampered in the past due to stigma, inconsistent diagnostic criteria, mismanagement and lack of investment. Little is known about the nutritional intake of women with HG and whether poor intake at critical stages of pregnancy is associated with perinatal outcomes. Effective treatment requires a combination of medical interventions, lifestyle changes, dietary changes, supportive care and patient education. There is, however, limited evidence-based research on the effectiveness of dietary approaches. Enteral tube feeding and parenteral nutrition are generally reserved for the most intractable cases, where other treatment modalities have failed. Wernicke encephalopathy is a rare but very serious and avoidable consequence of unmanaged HG. A recent priority-setting exercise involving patients, clinicians and researchers highlighted the importance of nutrition research to all. Future research should focus on these priorities to better understand the nutritional implications of HG. Ultimately improved recognition and management of malnutrition in HG is required to prevent complications and optimise nutritional care.
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14
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Hansen JD, Perri RE, Riess ML. Liver and Biliary Disease of Pregnancy and Anesthetic Implications: A Review. Anesth Analg 2021; 133:80-92. [PMID: 33687174 DOI: 10.1213/ane.0000000000005433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Liver and biliary disease complicates pregnancy in varying degrees of severity to the mother and fetus, and anesthesiologists may be asked to assist in caring for these patients before, during, and after birth of the fetus. Therefore, it is important to be familiar with how different liver diseases impact the pregnancy state. In addition, knowing symptoms, signs, and laboratory markers in the context of a pregnant patient will lead to faster diagnosis and treatment of such patients. This review article discusses changes in physiology of parturients, patients with liver disease, and parturients with liver disease. Next, general treatment of parturients with acute and chronic liver dysfunction is presented. The article progresses to specific liver diseases with treatments as they relate to pregnancy. And finally, important aspects to consider when anesthetizing parturients with liver disease are discussed.
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Affiliation(s)
- Jennette D Hansen
- From the Department of Anesthesiology, North Kansas City Hospital, North Kansas City, Missouri
| | - Roman E Perri
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthias L Riess
- From the Department of Anesthesiology, North Kansas City Hospital, North Kansas City, Missouri.,Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Pharmacology, Vanderbilt University, Nashville, Tennessee
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15
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Effectiveness of Acupuncture in the Treatment of Hyperemesis Gravidarum: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:2731446. [PMID: 34367299 PMCID: PMC8337134 DOI: 10.1155/2021/2731446] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/15/2021] [Indexed: 11/18/2022]
Abstract
Background Hyperemesis gravidarum (HG) is a common gastrointestinal disease afflicting gravidas. It usually results in hospital admission in early pregnancy. Objective Through a meta-analysis, this study intended to explore acupuncture's clinical efficacy in treating HG. Materials and Methods A comprehensive search of PubMed, the Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biological Medical (CBM), Wanfang Database, and China Science and Technology Journal (VIP) for published clinical randomized controlled trials (RCTs) of acupuncture for treating HG was conducted from the date of database creation to 20th January 2021. We also searched grey literature in four databases: Chinese Cochrane Center, Chinese Clinical Trial Registry, GreyNet International, and Open Grey from their inception to 20th January 2021. Two authors independently screened the literature, extracted data, and evaluated the quality of the literature with Cochrane Handbook 5.1.0 and Review Manager 5.2 software. Review Manager 5.2 and STATA 12.0 software were applied to analyze data. Heterogeneity analysis was performed by the Cochran Chi-square test and I 2 statistic. Egger's tests together with funnel plots were used to identify publication bias. Results A total of 16 trials covering 1043 gravidas were included. Compared with the conventional treatment, acupuncture had a significantly higher effective rate (OR: 8.11, 95% CI: 5.29∼12.43; P < 0.00001), a higher conversion rate of urine ketone (RR: 1.36, 95% CI: 1.15∼1.60; P=0.0003), an improvement rate of nausea and vomiting (OR: 26.44, 95% CI: 3.54∼197.31; P=0.001), and a relatively higher improvement rate of food intake (RR: 1.17, 95% CI: 1.01∼1.36; P=0.04). Acupuncture also shortened hospitalization time and manifested with a lower pregnancy termination rate and fewer adverse events. Nevertheless, no statistical variation in the improvement of nausea intensity, vomiting episodes, and lassitude symptom, recurrence rate, and serum potassium was observed. Conclusion Our study suggested that acupuncture was effective in treating HG. However, as the potential inferior quality and underlying publication bias were found in the included studies, there is a need for more superior-quality RCTs to examine their effectiveness and safety. PROSPERO registration number: CRD42021232187.
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16
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The Contribution of Registered Dietitians in the Management of Hyperemesis Gravidarum in the United Kingdom. Nutrients 2021; 13:nu13061964. [PMID: 34201043 PMCID: PMC8226879 DOI: 10.3390/nu13061964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 02/07/2023] Open
Abstract
Hyperemesis Gravidarum (HG) is a condition at the extreme end of the pregnancy sickness spectrum, which can cause poor oral intake, malnutrition, dehydration and weight loss. The aim of this study is to explore the role of Registered Dietitians (RD) in the management of HG in the United Kingdom (UK). A survey was designed and distributed electronically to members of the British Dietetic Association. There were 45 respondents, 76% (n = 34) worked in secondary care hospitals, 11% (n = 5) were in maternal health specialist roles. The most commonly used referral criteria was the Malnutrition Universal Screening Tool (40%, n = 18), followed by second admission (36%, n = 16). However 36% (n = 16) reported no specific referral criteria. About 87% (n = 37) of respondents did not have specific clinical guidelines to follow. Oral nutrition supplements were used by 73% (n = 33) either ‘sometimes’ or ‘most of the time’. Enteral and parenteral nutrition were less commonly used. There was an inconsistent use of referral criteria to dietetic services and a lack of specific clinical guidelines and patient resources. Further training for all clinicians and earlier recognition of malnutrition, alongside investment in the role of dietitians were recommended to improve the nutritional care of those with HG.
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17
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Tan GN, Tan PC, Hong JGS, Kartik B, Omar SZ. Rating of four different foods in women with hyperemesis gravidarum: a randomised controlled trial. BMJ Open 2021; 11:e046528. [PMID: 33986063 PMCID: PMC8126296 DOI: 10.1136/bmjopen-2020-046528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 04/03/2021] [Accepted: 04/26/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate four foods in women with hyperemesis gravidarum (HG) on their agreeability and tolerability. DESIGN Prospective, randomised, within-subject cross-over trial. SETTING Single-centre, tertiary, university hospital in Malaysia. PARTICIPANTS 72 women within 24-hour of first admission for HG who were 18 years or above, with confirmed clinical pregnancy of less than 16 weeks' gestation were recruited and analysed. Women unable to consume food due to extreme symptoms, known taste or swallowing disorder were excluded. INTERVENTIONS Each participant chewed and swallowed a small piece of apple, watermelon, cream cracker and white bread in random order and was observed for 10 min after each tasting followed by a 2 min washout for mouth rinsing and data collection. OUTCOME MEASURES Primary outcome was food agreeability scored after 10 min using an 11-point 0-10 Visual Numerical Rating Scale (VNRS). Nausea was scored at baseline (prior to tasting) and 2 and 10 min using an 11-point VNRS. Intolerant responses of gagging, heaving and vomiting were recorded. RESULTS On agreeability scoring, apple (mean±SD 7.2±2.4) ranked highest followed by watermelon (7.0±2.7) and crackers (6.5±2.6), with white bread ranked lowest (6.0±2.7); Kruskal-Wallis H test, p=0.019. Apple had the lowest mean nausea score and mean rank score, while white bread had the highest at both 2 and 10 min; the Kruskal-Wallis H test showed a significant difference only at 10 min (p=0.019) but not at 2 min (p=0.29) in the ranking analyses. The intolerant (gagged, heaved or vomited) response rates within the 10 min study period were apple 3/72 (4%), watermelon 7/72 (10%), crackers 8/72 (11%) and white bread 12/72 (17%): χ2 test for trend p=0.02. CONCLUSION Sweet apple had the highest agreeability score, the lowest nausea severity and intolerance-emesis response rate when tasted by women with HG. White bread consistently performed worst.
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Affiliation(s)
- Gi Ni Tan
- Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur, Malaysia
| | - Peng Chiong Tan
- Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Balaraman Kartik
- Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Zawiah Omar
- Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur, Malaysia
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18
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Popa SL, Barsan M, Caziuc A, Pop C, Muresan L, Popa LC, Perju-Dumbrava L. Life-threatening complications of hyperemesis gravidarum. Exp Ther Med 2021; 21:642. [PMID: 33968173 PMCID: PMC8097228 DOI: 10.3892/etm.2021.10074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/01/2021] [Indexed: 01/16/2023] Open
Abstract
Hyperemesis gravidarum (HG) refers to severe nausea and emesis noted during pregnancy. However, no consensus exists on the specific diagnostic criteria that can be used for this condition. The aim of the present systematic review was to summarize the available evidence regarding the severe complications observed during HG with a heightened risk of fatality. A systematic search was conducted on PubMed, Cochrane Library, EMBASE and WILEY databases for the relevant publications regarding the severe and life-threatening complications of HG. The search terms were as follows: '(Hyperemesis gravidarum)' AND ('complications' OR 'severe' OR 'adverse pregnancy outcomes' OR 'stroke' OR 'seizures' OR 'Wernicke's encephalopathy' OR 'arrhythmias' OR 'pneumomediastinum' OR 'coagulopathy' OR 'electrolytic imbalance'). Abstracts, conference presentations, letters to the editor, studies written in languages other than English and editorials were all excluded. This search identified 43 studies analyzing life-threatening complications of HG, of which 11, seven, eight and 17 articles analyzed neurological, cardiovascular, thoracic and systemic complications, respectively. Reports on life-threatening complications were exceptionally rare in HG. The most frequent severe complications noted were Wernicke's encephalopathy, electrolyte imbalance and vitamin K deficiency. The low mortality rate for patients with HG over the last decade could be explained by the high efficiency of modern therapy, and the precise management of every complication according to current guidelines.
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Affiliation(s)
- Stefan L Popa
- Second Medical Department, 'Iuliu Hatieganu' University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca 400000, Romania
| | - Maria Barsan
- Department of Occupational Health, 'Iuliu Hatieganu' University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca 400000, Romania
| | - Alexandra Caziuc
- Department of Surgery, 'Iuliu Hatieganu' University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca 400000, Romania
| | - Cristina Pop
- Department of Pharmacology, Physiology and Pathophysiology, Faculty of Pharmacy, 'Iuliu Hatieganu' University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca 400349, Romania
| | - Lucian Muresan
- Department of Cardiology, 'Emile Muller' Hospital, Mulhouse, 68200 Mulhouse, France
| | - Luminita Celia Popa
- Department of Neurology, 'Iuliu Hatieganu' University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca 400012, Romania
| | - Lacramioara Perju-Dumbrava
- Department of Neurology, 'Iuliu Hatieganu' University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca 400012, Romania
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19
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Abstract
Hyperemesis gravidarum (HG) is a debilitating and potentially life-threatening pregnancy disease marked by weight loss, malnutrition, and dehydration attributed to unrelenting nausea and/or vomiting; HG increases the risk of adverse outcomes for the mother and child(ren). The complexity of HG affects every aspect of a woman's life during and after pregnancy. Without methodical intervention by knowledgeable and proactive clinicians, life-threatening complications may develop. Effectively managing HG requires an understanding of both physical and psychosocial stressors, recognition of potential risks and complications, and proactive assessment and treatment strategies using innovative clinical tools.
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20
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Lindberg R, Lindqvist M, Trupp M, Vinnars MT, Nording ML. Polyunsaturated Fatty Acids and Their Metabolites in Hyperemesis Gravidarum. Nutrients 2020; 12:nu12113384. [PMID: 33158081 PMCID: PMC7694173 DOI: 10.3390/nu12113384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 12/26/2022] Open
Abstract
Polyunsaturated fatty acids (PUFAs) have been studied in relation to pregnancy. However, there is limited knowledge on PUFAs and their metabolites in relation to hyperemesis gravidarum (HG), a pregnancy complication associated with nutritional deficiencies and excessive vomiting. In order to survey the field, a systematic review of the literature was performed, which also included nausea and vomiting of pregnancy (NVP) due to its close relationship with HG. In the very few published studies found, the main subjects of the research concerned free fatty acids (four records), lipid profiles (three records), and bioactive lipids (one article about prostaglandin E2 and one about endocannabinoids). The authors of these studies concluded that, although no cause-and-effect relationship can be established, HG is linked to increased sympathetic responsiveness, thermogenic activity and metabolic rate. In addition, NVP is linked to a metabolic perturbance (which lasts throughout pregnancy). The low number of retrieved records underlines the need for more research in the area of PUFAs and HG, especially with regard to the underlying mechanism for the detected effects, potentially involving growth differentiation factor 15 (GDF15) since evidence for GDF15 regulation of lipid metabolism and the role for GDF15 and its receptor in nausea and vomiting is emerging.
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Affiliation(s)
| | - Maria Lindqvist
- Department of Nursing, Umeå University, 901 87 Umeå, Sweden;
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87 Umeå, Sweden;
| | - Miles Trupp
- Department of Clinical Sciences, Neurosciences, Umeå University, 901 87 Umeå, Sweden;
| | - Marie-Therese Vinnars
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87 Umeå, Sweden;
- Division of Obstetrics and Gynecology, Örnsköldsvik Hospital, 891 89 Örnsköldsvik, Sweden
| | - Malin L. Nording
- Department of Chemistry, Umeå University, 901 87 Umeå, Sweden;
- Correspondence:
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21
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Jacobs NF, Veronese LR, Okano S, Hurst C, Dyer RA. The incidence of postoperative nausea and vomiting after caesarean section in patients with hyperemesis gravidarum: a retrospective cohort study. Int J Obstet Anesth 2020; 44:81-89. [PMID: 32823251 DOI: 10.1016/j.ijoa.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/22/2020] [Accepted: 07/15/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postoperative nausea and vomiting is one of the most common anaesthetic complications of caesarean section. This study examined the association between hyperemesis gravidarum during pregnancy and nausea and vomiting after caesarean section. METHODS A single-centre, retrospective cohort study, using electronic databases of patients with and without hyperemesis gravidarum, undergoing caesarean section from 2015 to 2019. The incidence and severity of postoperative nausea and vomiting were established by a review of the documentation of administration of postoperative anti-emetics within the 24-h period after surgery, and examined using univariable, multivariable binary and ordered logistic regression models. RESULTS Data were compared for 76 patients with hyperemesis gravidarum and 315 patients without the condition. The incidence of postoperative nausea and vomiting in the hyperemesis group versus the non-hyperemesis group was 43.4% vs 29.6%, respectively. The odds of experiencing postoperative nausea and vomiting was 1.95 times higher in women with hyperemesis gravidarum than in those without (aOR 1.95, 95% CI 1.13 to 3.36, P=0.016). The odds of having more severe postoperative nausea and vomiting were greater in the hyperemesis gravidarum group (aOR 1.91, 95% CI 1.14 to 3.20, P=0.014). CONCLUSION Patients with hyperemesis gravidarum are more likely to develop nausea and vomiting after caesarean section, and this is likely to be of greater severity than in those without the condition. This finding should assist the effective provision of intra-operative and postoperative anti-emetics for patients with hyperemesis gravidarum undergoing caesarean section.
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Affiliation(s)
- N F Jacobs
- Department of Anaesthesia, Mater Health Services, South Brisbane, QLD, Australia.
| | - L R Veronese
- Department of Anaesthesia, Redland Hospital, Cleveland, QLD, Australia
| | - S Okano
- Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia; Mater Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - C Hurst
- Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia; Mater Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - R A Dyer
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
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22
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Abstract
Hyperemesis gravidarum (HG) is the most common cause of in-patient hospitalizations during the first half of pregnancy. The etiology of HG has not yet been elucidated, and the treatment is mainly symptomatic. Untreated severe HG can lead to catastrophic maternal complications such as cardiac arrhythmia and death. In contrast, the impact of untreated severe HG on the fetuses remains contradictory. Evidence suggested that HG may increase the risk of a small for gestational age (GA) fetus. We here report a case of 32-year-old nulliparous woman, GA of 14 weeks, who presented with worsening HG and later had a diagnosis of missed abortion. More research is needed to clarify the possibility of HG as a contributory cause of abortion.
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Affiliation(s)
| | - Nehad Shabarek
- Internal Medicine, Lincoln Medical Center, New York City, USA
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23
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Dean CR, Bruin CM, O’Hara ME, Roseboom TJ, Leeflang MM, Spijker R, Painter RC. The chance of recurrence of hyperemesis gravidarum: A systematic review. Eur J Obstet Gynecol Reprod Biol X 2020; 5:100105. [PMID: 32021976 PMCID: PMC6994404 DOI: 10.1016/j.eurox.2019.100105] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/03/2019] [Accepted: 12/06/2019] [Indexed: 01/19/2023] Open
Abstract
Around 1 % of pregnancies develop Hyperemesis Gravidarum (HG), causing high physical and psychological morbidity. Reports on HG recurrence rate in subsequent pregnancies vary widely. An accurate rate of recurrence is needed for informed reproductive decision making. Our objective is to systematically review and aggregate reported rates for HG subsequent to index pregnancies affected by HG. We searched databases from inception as per the protocol registered on PROSPERO. No language restrictions were applied. Inclusion was not restricted based on how HG was defined; reports of severe NVP were included where authors defined the condition as HG. We included descriptive epidemiological, case control and cohort study designs. Eligibility screening was performed in duplo. We extracted data on populations, study methods and outcomes of significance. A panel of patients reviewed the results and provided discussion and feedback. Quality was assessed with the JBI (2017) critical appraisal tool independently by two reviewers. We performed the searches on 1st November 2019. Our search yielded 4454 unique studies, of which five (n = 40,350 HG cases) matched eligibility criteria; One longitudinal and four population-based cohort studies from five countries. Follow-up ranged from 2 to 31 years. Definition of HG and data collection methods in all the studies created heterogeneity. Quality was low; studies lacked valid and reliable exposure, and/or follow-up was insufficient. Meta-analysis was not possible due to clinical and statistical heterogeneity. This systematic review found five heterogeneous studies reporting recurrence rates from 15 to 81%. Defining HG as hospital cases may have introduced detection bias and contribute to clinical heterogeneity. A prospective longitudinal cohort study using an internationally agreed definition of HG and outcomes meaningful to patients is required to establish the true recurrence rate of HG.
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Affiliation(s)
- Caitlin R. Dean
- Department of Gynaecology and Obstetrics, University Medical Centres Amsterdam, Amsterdam, the Netherlands
- Pregnancy Sickness Support, 19G Normandy Way, Bodmin, Cornwall, PL31 1RB, UK
| | - Claartje M. Bruin
- Department of Gynaecology and Obstetrics, University Medical Centres Amsterdam, Amsterdam, the Netherlands
| | - Margaret E. O’Hara
- Pregnancy Sickness Support, 19G Normandy Way, Bodmin, Cornwall, PL31 1RB, UK
| | - Tessa J. Roseboom
- Department of Gynaecology and Obstetrics, University Medical Centres Amsterdam, Amsterdam, the Netherlands
| | - Mariska M. Leeflang
- Clinical Epidemiology and Biostatistics, University Medical Centres Amsterdam, Amsterdam, the Netherlands
| | - René Spijker
- Clinical Epidemiology and Biostatistics, University Medical Centres Amsterdam, Amsterdam, the Netherlands
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, the Netherlands
| | - Rebecca C. Painter
- Department of Gynaecology and Obstetrics, University Medical Centres Amsterdam, Amsterdam, the Netherlands
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Effect of hyperemesis gravidarum on maternal renal health: An investigation of the levels of neutrophil gelatinase-associated lipocalin in maternal serum. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.659787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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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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26
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Elliott B, Czuzoj-Shulman N, Spence AR, Mishkin DS, Abenhaim HA. Effect of celiac disease on maternal and neonatal outcomes of pregnancy. J Matern Fetal Neonatal Med 2019; 34:2117-2123. [PMID: 34016019 DOI: 10.1080/14767058.2019.1658733] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Celiac disease (CD) is a permanent immune reaction to gluten that is likely related to genetic factors. Some studies have linked CD to adverse maternal and/or neonatal outcomes but the data has been contradictory. The purpose of this study was to evaluate the effect of CD on pregnancy outcomes. MATERIALS AND METHODS We used data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (NIS) of the USA to conduct a population-based retrospective cohort study of women who delivered between 1999 and 2014. Pregnancies were categorized as having CD if corresponding ICD-9 code was present. Unconditional logistic regression models were used to estimate the adjusted effect on maternal and fetal outcomes. RESULTS There were 14,513,587 births during the study period of which 2755 were to women with CD, for an overall prevalence of 1.9 cases/10,000 births and with rates increasing over the study period. Women with CD tended to be older, Caucasian and to have pre-existing comorbidities, especially other autoimmune diseases. Women with CD were at greater risk of hyperemesis gravidarum, 4.52 (3.68-5.57), Clostridium difficile colitis, 7.56 (3.14-18.20), and venous thromboembolic events, 2.93 (2.07-4.15), as well as, hospital stays >3 d, 2.06 (1.75-2.43). Infants of women with CD were more likely to be growth restricted, 1.80 (1.46-2.21) and have congenital malformations, 3.51 (2.68-4.58). CONCLUSIONS CD in pregnancy is associated with increased adverse maternal and newborn complications. These pregnancies should be considered high risk and may benefit from increased surveillance.
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Affiliation(s)
- Brittney Elliott
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Nicholas Czuzoj-Shulman
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Canada
| | - Andrea R Spence
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Canada
| | | | - Haim Arie Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Canada.,Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Canada
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Groleau D, Benady-Chorney J, Panaitoiu A, Jimenez V. Hyperemesis Gravidarum in the context of migration: when the absence of cultural meaning gives rise to "blaming the victim". BMC Pregnancy Childbirth 2019; 19:197. [PMID: 31182057 PMCID: PMC6558872 DOI: 10.1186/s12884-019-2344-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 05/27/2019] [Indexed: 01/26/2023] Open
Abstract
Background Hyperemesis gravidarum (HG) is a rare complication of pregnancy that involves persistent nausea and extreme vomiting to an intensity that differentiates HG from nausea and vomiting commonly experienced during pregnancy. Research has suggested potential biological and psychological etiological pathways for HG, but the augmented prevalence in immigrant populations, which is 4.5 times higher, remains unclear. Studies show that in order to better address the psychosocial needs of immigrant patients with HG, we must first improve our understanding of how they experience their illness. The objective of this study was to understand the meaning and experience of HG among immigrant women in Canada. Methods Our “qualitative comparative analysis design” involved a sample of 15 pregnant mothers following their hospitalization for HG, including 11 immigrant women and 4 Canadian-born women recruited for comparison purposes. We used the Edinburgh Perinatal Depression Scale to assess distress, and the McGill Illness Narrative Interview Schedule to explore how pregnant women understood and experienced their HG and the health services that they received. Results With the exception of a few women whose mothers suffered from HG, immigrant women and their loved ones did not have cultural knowledge to attribute meaning to HG symptoms. This left them vulnerable to criticism from family, as well as feelings of self-doubt, stress, and anxiety. We interpret this phenomenon as ‘victim blaming’. Immigrant women’s experience of HG was also characterised by high levels of depressive symptoms (40%) which they linked to the severity of their symptoms, high levels of stress associated with adapting to their new country, social isolation, and loss of female family members. Furthermore, in contrast to Canadian-born women, immigrant women frequently reported feeling that their symptoms were minimized by hospital emergency room medical staff, which led to delays in obtaining appropriate health care. However, once admitted to hospital, they perceived the care provided by dieticians and nurses as helpful in managing their symptoms. Conclusions Wider awareness of the impact of HG may improve the quality of family support for immigrant women. There is a need to improve the delays and appropriateness of clinical care.
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Affiliation(s)
- Danielle Groleau
- Division of Social and Transcultural Psychiatry, McGill University; Culture and Mental Health Unit - Lady Davis Medical Institute, Jewish General Hospital- CIUSSS West-Central Montreal, 4333 Chemin de la Côte-Ste-Catherine, Montréal, QC, H3T 1E4, Canada.
| | - Jessica Benady-Chorney
- Division of Social and Transcultural Psychiatry, McGill University; Culture and Mental Health Unit - Lady Davis Medical Institute, Jewish General Hospital- CIUSSS West-Central Montreal, 4333 Chemin de la Côte-Ste-Catherine, Montréal, QC, H3T 1E4, Canada
| | - Alexandra Panaitoiu
- Department of Psychiatry, University of Toronto, 500 University Avenue, Suite 602, Toronto, ON, M5G 1V7, Canada
| | - Vania Jimenez
- Department of Family Medicine, McGill University, CLSC de Côte-des-Neiges- CIUSSS West-Central Montreal, 5700 Chemin de la Cote-des-Neiges, Montreal, QC, H3T 2A8, Canada
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28
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Kjeldgaard HK, Vikanes Å, Benth JŠ, Junge C, Garthus-Niegel S, Eberhard-Gran M. The association between the degree of nausea in pregnancy and subsequent posttraumatic stress. Arch Womens Ment Health 2019; 22:493-501. [PMID: 30225528 PMCID: PMC6647437 DOI: 10.1007/s00737-018-0909-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 08/27/2018] [Indexed: 12/27/2022]
Abstract
Hyperemesis gravidarum (HG) is a pregnancy condition characterised by severe nausea and vomiting during early pregnancy. The experience of HG is for many women a traumatic event. Few studies have investigated a possible association between HG and birth-related posttraumatic stress. The objective of the current study was to assess whether HG increases the risk of birth-related posttraumatic stress symptoms (PTSS). This was a population-based pregnancy cohort study using data from the Akershus Birth Cohort Study (ABC study). A linear mixed model was used to estimate the association between the degree of nausea (no nausea (n = 574), mild nausea (n = 813), severe nausea (n = 522) and HG (hospitalised due to nausea, n = 20)) and PTSS score at 8 weeks and 2 years after birth. At 8 weeks postpartum, women with HG had higher PTSS scores compared to women with no nausea (p = 0.008), women with mild nausea (p = 0.019) and women with severe nausea (p = 0.027). After 2 years, women with HG had higher PTSS scores compared to women with no nausea (p = 0.038). Women with HG had higher PTSS scores following childbirth compared to women with less pronounced symptoms or no nausea at all. After 2 years, women with HG still had higher PTSS scores compared to women with no nausea. Although the overall differences in PTSS scores were small, the results may still be of clinical relevance.
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Affiliation(s)
- Helena Kames Kjeldgaard
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway. .,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway.
| | - Åse Vikanes
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway ,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Carolin Junge
- Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway ,Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Susan Garthus-Niegel
- Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway ,Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Malin Eberhard-Gran
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway ,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway ,Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway
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29
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Sahin E, Madendag Y, Eraslan Sahin M, Tayyar AT, Col Madendag I, Gozukucuk M, Karakukcu C, Acmaz G, Muderris II. Maternal type 1collagen N-terminal telopeptide levels in severe hyperemesis gravidarum. BMC Pregnancy Childbirth 2018; 18:502. [PMID: 30572827 PMCID: PMC6302387 DOI: 10.1186/s12884-018-2149-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 12/12/2018] [Indexed: 11/12/2022] Open
Abstract
Background Nausea and vomiting occur 50–90% during the first trimester of pregnancy. However, patients with hyperemesis gravidarum (HG) may be hospitalized at an incidence rate of 0.8–2% before the 20th week of gestational age. The symptoms generally start during the 5–6th gestational weeks, reaching the highest degree during the 9th week, and decline after the 16–20th weeks of gestation. Clinical findings are proportional to the severity of the disease and severe HG is characterized with dehydration, electrolyte imbalance, and nutritional deficiency as a result of vomiting. Methods The study population consisted of two groups of pregnant volunteers at 5–12 weeks of gestation: a severe HG group and a control group. The HG severity was scored using the Pregnancy-Unique Quantification of Emesis (and nausea) (PUQE).The serum levels of the maternal Ca, parathyroid hormone (PTH), Na, K, blood urea nitrogen(BUN), creatinine, vitamin D(25OHD3), and the maternal urine NTx levels were compared between the groups. Results In total, 40 volunteers were enrolled in this study: 20 healthy pregnant volunteers and 20 with severe HG. There were no statistically significant differences between the maternal characteristics. The first trimester weight loss of ≥5 kg was significantly higher in the severe HG group (p < 0.001), while the control group had a significantly higher sunlight exposure ratio than the severe HG group (p = 0.021). The urine NTx levels were significantly higher in the severe HG group (39.22 ± 11.68NTx/Cre) than in the control group(32.89 ± 8.33NTx/Cre) (p = 0.028).The serum Ca, PTH, Na, K, BUN, and creatinine levels were similar between the groups (p = 0.738, p = 0.886, p = 0.841, p = 0.957, p = 0.892, and p = 0.824, respectively). In the severe HG group, the serum 25OHD3 levels were significantly lower than in the control group (p < 0.001). Conclusions The data from this study indicated that severe HG is associated with increased urine NTx levels. However, large-scale studies are required to understand the clinical significance of this finding, as well as the long-term consequences of elevated urine NTx levels and the underlying mechanisms. Trial registration NCT02862496 Date of registration: 21/07/2016.
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Affiliation(s)
- E Sahin
- Department of Obstetrics and Gynecology, Health Sciences University, Sivas Sarkısla Government Hospital, Sivas, Turkey.
| | - Y Madendag
- Department of Obstetrics and Gynecology, Health Sciences University, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - M Eraslan Sahin
- Department of Obstetrics and Gynecology, Health Sciences University, Sivas Sarkısla Government Hospital, Sivas, Turkey
| | - A T Tayyar
- Department of Obstetrics and Gynecology, Health Sciences University, Zeynep Kamil Maternity and Children's Training and Research Hospital, İstanbul, Turkey
| | - I Col Madendag
- Department of Obstetrics and Gynecology, Health Sciences University, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - M Gozukucuk
- Department of Obstetrics and Gynecology, Health Sciences University, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - C Karakukcu
- Department of Biochemistry Clinic, Health Sciences University, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - G Acmaz
- Department of Obstetrics and Gynecology, Health Sciences University, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - I I Muderris
- Department of Obstetrics and Gynecology, Erciyes University Faculty of Medicine, Kayseri, Turkey
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30
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Dean CR, Shemar M, Ostrowski GAU, Painter RC. Management of severe pregnancy sickness and hyperemesis gravidarum. BMJ 2018; 363:k5000. [PMID: 30504245 DOI: 10.1136/bmj.k5000] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Caitlin R Dean
- Pregnancy Sickness Support, Dunmore Farm, Par, Cornwall, UK
- Amsterdam UMC, University of Amsterdam, Obstetrics and Gynaecology, Amsterdam, The Netherlands
| | - Manjeet Shemar
- Pregnancy Sickness Support, Dunmore Farm, Par, Cornwall, UK
- Birmingham Women's & Children's Hospital, Birmingham, UK
| | - Gillian A U Ostrowski
- Pregnancy Sickness Support, Dunmore Farm, Par, Cornwall, UK
- Bridge Lane Group Practice, Battersea, London, UK
- NHS England, London, UK
| | - Rebecca C Painter
- Amsterdam UMC, University of Amsterdam, Obstetrics and Gynaecology, Amsterdam, The Netherlands
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31
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Women with prolonged nausea in pregnancy have increased risk for depressive symptoms postpartum. Sci Rep 2018; 8:15796. [PMID: 30361517 PMCID: PMC6202412 DOI: 10.1038/s41598-018-33197-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 09/19/2018] [Indexed: 01/07/2023] Open
Abstract
The aim of this population-based, longitudinal study was to assess the association between nausea and vomiting in pregnancy (NVP) and perinatal depressive symptoms. Pregnant women (N = 4239) undergoing routine ultrasound at gestational week (GW) 17 self-reported on NVP and were divided into those without nausea (G0), early (≤17 GW) nausea without medication (G1), early nausea with medication (G2), and prolonged (>17 GW) nausea (G3). The Edinburgh Postnatal Depression Scale at GW 17 and 32 (cut-off ≥13) and at six weeks postpartum (cut-off ≥12) was used to assess depressive symptoms. Main outcome measures were depressive symptoms at GW 32 and at six weeks postpartum. NVP was experienced by 80.7%. The unadjusted logistic regression showed a positive association between all three nausea groups and depressive symptoms at all time-points. After adjustment, significant associations with postpartum depressive symptoms remained for G3, compared to G0 (aOR = 1.66; 95% CI 1.1–2.52). After excluding women with history of depression, only the G3 group was at higher odds for postpartum depressive symptoms (aOR = 2.26; 95% CI 1.04–4.92). In conclusion, women with prolonged nausea have increased risk of depressive symptoms at six weeks postpartum, regardless of history of depression.
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32
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Ellilä P, Laitinen L, Nurmi M, Rautava P, Koivisto M, Polo-Kantola P. Nausea and vomiting of pregnancy: A study with pregnancy-unique quantification of emesis questionnaire. Eur J Obstet Gynecol Reprod Biol 2018; 230:60-67. [PMID: 30243227 DOI: 10.1016/j.ejogrb.2018.09.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 09/13/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Nausea and vomiting of pregnancy (NVP) is frequent, affecting up to 70-85% of pregnant women. However, severity of NVP especially in clinical practice is often uncertainly assessed and thus both under- and overdiagnosing is probable. Furthermore, risk factors for NVP, although recognized, are not well established. The aim of our study was to evaluate the severity of NVP with a structured questionnaire and evaluate associative risk factors. STUDY DESIGN Sample of 2411 women were recruited from maternity health care clinics. Severity of NVP was assessed with pregnancy-unique quantification of emesis (PUQE) questionnaire. Age, previous pregnancies, previous deliveries, previous miscarriages including ectopic pregnancies, previous pregnancy terminations, nationality, pre-pregnancy body mass index, smoking, marital status and employment were used as explanatory factors. RESULTS Altogether 88.0% of the women reported some level of NVP, of which 6.4% was severe, 52.2% moderate and 29.4% mild. Daily duration of NVP was ≥ four hours in 12 h in 45.0%. Further, 18.8% of the women had vomiting episodes ≥ three times and 37.4% retching episodes ≥ three times in 12 h. Women with ≥ two previous pregnancies had increased risk for more severe NVP (OR 2.17, 95%CI; 1.34-3.51, p < 0.0001). Older women had increased daily duration of nausea (OR 1.03, 95%CI; 1.00-1.06, p = 0.004) but lower number of vomits (OR 0.93, 95%CI; 0.93-0.97, p < 0.0001) and lower number of retching (OR 0.93, 95%CI; 0.90-0.96, p < 0.0001). Smokers had shorter daily duration of nausea (OR 0.49, 95%CI; 0.33-0.73, p < 0.0001), but higher number of vomiting episodes compared to non-smokers (OR 1.83, 95%CI; 1.26-2.66, p = 0.021). CONCLUSIONS Women suffered from NVP very frequently. The daily duration of NVP was moderately long, in nearly half of the women four hours or more. In addition, retching was more frequent than vomiting. From studied risk factors, few associations with different aspects of NVP emerged, but only multiparity was associated with the severity of NVP. As NVP affects several women during pregnancy, in future, the impact of NVP on quality of life, future family planning and health costs should be evaluated.
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Affiliation(s)
- Pauliina Ellilä
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Linda Laitinen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland.
| | - Miina Nurmi
- Department of Obstetrics and Gynecology, Turku University Hospital and 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
| | - Mari Koivisto
- Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
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Rudd JA, Chan SW, Ngan MP, Tu L, Lu Z, Giuliano C, Lovati E, Pietra C. Anti-emetic Action of the Brain-Penetrating New Ghrelin Agonist, HM01, Alone and in Combination With the 5-HT 3 Antagonist, Palonosetron and With the NK 1 Antagonist, Netupitant, Against Cisplatin- and Motion-Induced Emesis in Suncus murinus (House Musk Shrew). Front Pharmacol 2018; 9:869. [PMID: 30127745 PMCID: PMC6087754 DOI: 10.3389/fphar.2018.00869] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/18/2018] [Indexed: 11/22/2022] Open
Abstract
Ghrelin has well-known activity to stimulate appetite and weight gain. Evidence suggests that ghrelin may also have effects in reducing chemotherapy-induced emesis via growth hormone secretagogue receptors (GHS-R1A) in the brain. However, it is not known whether the stimulation of GHS-R1A has broad inhibitory anti-emetic effects. In the present studies, we used Suncus murinus to investigate the potential of the new and novel orally bioavailable brain-penetrating GHS-R1A mimetic, HM01 (1-[(1S)-1-(2,3-dichloro-4-methoxyphenyl)ethyl]-3-methyl-3-[(4R)-1-Methyl-3,3-dimethyl-4-piperidyl]urea), to reduce emesis induced by a variety of emetic challenges. HM01 (1 to 30 mg/kg, p.o.) antagonized emesis induced by cisplatin (30 mg/kg, i.p.) and by motion (4 cm horizontal displacement, 1 Hz) but was ineffective against emesis induced by nicotine (5 mg/kg, s.c.) and copper sulfate (120 mg/kg by intragastric gavage). In other experiments, HM01 (3 mg/kg, p.o.) enhanced the anti-emetic control of a regimen of palonosetron (0.01 mg/kg, p.o.) alone and palonosetron (0.01 mg/kg p.o.) plus netupitant (1 mg/kg, p.o.). HM01 (10 mg/kg, p.o.) also had positive effects in increasing feeding and drinking in nicotine-treated animals, and it shortened the latency to drink in animals treated with cisplatin. These data indicate that brain-penetrating GHS-R1A agonists may have use alone and/or in combination with standard anti-emetic regimens for the treatment of chemotherapy-induced nausea and vomiting and motion sickness.
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Affiliation(s)
- John A Rudd
- Emesis Research Group, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.,Brain and Mind Institute, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sze W Chan
- School of Health Sciences, Caritas Institute of Higher Education, Tseung Kwan O New Town, Hong Kong
| | - Man P Ngan
- Emesis Research Group, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Longlong Tu
- Emesis Research Group, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Zengbing Lu
- Emesis Research Group, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Claudio Giuliano
- Helsinn Healthcare SA, Research and Development, Lugano, Switzerland
| | - Emanuela Lovati
- Helsinn Healthcare SA, Research and Development, Lugano, Switzerland
| | - Claudio Pietra
- Helsinn Healthcare SA, Research and Development, Lugano, Switzerland
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Ondansetron in Pregnancy and the Risk of Congenital Malformations: A Systematic Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:910-918. [PMID: 29754832 DOI: 10.1016/j.jogc.2017.10.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/08/2017] [Accepted: 10/10/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Ondansetron, not approved for use in pregnancy, is increasingly being prescribed for nausea and vomiting in pregnancy and hyperemesis gravidarum. A number of recent lawsuits have highlighted the possibility that ondansetron may cause congenital malformations. The aim of this study was to systematically review epidemiological evidence on the potential association of prenatal exposure to ondansetron and congenital malformations. METHODS Systematic searches in Medline and Embase were performed in June 2017 using controlled vocabulary and key words, and references of search results were reviewed. Full papers (RCTs, cohort, and case-control studies) were eligible for inclusion if they reported fetal outcomes of prenatal ondansetron exposure in humans. Excluded were: case reports, studies involving pre-medication with ondansetron prior to CS, animal studies, and foreign languages studies. RESULTS Ten epidemiologic studies were included: five large retrospective cohort studies, two prospective observational studies, two population-based case-controls. and a retrospective case series. Sample sizes ranged from 17 to 1 501 434 infants exposed to ondansetron. A case-control study identified an association between prenatal exposure to ondansetron and cleft palate, and one cohort study found an increased risk of cardiovascular defects. These findings were not reproduced in the other studies. CONCLUSION While further investigation of the literature is needed, our results highlight the paucity of evidence linking prenatal exposure to ondansetron to an increased risk of congenital malformations. There is a need for additional epidemiologic studies to confirm whether ondansetron represents a safe and effective alternative treatment for nausea and vomiting in pregnancy and hyperemesis gravidarum.
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Dayangan Sayan C. A case of prolonged hyperemesis resulting in hepatorenal failure, foetal distress and neonatal mortality. J OBSTET GYNAECOL 2018; 38:573-575. [PMID: 29385934 DOI: 10.1080/01443615.2017.1378874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Hyperemesis gravidarum is defined as a condition emerging during pregnancy, is prominent with severe nausea and vomiting, a water-electrolyte imbalance and liver-kidney function disorder and causes more than 5% loss of body weight. In cases of severe hyperemesis gravidarum, maternal morbidities such as water-electrolyte imbalance, hepatorenal failure, Wernicke's encephalopathy, splenic avulsion, oesophageal rupture, pneumothorax have been reported. We present a case of hyperemesis gravidarum, which continued until the third trimester and developed secondary hepatorenal failure, a water-electrolyte imbalance, intrauterine growth restriction, anhydramnios, foetal distress and neonatal mortality.
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Affiliation(s)
- Cemile Dayangan Sayan
- a Departmant of Obstetrics and Gynecology , Kırıkkale University Faculty of Medicine , Kırıkkale , Turkey
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36
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Kleine I, Da Silva A, Ahmed W, Forya F, Whitten SM, David AL, James CP. Hospital admission for hyperemesis gravidarum in women at increased risk of spontaneous preterm birth. Birth 2017; 44:384-389. [PMID: 28857251 PMCID: PMC5697573 DOI: 10.1111/birt.12303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 06/28/2017] [Accepted: 06/28/2017] [Indexed: 12/27/2022]
Abstract
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.
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Affiliation(s)
| | - Ana Da Silva
- Fetal Medicine UnitUniversity College London Hospitals NHS Foundation TrustLondonUK
| | | | | | - Sara M. Whitten
- UCL Medical SchoolLondonUK,Fetal Medicine UnitUniversity College London Hospitals NHS Foundation TrustLondonUK,UCL Institute for Women's HealthLondonUK
| | - Anna L. David
- Fetal Medicine UnitUniversity College London Hospitals NHS Foundation TrustLondonUK,UCL Institute for Women's HealthLondonUK
| | - Catherine P. James
- Fetal Medicine UnitUniversity College London Hospitals NHS Foundation TrustLondonUK,UCL Institute for Women's HealthLondonUK
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Abramowitz A, Miller ES, Wisner KL. Treatment options for hyperemesis gravidarum. Arch Womens Ment Health 2017; 20:363-372. [PMID: 28070660 PMCID: PMC7037589 DOI: 10.1007/s00737-016-0707-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 12/19/2016] [Indexed: 12/27/2022]
Abstract
Hyperemesis gravidarum (HG) is a severe and prolonged form of nausea and/or vomiting during pregnancy. HG affects 0.3-2% of pregnancies and is defined by dehydration, ketonuria, and more than 5% body weight loss. Initial pharmacologic treatment for HG includes a combination of doxylamine and pyridoxine. Additional interventions include ondansetron or dopamine antagonists such as metoclopramide or promethazine. The options are limited for women who are not adequately treated with these medications. We suggest that mirtazapine is a useful drug in this context and its efficacy has been described in case studies. Mirtazapine acts on noradrenergic, serotonergic, histaminergic, and muscarinic receptors to produce antidepressant, anxiolytic, antiemetic, sedative, and appetite-stimulating effects. Mirtazapine is not associated with an independent increased risk of birth defects. Further investigation of mirtazapine as a treatment for HG holds promise to expand treatment options for women suffering from HG.
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Affiliation(s)
- Amy Abramowitz
- UIC Department of Psychiatry, University of Illinois at Chicago, 912 S. Wood Street, Chicago, IL, 60612, USA.
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave, Chicago, IL, 60611, USA
| | - Katherine L Wisner
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave, Chicago, IL, 60611, USA
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Sari N, Ede H, Engin-Ustun Y, Göçmen AY, Çağlayan EK. Hyperemesis gravidarum is associated with increased maternal serum ischemia-modified albumin. J Perinat Med 2017; 45:421-425. [PMID: 27474836 DOI: 10.1515/jpm-2015-0421] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 06/22/2016] [Indexed: 11/15/2022]
Abstract
AIM Our objective was to measure the circulating levels of ischemia-modified albumin (IMA) among pregnant with hyperemesis gravidarum (HEG) and to compare their levels with age- and body mass index (BMI)-matched control pregnant women. METHOD The pregnant subjects were classified into the HEG group diagnosed with HEG (n=45) and age- and BMI-matched control group without a diagnosis of HEG (n=45) during their pregnancies. Serum IMA, hemoglobin, hematocrit, white blood cells, platelet, fasting blood glucose, creatinine, lipid profile, aspartate aminotransferase (AST) urea, alanine aminotransferase (ALT), sodium, potassium and thyroid-stimulating hormone (TSH) levels of the groups were measured. RESULT Serum hemoglobin, hematocrit, white blood cells, platelet, fasting blood glucose, creatinine, lipid profile, AST, urea, ALT, sodium, potassium and TSH levels of the groups were statistically similar. Serum IMA values were significantly higher in subjects with HEG compared to the subjects without HEG. CONCLUSIONS We found that HEG was related to increased maternal serum IMA levels. HEG might be due to an ischemic intrauterine environment leading to elevated serum IMA concentrations.
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Hyperemesis gravidarum: a holistic overview and approach to clinical assessment and management. J Perinat Neonatal Nurs 2015; 29:12-22; quiz E1. [PMID: 25534678 DOI: 10.1097/jpn.0000000000000075] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hyperemesis gravidarum (HG) is a rare and severe form of nausea and vomiting of pregnancy associated with significant costs and psychosocial impacts. The etiology of HG remains largely unknown, although maternal genetics and placental factors are suspected. Prompt recognition and treatment of HG are essential to minimize associated maternal and fetal morbidity. Diagnosis is made on the basis of typical presentation, with exclusion of other causes of severe nausea and vomiting of pregnancy. Validated clinical tools are available to assess severity of symptoms and guide plans of care. Evidence to guide management of HG is limited, but many nonpharmacologic and pharmacologic interventions are available with published guidelines to inform implementation. Care of the woman with HG requires compassion and acknowledgement of individual needs and responses to interventions.
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Grooten IJ, Painter RC, Pontesilli M, van der Post JAM, Mol BWJ, van Eijsden M, Vrijkotte TGM, Roseboom TJ. Weight loss in pregnancy and cardiometabolic profile in childhood: findings from a longitudinal birth cohort. BJOG 2014; 122:1664-73. [PMID: 25145598 DOI: 10.1111/1471-0528.13042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate the consequences of weight loss in pregnancy on pregnancy outcomes and cardiometabolic profile in childhood. DESIGN Prospective birth cohort (ABCD study). SETTING Between 2003 and 2004, all pregnant women in Amsterdam were approached for study participation. POPULATION 7818 pregnant women were included, of which 3165 consented to having their children examined at 5-6 years of age. In 1956 children fasting capillary blood samples were also taken. METHODS At antenatal booking, women answered questions about their pregnancy and whether they suffered from severe weight loss (SWL; >5 kg). Pregnancy details and outcomes were available through the obstetric caregiver. MAIN OUTCOME MEASURES At birth main outcome measures were prematurity (<37 weeks) and birthweight. At follow-up, body mass index (BMI), blood pressure, glucose and lipids were assessed. RESULTS SWL occurred in 6.8% of cases. Women with SWL had similar preterm birth rates compared with women without these complaints (adjusted OR 1.1, 95%CI 0.7, 1.7). Birthweight (adjusted difference - 31 g, 95%CI -76, 15) and BMI at 5-6 years of age (adjusted difference 0.2 kg/m(2) , 95%CI 0.0, 0.5) were similar in children born to mothers with SWL and without SWL, but blood pressure was increased. For diastolic blood pressure this association was independent of confounders (adjusted difference 1.4 mmHg, 95%CI 0.4, 2.4). Lipid and glucose levels were not significantly different between these groups. CONCLUSION Early pregnancy weight loss, usually occurring as a manifestation of hyperemesis gravidarum, could have long-term consequences for offspring health.
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Affiliation(s)
- I J Grooten
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, the Netherlands
| | - R C Painter
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands
| | - M Pontesilli
- Department of Obstetrics and Gynaecology, Medical Centre Alkmaar, Alkmaar, the Netherlands
| | - J A M van der Post
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands
| | - B W J Mol
- School of Paediatrics and Reproductive Health, The Robinson Institute, Adelaide, SA, Australia
| | - M van Eijsden
- Department of Epidemiology and Health Promotion, Public Health Service of Amsterdam, the Netherlands
| | - T G M Vrijkotte
- Department of Public Health, Academic Medical Centre, Amsterdam, the Netherlands
| | - T J Roseboom
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, Amsterdam, the Netherlands
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Abstract
Hyperemesis gravidarum is a complex condition with a multifactorial etiology characterized by severe intractable nausea and vomiting. Despite a high prevalence, studies exploring underlying etiology and treatments are limited. We performed a literature review, focusing on articles published over the last 10 years, to examine current perspectives and recent developments in hyperemesis gravidarum.
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Affiliation(s)
- Fergus P McCarthy
- The Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | - Jennifer E Lutomski
- National Perinatal Epidemiology Centre, Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Richard A Greene
- National Perinatal Epidemiology Centre, Cork University Maternity Hospital, Wilton, Cork, Ireland
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Vlachodimitropoulou Koumoutsea E, Vlachodimitropoulou-Koumoutsea E, Gosh S, Manmatharajah B, Ray A, Igwe-Omoke N, Yoong W. Pregnancy outcomes in severe hyperemesis gravidarum in a multi-ethnic population. J OBSTET GYNAECOL 2014; 33:455-8. [PMID: 23815195 DOI: 10.3109/01443615.2013.767788] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We evaluated pregnancy outcomes among women with hyperemesis gravidarum (HG) in a North London multi-ethnic population. A retrospective case-control study was performed on records of obstetric admissions during a 4-year period, at North Middlesex University Hospital in North London. A total of 208 women with HG were identified according to Fairweather's criteria occurring in the first 20 weeks of pregnancy, which is severe enough to require admission to hospital. The control study group consisted of 208 women without HG, matched for age, ethnicity and parity. Maternal characteristics as well as pregnancy outcomes were compared in the two groups. The incidence of a delivery of a small-for-gestational-age (SGA) neonate below the 10th per centile was significantly higher in the HG group compared with unaffected pregnancies (8.7% vs 16.8%, p = 0.01). Hyperemesis gravidarum in a multi-ethnic population in North London is associated with SGA neonates.
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Cakmak B, Inanir A, Nacar MC. Postural balance in pregnancies complicated by hyperemesis gravidarum. J Matern Fetal Neonatal Med 2014; 28:819-22. [DOI: 10.3109/14767058.2014.934220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Peled Y, Melamed N, Hiersch L, Pardo J, Wiznitzer A, Yogev Y. The impact of total parenteral nutrition support on pregnancy outcome in women with hyperemesis gravidarum. J Matern Fetal Neonatal Med 2013; 27:1146-50. [PMID: 24093458 DOI: 10.3109/14767058.2013.851187] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess pregnancy outcome among women with hyperemesis gravidarum (HEG) with and without total parenteral nutrition (TPN) support. STUDY DESIGN A retrospective study of all pregnant women with singleton pregnancies who were hospitalized due to HEG between 1997 and 2011. Pregnancy outcome was compared with a control group without HEG matched by maternal age and parity in a 3:1 ratio. RESULTS Overall 599 women were admitted during the study period with the diagnosis of HEG and subsequently delivered in our center. Of those, 122 (20.4%) received TPN support. Women in the HEG group were characterized by a higher rate of severe preeclampsia (1.3% versus 0.5%, p = 0.04), and a higher rate of preterm delivery at less than 37 and 34 weeks (10.9% versus 6.9%, p < 0.001 and 4.7% versus 1.6%, p < 0.001, respectively). Neonates in the HEG group were characterized by a lower birth weight (3074 ± 456 g versus 3248 ± 543 g, p < 0.001), higher rate of birth weight < 10th percentile (12.7% versus 6.8%, p < 0.001), and a higher rate of neonatal morbidity (8.7% versus 3.8%, p < 0.001). These associations persisted after adjustment for potential confounders, and were of most notable among women with HEG who did not receive TPN support. CONCLUSION HEG is an independent risk factor for adverse pregnancy outcome. TPN support during early pregnancy is associated with a decreased risk for perinatal morbidity.
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Affiliation(s)
- Yoav Peled
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center , Petach Tikva , Israel and
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Fejzo MS, Ching C, Schoenberg FP, Macgibbon K, Romero R, Goodwin TM, Mullin PM. Change in paternity and recurrence of hyperemesis gravidarum. J Matern Fetal Neonatal Med 2012; 25:1241-5. [PMID: 22010839 PMCID: PMC3527097 DOI: 10.3109/14767058.2011.632039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine whether change in paternity changes recurrence risk of hyperemesis gravidarum (HG). STUDY DESIGN Survey data on recurrence of HG was compared between cases who had a paternity change between pregnancies and cases who did not. RESULTS The percentage of HG pregnancies in women with the same partner for all pregnancies was not significantly different from the percentage of HG pregnancies in women who changed partners for at least one pregnancy (78% vs 71%, p > 0.05). Participants who did and did not change partners between their first and second pregnancies, were asked to rate their first and second pregnancy in regards to symptoms of HG. Neither the ratings nor the change in rating between pregnancies was significantly different between the two groups. CONCLUSION Women reported HG in over 70% of their pregnancies regardless of a paternity change. Paternal genes expressed through the fetus do not have a significant effect on incidence or recurrence of HG. This study supports a strong maternal genetic factor involved in HG. However, because the recurrence risk is not 100%, other factors play a role. Identification of the predisposing gene(s) and other factors will determine the cause of this poorly understood complication of pregnancy.
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Affiliation(s)
- Marlena S Fejzo
- Department of Maternal-Fetal Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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