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Hazan G, Sheiner E, Golan-Tripto I, Goldbart A, Sergienko R, Wainstock T. The impact of maternal hyperemesis gravidarum on early childhood respiratory morbidity. Pediatr Pulmonol 2024; 59:707-714. [PMID: 38131521 DOI: 10.1002/ppul.26817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/27/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Lung maldevelopment due to in-utero events may potentially cause respiratory morbidity during childhood. Maternal nutritional status during pregnancy is critical for lung development. This study is contributing to the understanding of the interplay between maternal nutrition status during pregnancy, fetal lung development and the risk for respiratory diseases in early life. RESEARCH QUESTION To investigate the association between maternal hyperemesis gravidarum (HG) during pregnancy and respiratory morbidity in the offspring's early childhood. STUDY DESIGN AND METHODS This is a retrospective population-based cohort study that included all singleton term deliveries at Soroka University Medical Center (SUMC) between 1991 and 2021. Preterm deliveries (<37 gestational week), perinatal deaths, multiple gestations, and children with congenital malformations or chromosomal abnormalities were excluded. The main outcomes measured were offspring's hospitalizations due to pneumonia, acute bronchiolitis, asthma, or wheezing. RESULTS Overall 232,476 deliveries were included in the study, of which 3227 women (1.4%) were diagnosed with HG. Offspring in the HG group exhibited significantly higher rates of respiratory morbidity, including asthma (OR = 1.36, 95% CI 1.22-1.36, p < .001), acute bronchiolitis (OR = 1.38, 95% CI 1.21-1.59, p < .001), and pneumonia (OR = 1.2, 95% CI 1.12-1.48, p < .001). An inverse correlation between multivariate adjusted-hazard ratios for asthma and pneumonia with offspring's age was noted. INTERPRETATION This study provides evidence of a potential association between maternal HG during pregnancy and increased risk of respiratory morbidity in offspring's early childhood. Maternal nutritional status during pregnancy plays a crucial role in lung development, affecting respiratory health in childhood.
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Affiliation(s)
- Guy Hazan
- Pediatric Pulmonary Unit, Saban Pediatric Medical Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Inbal Golan-Tripto
- Pediatric Pulmonary Unit, Saban Pediatric Medical Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel
| | - Aviv Goldbart
- Pediatric Pulmonary Unit, Saban Pediatric Medical Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel
| | - Ruslan Sergienko
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Fan J, Yin M. Offspring of women with hyperemesis gravidarum are more likely to have cardiovascular abnormalities. BMC Pregnancy Childbirth 2024; 24:119. [PMID: 38331740 PMCID: PMC10854153 DOI: 10.1186/s12884-024-06293-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/26/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Hyperemesis gravidarum (HG) is a severe form of pregnancy-related nausea and vomiting affecting 0.3-2.3% of pregnancies, which can lead to fluid, electrolyte, and acid-base imbalances, nutritional deficiencies, and weight loss, and is usually severe enough to require hospitalization. Abnormally elevated urinary ketones are commonly seen in patients with HG, and ketone bodies are free to pass through the placenta, and maternal hyperketonemia, with or without acidosis, is associated with an increased rate of stillbirth, an increased incidence of congenital anomalies, and impaired neurophysiologic development of the infant. This study investigates the obstetric outcomes of patients with HG and whether HG increases the incidence of cardiovascular disease in the offspring. METHODS This study included 1020 pregnant women who were hospitalized in our hospital for HG and ultimately delivered in our hospital as well as pregnant women without HG in early gestation and delivered in our hospital from January 2019-January 2020, and we collected and followed up the clinical information of the pregnant women and their offspring. RESULTS Pregnant women with HG were more likely to have severe urinary ketones, the rate of early miscarriage and mid-term miscarriage was significantly higher in women with HG compared to pregnant women without HG. Fetal and neonatal head and abdominal circumferences were smaller in HG group than in control group. Neonatal birth weight and length were also lower in the HG group and cardiovascular anomalies were more likely to occur in the offspring of women with HG when all births were followed up for 3 years. CONCLUSIONS HG may cause poor obstetric outcomes and was associated with the development of cardiovascular disease in the offspring of women with HG.
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Affiliation(s)
- Jiao Fan
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Minghong Yin
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
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Bentahar A, Boubga T, Bellamlih H, Chafi K, Salek M, Belabbes S, Zinoun B, Africha T. [Hyperemesis gravidarum leading to Gayet-Wernicke encephalopathy]. Rev Prat 2024; 74:174-175. [PMID: 38415422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Amine Bentahar
- Service de radiologie, hôpital militaire Moulay-Ismail, Meknès, université Sidi Mohamed Ben Abdellah, Fès, Maroc
| | - Taoufik Boubga
- Service de neurologie, hôpital militaire Moulay-Ismail, Meknès, université Sidi Mohamed Ben Abdellah, Fès, Maroc
| | - Habib Bellamlih
- Service de radiologie, hôpital militaire Moulay-Ismail, Meknès, université Sidi Mohamed Ben Abdellah, Fès, Maroc
| | - Khalil Chafi
- Service de radiologie, hôpital militaire Moulay-Ismail, Meknès, université Sidi Mohamed Ben Abdellah, Fès, Maroc
| | - Monsif Salek
- Service de radiologie, hôpital militaire Moulay-Ismail, Meknès, université Sidi Mohamed Ben Abdellah, Fès, Maroc
| | - Soufiane Belabbes
- Service de radiologie, hôpital militaire Moulay-Ismail, Meknès, université Sidi Mohamed Ben Abdellah, Fès, Maroc
| | - Brahim Zinoun
- Service de radiologie, hôpital militaire Moulay-Ismail, Meknès, université Sidi Mohamed Ben Abdellah, Fès, Maroc
| | - Taoufik Africha
- Service de radiologie, hôpital militaire Moulay-Ismail, Meknès, université Sidi Mohamed Ben Abdellah, Fès, Maroc
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Pereyra PDLM, Aciar MDLÁ, Fregenal MM, Ceballos GA, Ramírez Stieben LA. Primary hyperparathyroidism in pregnancy: a case report highlighting uncommon complication. Medicina (B Aires) 2024; 84:342-346. [PMID: 38683521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Abstract
Primary hyperparathyroidism (PHPT) is characterized by elevated levels of calcium and parathyroid hormone (PTH). However, the interpretation of diagnostic tests, such as serum calcium and PTH levels, is complex in pregnant women. The aim of this report is to present a case of PHTP in a pregnant adolescent, with a special emphasis on an uncommon complication, as well as diagnostic and treatment strategies. A 17-year-old pregnant female presented with hyperemesis gravidarum and neurological symptoms, leading to the diagnosis of cerebral venous thrombosis. Further investigations revealed hypercalcemia and persistently elevated PTH levels, consistent with PHPT. After localization studies, the patient underwent an emergency parathyroidectomy with a diagnosis of parathyroid adenoma. During follow-up, intrauterine growth restriction and severe preeclampsia developed, necessitating an emergency cesarean section. Both the mother and neonate had favorable outcomes. PHPT is an infrequent condition in the pregnant population, and its diagnosis can be challenging due to the overlap of symptoms with normal physiological changes during pregnancy. The occurrence of uncommon complications, such as thrombotic phenomena, highlights the need for a comprehensive approach to ensure early detection and management. In most cases, parathyroidectomy is the treatment of choice.
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Affiliation(s)
| | | | - María Mercedes Fregenal
- Servicio de Endocrinología y Metabolismo, Hospital Público Materno Infantil de Salta, Salta, Argentina
| | - Gustavo A Ceballos
- Servicio de Cirugía de Cabeza y Cuello, Hospital Público Materno Infantil de Salta, Salta, Argentina
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Feng Y, Huang Q, Luo M, Wei J, Gao T, Chu D, Jia A, Li Y, He S, Duan T. The association between Helicobacter pylori and gastrointestinal disorders during pregnancy: A Multicenter retrospective study. Helicobacter 2024; 29:e13032. [PMID: 38009269 DOI: 10.1111/hel.13032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/07/2023] [Accepted: 10/10/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Some gastrointestinal disorders may be associated with Helicobacter pylori infection, which not only affect maternal health, but may also lead to adverse pregnancy outcomes. We aim to explore the association between H. pylori and gastrointestinal disorders in pregnant women. MATERIALS AND METHODS In total, 503 patients were retrospectively analyzed and divided into the H. pylori-uninfected group, the H. pylori-infected group, or the H. pylori-eradicated group. We analyzed the influence of H. pylori on gastrointestinal diseases during pregnancy among the groups, as well as the severity, symptoms, laboratory tests of the H. pylori-related diseases. RESULTS Pregnant women with H. pylori infection had higher risk of nausea and vomiting of pregnancy (NVP) (p < 0.001), severe NVP(p = 0.012), hyperemesis gravidarum (p = 0.027), hematemesis (p = 0.018), hyponatremia (p = 0.033), as well as functional dyspepsia symptoms including epigastric pain (p = 0.004), bloating (p = 0.024), and feeling full quickly in a meal (p = 0.031) compared with those without H. pylori infection. While the prevalence of NVP (p = 0.024), severe NVP (p = 0.009), epigastric pain (p = 0.037), and bloating (p = 0.032) were lower in H. pylori-eradicated pregnant women than in H. pylori-infected women. In addition, pregnant women with H. pylori infection had higher risk of spontaneous preterm birth than whom without H. pylori infection (p = 0.033). CONCLUSIONS Helicobacter pylori infection was associated with higher risks of NVP, severe NVP, hyperemesis gravidarum, functional dyspepsia, and spontaneous preterm birth in pregnant women.
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Affiliation(s)
- Yun Feng
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, Shaanxi, China
- Shannxi clinical research center of digestive disease (cancer devision), Xi'an, Shaanxi, China
| | - Qing Huang
- Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Miaosha Luo
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, Shaanxi, China
- Shannxi clinical research center of digestive disease (cancer devision), Xi'an, Shaanxi, China
| | - Jia Wei
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, Shaanxi, China
- Shannxi clinical research center of digestive disease (cancer devision), Xi'an, Shaanxi, China
| | - Tiantian Gao
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, Shaanxi, China
- Shannxi clinical research center of digestive disease (cancer devision), Xi'an, Shaanxi, China
| | - Dake Chu
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, Shaanxi, China
- Shannxi clinical research center of digestive disease (cancer devision), Xi'an, Shaanxi, China
| | - Ai Jia
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, Shaanxi, China
- Shannxi clinical research center of digestive disease (cancer devision), Xi'an, Shaanxi, China
| | - Yingchao Li
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, Shaanxi, China
- Shannxi clinical research center of digestive disease (cancer devision), Xi'an, Shaanxi, China
| | - Shuixiang He
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, Shaanxi, China
- Shannxi clinical research center of digestive disease (cancer devision), Xi'an, Shaanxi, China
| | - Tianjiao Duan
- Department of Gastroenterology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
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Fejzo M, Rocha N, Cimino I, Lockhart SM, Petry CJ, Kay RG, Burling K, Barker P, George AL, Yasara N, Premawardhena A, Gong S, Cook E, Rimmington D, Rainbow K, Withers DJ, Cortessis V, Mullin PM, MacGibbon KW, Jin E, Kam A, Campbell A, Polasek O, Tzoneva G, Gribble FM, Yeo GSH, Lam BYH, Saudek V, Hughes IA, Ong KK, Perry JRB, Sutton Cole A, Baumgarten M, Welsh P, Sattar N, Smith GCS, Charnock-Jones DS, Coll AP, Meek CL, Mettananda S, Hayward C, Mancuso N, O'Rahilly S. GDF15 linked to maternal risk of nausea and vomiting during pregnancy. Nature 2024; 625:760-767. [PMID: 38092039 PMCID: PMC10808057 DOI: 10.1038/s41586-023-06921-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 11/30/2023] [Indexed: 01/19/2024]
Abstract
GDF15, a hormone acting on the brainstem, has been implicated in the nausea and vomiting of pregnancy, including its most severe form, hyperemesis gravidarum (HG), but a full mechanistic understanding is lacking1-4. Here we report that fetal production of GDF15 and maternal sensitivity to it both contribute substantially to the risk of HG. We confirmed that higher GDF15 levels in maternal blood are associated with vomiting in pregnancy and HG. Using mass spectrometry to detect a naturally labelled GDF15 variant, we demonstrate that the vast majority of GDF15 in the maternal plasma is derived from the feto-placental unit. By studying carriers of rare and common genetic variants, we found that low levels of GDF15 in the non-pregnant state increase the risk of developing HG. Conversely, women with β-thalassaemia, a condition in which GDF15 levels are chronically high5, report very low levels of nausea and vomiting of pregnancy. In mice, the acute food intake response to a bolus of GDF15 is influenced bi-directionally by prior levels of circulating GDF15 in a manner suggesting that this system is susceptible to desensitization. Our findings support a putative causal role for fetally derived GDF15 in the nausea and vomiting of human pregnancy, with maternal sensitivity, at least partly determined by prepregnancy exposure to the hormone, being a major influence on its severity. They also suggest mechanism-based approaches to the treatment and prevention of HG.
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Affiliation(s)
- M Fejzo
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - N Rocha
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - I Cimino
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - S M Lockhart
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - C J Petry
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - R G Kay
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Peptidomics and Proteomics Core Facility, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - K Burling
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Core Biochemical Assay Laboratory, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - P Barker
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Core Biochemical Assay Laboratory, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A L George
- Peptidomics and Proteomics Core Facility, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - N Yasara
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, Sri Lanka
| | - A Premawardhena
- Adolescent and Adult Thalassaemia Care Center (University Medical Unit), North Colombo Teaching Hospital, Kadawatha, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - S Gong
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
- Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - E Cook
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - D Rimmington
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - K Rainbow
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - D J Withers
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - V Cortessis
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - P M Mullin
- Department of Obstetrics and Gynaecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - K W MacGibbon
- Hyperemesis Education and Research Foundation, Clackamas, OR, USA
| | - E Jin
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - A Kam
- Department of Obstetrics and Gynaecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - A Campbell
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - O Polasek
- Faculty of Medicine, University of Split, Split, Croatia
| | - G Tzoneva
- Regeneron Genetics Center, Tarrytown, NY, USA
| | - F M Gribble
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - G S H Yeo
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - B Y H Lam
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - V Saudek
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - I A Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - K K Ong
- Department of Paediatrics, University of Cambridge, Cambridge, UK
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - J R B Perry
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - A Sutton Cole
- Department of Obstetrics and Gynaecology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M Baumgarten
- Department of Obstetrics and Gynaecology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - P Welsh
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - N Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - G C S Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
- Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - D S Charnock-Jones
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
- Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - A P Coll
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - C L Meek
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - S Mettananda
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, Sri Lanka
- University Paediatrics Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - C Hayward
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - N Mancuso
- Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Quantitative and Computational Biology, University of Southern California, California, CA, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, California, CA, USA
| | - S O'Rahilly
- Medical Research Council (MRC) Metabolic Diseases Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK.
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Orimoloye HT, Deng C, Hansen J, Olsen J, Saechao C, Ritz B, Heck JE. Hyperemesis gravidarum and the risk of childhood cancer - A case-control study in Denmark. Cancer Epidemiol 2023; 87:102472. [PMID: 37879293 PMCID: PMC10754053 DOI: 10.1016/j.canep.2023.102472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE Only a few studies have reported on the association between hyperemesis gravidarum and the risk of childhood cancer. We examined possible associations in this population-based study in Denmark. METHODS Pediatric cancer cases (n = 6420) were ascertained from the Denmark Cancer Registry among children born between 1977 and 2013. Twenty-five controls were matched to each case by sex and birth date from the Central Person Registry (n = 160500). Mothers with hyperemesis gravidarum were ascertained from the National Patient Register. The risk of childhood cancer was estimated using conditional logistic regression. In a separate analysis, we examined pregnancy prescription of antinauseant medications, ascertained from the National Pharmaceutical Register, to determine associations with childhood cancers. RESULTS In Denmark, hyperemesis gravidarum was associated with an increased risk of childhood cancer [all types combined; Odds Ratio (OR) = 1.43, 95% confidence interval (CI) 1.12, 1.81; n = 73 exposed cases). Hyperemesis gravidarum was also associated with an increased risk of neuroblastoma (OR = 2.52, 95% CI 1.00, 6.36; n = 5 exposed cases), acute lymphoblastic leukemia (OR = 1.63, 95% CI 0.98, 2.72; n = 16 exposed cases), and non-Hodgkin's lymphoma (OR = 2.41, 95% CI 0.95, 6.08; n = 5 exposed cases). We observed no childhood cancer risk increase from antinauseant prescriptions (OR = 1.05, 95% CI 0.84, 1.30; n = 91 exposed cases). CONCLUSION Our results are suggestive of an association between hyperemesis gravidarum and the overall cancer risk in offspring, particularly for neuroblastoma. Mothers with hyperemesis gravidarum should be closely monitored and receive appropriate treatment during pregnancy.
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Affiliation(s)
- Helen T Orimoloye
- College of Health and Public Service, University of North Texas, 1155 Union Circle # 311340, Denton, TX 76203-5017, USA
| | - Chuanjie Deng
- Department of Epidemiology, Fielding School of Public Health, Box 951772, University of California, Los Angeles, Los Angeles, CA, 900951772 USA
| | - Johnni Hansen
- Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark
| | - Jorn Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Chai Saechao
- UCLA Health, University of California, Los Angeles, CA, USA
| | - Beate Ritz
- Department of Epidemiology, Fielding School of Public Health, Box 951772, University of California, Los Angeles, Los Angeles, CA, 900951772 USA
| | - Julia E Heck
- College of Health and Public Service, University of North Texas, 1155 Union Circle # 311340, Denton, TX 76203-5017, USA; Department of Epidemiology, Fielding School of Public Health, Box 951772, University of California, Los Angeles, Los Angeles, CA, 900951772 USA.
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8
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Shiraishi W, Tateishi T, Hayashida S, Tajima G, Tsumura M, Isobe N. [A case of very long chain acyl-CoA dehydrogenase deficiency diagnosed due to a trigger of hyperemesis gravidarum during pregnancy]. Rinsho Shinkeigaku 2023; 63:656-660. [PMID: 37779023 DOI: 10.5692/clinicalneurol.cn-001854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
A 25-year-old Japanese woman with a history of repeated episodes of rhabdomyolysis since the age of 12 presented with rhabdomyolysis caused by hyperemesis gravidarum. Blood tests showed an elevated serum CK level (11,755 IU/l; normal: 30-180 IU/l). Carnitine fractionation analysis revealed low levels of total carnitine (18.3 μmol/l; normal: 45-91 μmol/l), free carnitine (13.1 μmol/l; normal: 36-74 μmol/l), and acylcarnitine (5.2 μmol/l; normal: 6-23 μmol/l). Tandem mass spectrometry showed high levels of C14:1 acylcarnitine (0.84 nmol/ml: normal: <0.4 nmol/ml) and a high C14:1/C2 ratio of 0.253 (normal: <0.013), indicating a potential diagnosis of very long-chain acyl-CoA dehydrogenase (VLCAD) deficiency. Enzyme activity measurement in the patient's peripheral blood lymphocytes confirmed the diagnosis of VLCAD deficiency, with low palmitoyl-CoA dehydrogenase levels (6.5% of normal control value). With the patient's informed consent, acyl-CoA dehydrogenase very long-chain (ACADVL) gene analysis revealed compound heterozygous mutations of c.1332G>A in exon 13 and c.1349G>A (p.R450H) in exon 14. In Japan, neonatal mass screening is performed to detect congenital metabolic diseases. With the introduction of tandem mass screening in 2014, fatty acid metabolism disorders, including VLCAD deficiency, are being detected before the onset of symptoms. However, it is important to note that mass screening cannot detect all cases of this disease. For patients with recurrent rhabdomyolysis, it is essential to consider congenital diseases, including fatty acid metabolism disorders, as a potential diagnosis.
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Affiliation(s)
- Wataru Shiraishi
- Department of Neurology, Kokura Memorial Hospital
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
| | - Takahisa Tateishi
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine
| | - Shotaro Hayashida
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
| | - Go Tajima
- Division of Neonatal Screening, Research Institute, National Center for Child Health and Development
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences
| | - Miyuki Tsumura
- Division of Neonatal Screening, Research Institute, National Center for Child Health and Development
| | - Noriko Isobe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
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González MF, Facchini R, McGinley J, Bronshteyn D, Stimmel M, Weiss EF. A - 89 Cognitive Evaluation of Suspected Wernicke- Korsakoff's Encephalopathy in a Woman with Complicated Hyperemesis Gravidarum. Arch Clin Neuropsychol 2023; 38:1254. [PMID: 37807224 DOI: 10.1093/arclin/acad067.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE Wernicke-Korsakoff syndrome (WKS) is a neurological disorder caused by the lack of thiamine (vitamin B1) and includes Wernicke encephalopathy and the later stage of Korsakoff amnesic syndrome. WKS could be secondary to malnutrition, including Hyperemesis Gravidarum (HEG), which is characterized by severe vomiting during pregnancy. We present a case of HEG resulting in suspected WKS where neuropsychological evaluation clarified cognitive status with complex cultural, language, and educational factors. METHOD Repeat evaluations of a 29-year-old West-African* woman with mental status change, decreased verbal output, agitation, and inability to walk in the context of HEG. Initially referred for inpatient neuropsychological evaluation at 21 weeks gestation. MRI demonstrated mild diffuse cerebral atrophy and symmetric foci of T2 FLAIR hyperintensities in periaqueductal gray matter, hypothalamus, bilateral thalami, perirolandic cortex, and bilateral mammillary bodies. RESULTS Initial inpatient testing with a face-to-face language congruent interpreter demonstrated notable multidomain impairment. Possible Intellectual Disability was considered by the referring team and test performances. Attempts at re-evaluation were limited by medical complications and prolonged hospitalization. Repeat inpatient evaluation 5 months later following birth of healthy child and initiation of stimulant medication, demonstrated profound memory impairment but otherwise improved cognitive capacity and engagement. Results aided in discharge planning including cognitive remediation with goal of improving functional independence. CONCLUSIONS Wernicke-Korsakoff syndrome due to Hyperemesis Gravidarum is an uncommon but known complication that can have profound acute and long-term consequences. This case demonstrates that repeat neuropsychological evaluations can clarify cognitive status in complex medical/cultural/language situations. *(country of origin and primary language not provided for patient privacy).
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10
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Masaadeh AH, Mathias PC, Ford BA, Bosch DE. Helicobacter pylori Exposure in Nausea and Vomiting of Pregnancy Increases Risk of Preterm Delivery. Infect Dis Obstet Gynecol 2023; 2023:6612268. [PMID: 37808245 PMCID: PMC10555503 DOI: 10.1155/2023/6612268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/10/2023] [Accepted: 09/16/2023] [Indexed: 10/10/2023] Open
Abstract
Background Hyperemesis gravidarum (HG), a severe form of nausea and vomiting in pregnancy (NVP), is a leading indication for hospitalization in the first trimester. NVP and HG are associated with Helicobacter pylori (HP) infection in non-United States cohorts. How HP exposure and NVP interact to affect metabolic disturbance and pregnancy outcomes is not known. Materials and Methods We designed a retrospective cohort study relating HP and NVP to serum electrolyte laboratory results, preterm delivery, and infant birth weight. Single academic institution discovery and independent multi-institutional validation cohorts included pregnant subjects with an HP test result. Associations of HP, NVP, and pregnancy outcomes were assessed with odds ratio calculations, Student's t-tests, and multivariate logistic regression. Results Among subjects with positive HP test results, the prevalence of hyperemesis gravidarum (HG) was 0.025 (66 of 2671) and NVP was 0.27 (710 of 2671). Subjects with negative HP had prevalence of HG 0.015 (165 of 10,960) and NVP 0.22 (2392 of 10,960). History of HP exposure increased risk of NVP, including HG (odds ratio 1.3, 95% CI 1.1-1.4). Patients with HP exposure had lower serum potassium (mean difference 0.1 mEq/L) and bicarbonate (mean difference 0.3 mEq/L) during pregnancy than HP-negative patients (p < 0.01). Serum potassium was lowest in subjects with both NVP and HP exposure (mean 3.5 mEq/L [3.4-3.6], p < 0.0001). HP exposure alone carried increased risk for preterm delivery (OR 1.3 [1.1-1.4]). NVP alone increased risk of preterm delivery (OR 2.8 [2.5-3.1]) including second trimester delivery (OR 2.2 [1.7-2.8]). In multivariate analysis, HP exposure in the setting of NVP further increased risk of preterm delivery (adjusted OR 1.4 [1.0-1.9], p = 0.03). Conclusions H. pylori exposure and diagnosis of NVP are individually associated with metabolic disturbances and adverse pregnancy outcomes such as preterm labor and delivery, and their combination further increases risk in US populations.
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Affiliation(s)
- Amr H. Masaadeh
- Department of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Patrick C. Mathias
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Bradley A. Ford
- Department of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Dustin E. Bosch
- Department of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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11
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Bouladi M, Lajmi H, Ben Othmen A, El Fekih L. Uncommon bilateral optic neuropathy in Wernicke's encephalopathy complicating gravidarum hyperemesis. Tunis Med 2023; 101:530-532. [PMID: 38372521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/15/2023] [Indexed: 02/20/2024]
Abstract
Wernicke encephalopathy (WE) is a rare neurological disorder that results from vitamin B1 (Thiamin) deficiency, classically characterized by the triad of ophtalmoplagia, altered consciousness, and ataxia. WE is often associated with alcoholism, malnutrition, or gastrointestinal diseases with malabsorption. The association of «gravidarum hyperemesis» and WE seems to be underestimated. We report a 24-year-old pregnant woman with hyperemesis gravidarum, who presented with decreased visual acuity of both eyes. Fundus examination showed a bilateral stage 2 papillary edema. brain magnetic resonance imaging (MRI) showed bilateral and symmetrical hyper intense lesions on T2-weighted and FLAIR sequences in periaqueductal gray matter, thalamus, and mammillary bodies, which confirmed WE complicated by bilateral optic neuropathy. Her symptoms resolved after thiamine treatment. This case raises of the possibility of optic neuropathy in WE, which is a diagnostic emergency requiring early treatment to prevent complications.
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Affiliation(s)
- Mejda Bouladi
- Ophthalmology Department, Mongi Slim University Hospital, La Marsa, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Houda Lajmi
- Ophtalmology Department, Security Forces Hospital, La Marsa, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Amal Ben Othmen
- Ophthalmology Department, Mongi Slim University Hospital, La Marsa, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Lamia El Fekih
- Ophthalmology Department, Mongi Slim University Hospital, La Marsa, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
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12
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Ramaiah S, Bekas S, Annaiah TK. Trichobezoar-A rare cause of hyperemesis in a pregnant woman. Eur J Obstet Gynecol Reprod Biol 2023; 283:164-166. [PMID: 36842899 DOI: 10.1016/j.ejogrb.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
Bezoars consist of ingested foreign material or organic matter which forms a mass in the gastrointestinal tract, usually in the stomach. Trichobezoars formed by swallowed hair may present with vomiting, malnutrition, weight loss or abdominal pain with signs of gastrointestinal obstruction. There are limited case reports of Trichobezoar during pregnancy. We present a case of young pregnant women who was admitted on few occasions with vomiting in early pregnancy and was treated as hyperemesis gravidarum. Failure of response to conventional management prompted further investigation, revealing trichobezoar. Our case highlights the diagnostic challenge posed by trichobezoars in young pregnant women.
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Affiliation(s)
- Sunitha Ramaiah
- Department of Obstetrics and Gynaecology, NorthWestAnglia NHS Trust, United Kingdom.
| | - Spyridon Bekas
- Department of Obstetrics and Gynaecology, NorthWestAnglia NHS Trust, United Kingdom
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13
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Mori H, Kondo E, Yoshino K. Acute Myositis in a Pregnant Woman Complicated With COVID-19 and Hyperemesis Gravidarum: A Case Report. J UOEH 2023; 45:161-165. [PMID: 37661388 DOI: 10.7888/juoeh.45.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Myalgia is the most frequently reported neuromuscular symptom in COVID-19 patients, with a frequency of around 20% in pregnant women. Acute myositis due to COVID-19 is severe and requires medical intervention. There have been some reports of acute myositis due to COVID-19, mostly in elderly men, but rarely in pregnant women. Here we report a case of a pregnant woman who was diagnosed with acute myositis following COVID-19 illness early in her pregnancy. She had been affected by morning sickness since the 6th week of gestation and was diagnosed with COVID-19 at the 12th week. Muscle pain appeared in her limbs 5 days after the diagnosis of COVID-19, with a predominance of pain in the lower limbs, and her gait gradually became unstable. We concluded that it was acute myositis complicated by COVID-19 and hypokalemia, but we could not determine whether hypokalemia or COVID-19 or both were the cause of the muscle damage in this case. Pregnant women diagnosed with COVID-19 often complain of myalgia and fatigue, and when a pregnant woman's symptoms are severe we should keep in mind that they may be suffering from muscle damage that needs medical intervention.
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Affiliation(s)
- Hiroshi Mori
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental health, Japan
| | - Emi Kondo
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental health, Japan
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental health, Japan
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14
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Zhao H, Wu L, Yang B, Shang H. Midgut malrotation presenting with hyperemesis gravidarum: A case report. Medicine (Baltimore) 2022; 101:e29670. [PMID: 35905251 PMCID: PMC9333550 DOI: 10.1097/md.0000000000029670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Midgut malrotation is a rare congenital abnormality resulting from failure of complete intestinal rotation and subsequent fixation during early fetal development. There appeared to be no obvious symptoms in most patients, and a few patients may exhibit symptoms similar to hyperemesis gravidarum, such as nausea and vomiting. Here, we present a case of midgut malrotation presenting as hyperemesis gravidarum. PATIENT CONCERNS A 27-year-old woman with an intrauterine pregnancy of 27 + 6 weeks complained of severe nausea and vomiting for 2 weeks. DIAGNOSIS Magnetic resonance imaging showed obvious dilatation in the proximal part of the duodenum and gastric cavity and the absence of a duodenal path dorsal to the superior mesenteric artery, which was diagnosed as midgut malrotation. INTERVENTIONS Considering that the patient's vital signs were stable, without manifestation of peritonitis or the risks of surgery to the fetus, conservative treatment was adopted. Unfortunately, the fetus developed severe hydrocephalus at 32 weeks. The patient and her family decided to abandon the fetus, and a mid-trimester-induced abortion was performed. OUTCOMES The related symptoms completely disappeared after delivery, and the relevant examination after discharge also confirmed the presence of midgut malrotation without gastrointestinal discomfort within 1 year after delivery. LESSONS Midgut malrotation can be considered as a differential diagnosis of hyperemesis gravidarum. Conservative treatment under close monitoring is desirable in pregnant women diagnosed with midgut malrotation.
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Affiliation(s)
- Hongjiang Zhao
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Gynecology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Linzhen Wu
- Department of Obstetrics, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bin Yang
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongkai Shang
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Gynecology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Hongkai Shang, Department of Gynecology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China. (e-mail: )
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15
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Zanzal Ra'ad Al-Dorri A, Ibraheem Salih N, Saleh Khuder H. Serological Detection of Helicobacter pylori Infection in Pregnant Women Related to ABO Blood Group. Arch Razi Inst 2022; 77:591-597. [PMID: 36284970 PMCID: PMC9548265 DOI: 10.22092/ari.2022.357092.1970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/16/2022] [Indexed: 06/15/2023]
Abstract
Helicobacter pylori was known as a pathogen related to peptic ulcers and gastric carcinoma. Some researches confirmed that the infected pregnant women with H. pylori have poor pregnancy outcomes so that its effects extended to other systems other than gastrointestinal tracts. This study aimed to evaluate H. pylori infection in pregnant women who had morning sickness (nausea and vomiting) related to the ABO blood group. In total, 202 pregnant women within the age range of 15-45 years with severe nausea and vomiting attended the outpatient and specialized clinic. The seroprevalence of H. pylori was 62% in pregnant women, especially at the age group of 20-24 years with 32.5% of the cases who had epigastric pain, nausea, vomiting, flatulence, and burning of the stomach, the majority of which related to O+ (33.3%), followed by A+ and B+ (25.39%) blood groups. Most infected pregnant women with H. pylori were during the first (41.26%) and second trimesters (34.12%), especially in multigravida (68.25%) cases. This study found that hyperemesis (severe nausea and vomiting), dyspepsia, and other gastrointestinal symptoms during pregnancy were related to the infection with H. pylori; therefore, it is a risk factor for complications in pregnancy and its poor outcomes, especially in developing countries, such as Iraq. These results can be minimized by improving the socioeconomic and sanitation conditions. H. pylori infection in pregnancy is considered a health problem and should be treated before and during pregnancy. Further investigations are required in this regard and researchers are recommended to conduct studies on the RBC antigens to recognize the pathophysiology related to H. pylori infection.
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Affiliation(s)
| | - N Ibraheem Salih
- College of Medicine (TUCOM), 3. Pharmacy College, Tikrit University, Sallahaddin, Iraq
| | - H Saleh Khuder
- College of Medicine (TUCOM), 3. Pharmacy College, Tikrit University, Sallahaddin, Iraq
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16
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Piñel Pérez CS, Gómez-Roso Jareño MJ, García García AB, López Galián JJ. Severe hyperemesis gravidarum caused by Helicobacter pylori. Enferm Infecc Microbiol Clin (Engl Ed) 2022; 40:91-92. [PMID: 34887224 DOI: 10.1016/j.eimce.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/28/2020] [Indexed: 06/13/2023]
Affiliation(s)
- Carlos Santiago Piñel Pérez
- Servicio de Obstetricia y Ginecología, Hospital Quirónsalud San José, Madrid, Spain; Universidad Europea, Madrid, Spain.
| | - María José Gómez-Roso Jareño
- Servicio de Obstetricia y Ginecología, Hospital Quirónsalud San José, Madrid, Spain; Universidad Europea, Madrid, Spain
| | - Ana Belén García García
- Servicio de Microbiología Clínica, Hospital Quirónsalud San José/Rúber Juan Bravo, Madrid, Spain
| | - Juan José López Galián
- Servicio de Obstetricia y Ginecología, Hospital Quirónsalud San José, Madrid, Spain; Universidad Europea, Madrid, Spain
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17
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Obisesan A, Townsend EL, Wong JLH, Menon V. Unusual case of hyperemesis in a pregnant patient with prior antireflux surgery. BMJ Case Rep 2021; 14:e241935. [PMID: 34404647 PMCID: PMC8372790 DOI: 10.1136/bcr-2021-241935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/03/2022] Open
Abstract
A 33-year-old, 8 weeks pregnant, presented with severe upper abdominal pain with vomiting on a background of a previous laparoscopic Nissen fundoplication for reflux disease. An urgent MRI had shown herniation of the fundoplication wrap through the diaphragmatic hiatus. The cause of her symptoms was attributed to hyperemesis gravidarum. The plan was to manage this patient conservatively until the conclusion of her pregnancy. This plan was revised when she presented for the second time and developed worsening pain and haematemesis. An emergency gastroscopy showed ischaemic changes in most of the stomach requiring the patient to undergo an emergency laparotomy. In pregnant patients, presenting with abdominal pain, vomiting as well as haematemesis, having had previous antireflux surgery, incarceration of the stomach must be considered as a differential. Prompt assessment and early senior decision-making is extremely important in avoiding a potentially catastrophic outcome for such patients.
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Affiliation(s)
- Abimbola Obisesan
- General Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Eleanor Lucy Townsend
- General Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - John Lin Hieng Wong
- Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Vinod Menon
- General Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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18
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Affiliation(s)
- Afra Jiwa
- King's College Medical School, London, UK
| | - Adam D Jakes
- Guy's and St Thomas' Hospital NHS Trust, St Thomas' Hospital, London, UK
| | - Anita Banerjee
- Guy's and St Thomas' Hospital NHS Trust, St Thomas' Hospital, London, UK
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19
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Jdidia NB, Halima SB, Hakim H, Kebaili S, Koubaa I, Chelly H, Chaabane K. Reversible Wernicke encephalopathy caused by hyperemesis gravidarum in the second trimester of pregnancy: a case report. Pan Afr Med J 2021; 40:240. [PMID: 35178151 PMCID: PMC8817192 DOI: 10.11604/pamj.2021.40.240.30245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 12/14/2021] [Indexed: 11/18/2022] Open
Abstract
Wernicke encephalopathy is a potentially life-threatening neurologic syndrome caused by acute thiamine (vitamin B1) deficiency. It is usually associated with excessive alcohol consumption. Less frequently, this syndrome can be caused by persistent vomiting. This is a case report of a 33-year-old woman diagnosed with Wernicke encephalopathy (WE) during the second trimester of pregnancy. The presence of neurological and ophthalmological symptoms in the context of hyperemesis gravidarum led us to evoke the diagnosis of WE, and it was confirmed when specific lesions were found in the brain magnetic resonance imaging (MRI). Luckily for our patient, WE was diagnosed promptly and the signs were reversible after thiamine supplementation. In conclusion, any first line care taker or midwife must know the symptoms of Wernicke encephalopathy because prompt diagnosis and treatment can lead to recovery
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Affiliation(s)
- Nadia Ben Jdidia
- Department of Gynecology and Obstetrics, University of Medicine of Sfax, Hedi Chaker Hospital, 3029, Sfax, Tunisia
- Corresponding author: Nadia Ben Jdidia, Department of Gynecology and Obstetrics, University of Medicine of Sfax, Hedi Chaker Hospital, 3029, Sfax, Tunisia.
| | - Sawssan Ben Halima
- Department of Gynecology and Obstetrics, University of Medicine of Sfax, Hedi Chaker Hospital, 3029, Sfax, Tunisia
| | - Hana Hakim
- Department of Gynecology and Obstetrics, University of Medicine of Sfax, Hedi Chaker Hospital, 3029, Sfax, Tunisia
| | - Sahbi Kebaili
- Department of Gynecology and Obstetrics, University of Medicine of Sfax, Hedi Chaker Hospital, 3029, Sfax, Tunisia
| | - Ines Koubaa
- Department of Radiology, University of Medicine of Sfax, Hedi Chaker Hospital, 3029, Sfax, Tunisia
| | - Hedi Chelly
- Department of Intensive Care, University of Medicine of Sfax, Habib Bourguiba Hospital, 3029, Sfax, Tunisia
| | - Kais Chaabane
- Department of Gynecology and Obstetrics, University of Medicine of Sfax, Hedi Chaker Hospital, 3029, Sfax, Tunisia
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20
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Muraoka M, Takagi K, Ueno M, Morita Y, Nagano H. Fetal Head Growth during Early to Mid-Gestation Associated with Weight Gain in Mothers with Hyperemesis Gravidarum: A Retrospective Cohort Study. Nutrients 2020; 12:nu12061664. [PMID: 32503221 PMCID: PMC7353048 DOI: 10.3390/nu12061664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 11/22/2022] Open
Abstract
The epigenetic impact of malnutrition in mothers with hyperemesis gravidarum (HG) on their offspring has not been fully elucidated. Recently, several reports have demonstrated that children born to mothers with HG were small for gestational age and had low birth weight, reduced insulin sensitivity, and neurodevelopmental delays during childhood. Therefore, we examined the relationship between fetal growth and changes in the maternal body weight in HG cases. A total of 34 patients with HG were hospitalized and delivered at term between 2009 and 2012. The records of 69 cases of pregnant women without a history of HG were extracted after matching their maternal age, parity, pregestational body mass index (BMI), gestational age, and fetal sex ratio with those of the HG group for comparison. The maternal weight gain at term was less in the HG than in the control group. There was no statistical difference in birth weight, placental weight, and ultrasonic fetometric parameters expressed in standard deviation (SD) scores, including biparietal diameter, abdominal circumference, and femur length, between the HG and the control group. Whereas fetal head growth in the HG group was positively associated with maternal weight gain at 20 weeks of gestation only, this association was not observed in the control group. We herein demonstrate that maternal weight gain from the nadir is associated with fetal head growth at mid-gestation. Thus, maternal undernutrition in the first trimester of pregnancy could affect fetal brain growth and development, leading to an increased risk of neurodevelopmental delays in later life.
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Affiliation(s)
- Mitsue Muraoka
- Department of Obstetrics and Gynecology, Shiseikai-daini Hospital, Tokyo 157-8550, Japan;
| | - Koichiro Takagi
- Department of Obstetrics and Gynecology, Tokyo Women’s Medical University, Medical Center East, Tokyo 116-8567, Japan; (M.U.); (Y.M.); (H.N.)
- Correspondence:
| | - Mariko Ueno
- Department of Obstetrics and Gynecology, Tokyo Women’s Medical University, Medical Center East, Tokyo 116-8567, Japan; (M.U.); (Y.M.); (H.N.)
| | - Yoshihiro Morita
- Department of Obstetrics and Gynecology, Tokyo Women’s Medical University, Medical Center East, Tokyo 116-8567, Japan; (M.U.); (Y.M.); (H.N.)
| | - Hiroaki Nagano
- Department of Obstetrics and Gynecology, Tokyo Women’s Medical University, Medical Center East, Tokyo 116-8567, Japan; (M.U.); (Y.M.); (H.N.)
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21
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Fossum S, Næss Ø, Halvorsen S, Tell GS, Vikanes ÅV. Long-term cardiovascular morbidity following hyperemesis gravidarum: A Norwegian nationwide cohort study. PLoS One 2019; 14:e0218051. [PMID: 31188868 PMCID: PMC6561562 DOI: 10.1371/journal.pone.0218051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/24/2019] [Indexed: 12/27/2022] Open
Abstract
Objective To investigate whether exposure to hyperemesis gravidarum (hyperemesis) is associated with subsequent maternal cardiovascular morbidity. Design Nationwide cohort study. Setting Medical Birth Registry of Norway (1967–2002) linked to the nationwide Cardiovascular Disease in Norway project 1994–2009 (CVDNOR) and the Cause of Death Registry. Population Women in Norway with singleton births from 1967 to 2002, with and without hyperemesis, were followed up with respect to cardiovascular outcomes from 1994 to 2009. Methods Cox proportional hazards regression model was applied to estimate hazard ratios (HRs) with 95% confidence interval (CI). Main outcome measures The first hospitalisation due to nonfatal stroke, myocardial infarction or angina pectoris, or cardiovascular death. Results Among 989 473 women with singleton births, 13 212 (1.3%) suffered from hyperemesis. During follow-up, a total of 43 482 (4.4%) women experienced a cardiovascular event. No association was found between hyperemesis and the risk of a fatal or nonfatal cardiovascular event (adjusted HR 1.08; 95% CI 0.99–1.18). Women with hyperemesis had higher risk of hospitalisation due to angina pectoris (adjusted HR 1.28; 95% CI 1.15–1.44). The risk of cardiovascular death was lower among hyperemetic women in age-adjusted analysis (HR 0.73; 95% CI 0.59–0.91), but the association was no longer significant when adjusting for possible confounders. Conclusion Women with a history of hyperemesis did not have increased risk of a cardiovascular event (nonfatal myocardial infarction or stroke, angina pectoris or cardiovascular death) compared to women without.
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Affiliation(s)
- Stine Fossum
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
- * E-mail:
| | - Øyvind Næss
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Division for Mental and Physical Health, National Institute of Public Health, Oslo, Norway
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Grethe S. Tell
- Division for Mental and Physical Health, National Institute of Public Health, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Åse V. Vikanes
- The Intervention Center, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
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Agmon N, Sade S, Pariente G, Rotem R, Weintraub AY. Hyperemesis gravidarum and adverse pregnancy outcomes. Arch Gynecol Obstet 2019; 300:347-353. [PMID: 31098820 DOI: 10.1007/s00404-019-05192-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 05/07/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE To assess adverse pregnancy outcomes in patients complicated with mild or severe Hyperemesis Gravidarum (HG). METHODS A retrospective cohort study of women aged 18-45 with a singleton pregnancy that were admitted to the gynecological ward at the Soroka University Medical Center due to HG between the years 2013-2016 and gave birth at the same hospital was conducted. During the study period 89 patients met the inclusion criteria and comprised the study group. Women without HG who gave birth at the same time period comprised the comparison group (n = 91). Univariate analysis was carried out using Chi square or Fisher's exact test for nominal variables, and T test for numeric variables. Significance was defined as a P value < 0.05. RESULTS Women with HG were more likely to have experienced HG in a previous pregnancy. Rate of amniotic fluid abnormalities was significantly lower in the study group. However, rates of all other pregnancy complications were comparable between the groups. A sub-analysis of the HG group comparing mild and severe cases demonstrated no significant differences in rates of adverse pregnancy outcomes between the groups. CONCLUSIONS In this retrospective cohort study no association was demonstrated between HG and adverse pregnancy outcomes regardless of HG severity. Women with severe nausea and vomiting during pregnancy can be reassured that HG is not associated with unfavorable maternal and neonatal outcomes.
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Affiliation(s)
- Niv Agmon
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shanny Sade
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gali Pariente
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem Affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel.
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Kondo T, Nakamura M, Kawashima J, Matsumura T, Ohba T, Yamaguchi M, Katabuchi H, Araki E. Hyperemesis gravidarum followed by refeeding syndrome causes electrolyte abnormalities induced rhabdomyolysis and diabetes insipidus. Endocr J 2019; 66:253-258. [PMID: 30700639 DOI: 10.1507/endocrj.ej18-0496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although hyperemesis gravidarum (HG), an extreme form of morning sickness, is a common complication during pregnancy, HG associated simultaneous onset of rhabdomyolysis and diabetes insipidus due to electrolyte abnormalities are rare. A 34-year-old woman with severe HG at 17 weeks of gestation complicated with appetite loss, weight reduction by 17 kg, general fatigue, myalgia, weakness and polyuria was identified to have simultaneous hypophosphatemia (1.6 mg/dL) and hypokalemia (2.0 mEq/L). Appetite recovery and the improvement of the hypophosphatemia (3.2 mg/dL) were observed prior to the first visit to our department. At the admission, she presented polyuria around 7,000~8,000 mL/day with impaired concentrating activity (U-Osm 185 mOsm/L), and abnormal creatine kinase elevation (4,505 U/L). The electrolyte disturbances and physio-metabolic abnormalities in undernourished state due to HG let us diagnose this case as refeeding syndrome (RFS). In this case, abnormal loss by vomiting, insufficient intake and previous inappropriate fluid infusion as well as the development of RFS may accelerate the severity of hypokalemia due to HG. Thus, as her abnormalities were considered as results of rhabdomyolysis and diabetes insipidus due to severe HG associated hypokalemia based on RFS, oral supplementation of potassium chloride was initiated. After 6 days of potassium supplementation, her symptoms and biochemical abnormalities were completely resolved. Severe HG followed by RFS can be causes of electrolyte abnormalities and subsequent complications, including rhabdomyolysis and renal diabetes insipidus. Appropriate diagnosis and prompt interventions including adequate nutrition are necessary to prevent electrolyte imbalance induced cardiac, neuromuscular and/or renal complications.
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Affiliation(s)
- Tatsuya Kondo
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Miwa Nakamura
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Junji Kawashima
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Takeshi Matsumura
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Takashi Ohba
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Munekage Yamaguchi
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Hidetaka Katabuchi
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Eiichi Araki
- Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan
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Havnen GC, Truong MBT, Do MLH, Heitmann K, Holst L, Nordeng H. Women's perspectives on the management and consequences of hyperemesis gravidarum - a descriptive interview study. Scand J Prim Health Care 2019; 37:30-40. [PMID: 30822254 PMCID: PMC6454401 DOI: 10.1080/02813432.2019.1569424] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Hyperemesis gravidarum (HG) affects 0.3-3% of pregnant women and is a leading cause of hospitalization in early pregnancy. The aim of the study was to investigate women's treatment and management of HG, as well as the consequences of HG on women's daily life. DESIGN AND SETTING A cross-sectional study based on a structured telephone interview and an online questionnaire. Participants were recruited by social media and by the Norwegian patient's organization for HG. SUBJECTS Norwegian women that experienced HG. MAIN OUTCOME MEASURE Women's perspectives on management and consequences of HG. RESULTS The study included 107 women. Maternal morbidity was profound; about 3/4 of participants were hospitalized due to HG, and the majority showed clinical signs of dehydration (79%), ketonuria (75%), and >5% weight loss (84%). Antiemetics were used by >90% and frequently prescribed "as needed". Metoclopramide (71%) and meclozine (51%) were most commonly used. Participants described HG as having severe psychosocial consequences and profound impact on daily activities. Almost two out of five reported thoughts of elective abortion, and 8 women had at least one elective pregnancy termination due to HG. Overall, 20 women (19%) changed GPs due to dissatisfaction with HG management. CONCLUSION Despite the high psychosocial burden and major impact on daily activities, many women with HG reported a lack of support from healthcare professionals and suboptimal management. Greater awareness and knowledge among healthcare professionals is needed to improve care for women with HG. Key Points There is a paucity of studies on management and the consequences of HG on women's daily lives and psychosocial burden. We found that: • Many women described HG as one of their worst life experiences with profound morbidity. • Many women reported suboptimal management of HG and lack of support from healthcare professionals. • Greater understanding of patient perspectives among healthcare professionals is important to improve care and management for HG patients.
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Affiliation(s)
- Gro C. Havnen
- Regional Medicines Information and Pharmacovigilance Centre (RELIS), Oslo University Hospital, Oslo, Norway;
- CONTACT Gro C. Havnen Regional Medicines Information and Pharmacovigilance Centre (RELIS), Oslo University Hospital HF Rikshopitalet, Pb 4950 Nydalen, 0424Oslo, Norway
| | - Maria Bich-Thuy Truong
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway;
| | - Mai-Linh H. Do
- Regional Medicines Information and Pharmacovigilance Centre (RELIS), Oslo University Hospital, Oslo, Norway;
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway;
| | - Kristine Heitmann
- Regional Medicines Information and Pharmacovigilance Centre (RELIS), Haukeland University Hospital, Bergen, Norway;
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;
| | - Lone Holst
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway;
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
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Bronshtein M, Gover A, Beloosesky R, Dabaja H, Ginsberg Y, Weiner Z, Khatib N. Characteristics and Outcomes of Ptyalism Gravidarum. Isr Med Assoc J 2018; 20:573-575. [PMID: 30221872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Ptyalism gravidarum (PG) is a condition of hypersalivation that affects pregnant women early in gestation. Symptoms include massive saliva volumes (up to 2 liters per day), swollen salivary glands, sleep deprivation, significant emotional distress, and social difficulties. OBJECTIVES To examine maternal and fetal characteristics and pregnancy outcomes of patients with PG. METHODS Patients diagnosed with PG in our clinic during the years 2001-2016 were identified and contacted. Demographic data were extracted from patient charts and clinical and outcome data was collected via telephone interviews. RESULTS The incidence of PG was 1/963 (0.09%) in our sample. Eleven out of 22 women (40%) with PG were also diagnosed with hyperemesis gravidarum. Fetal gender did not increase the risk. Of the mothers presenting with PG, 37% had a positive family history for this condition. There was no associated increase in the rate of fetal or maternal complications. Two women reported a resolution of the symptoms immediately following hypnosis with acupuncture treatment. CONCLUSIONS Although PG represents an unpleasant mental and physical condition, it does not pose any specific risk to the health of the mother or increase adverse perinatal outcomes for the fetus. Alternative medicine could play a role in the treatment of PG.
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Affiliation(s)
- Moshe Bronshtein
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Ayala Gover
- Neonatal Intensive Care Unit, Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Hanin Dabaja
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Yuval Ginsberg
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
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Uysal G, Cagli F, Akkaya H, Nazik H, Karakukcu C, Sutbeyaz S, Yilmaz ES. Hyperemesis gravidarum is not a negative contributing factor for postpartum bone mineral density. J Chin Med Assoc 2018; 81:619-622. [PMID: 29398518 DOI: 10.1016/j.jcma.2017.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Hyperemesis gravidarum (HG), related to protracted vomiting and nausea, is a common cause of hospitalization during the first trimester of pregnancy. It can be accompanied by ketonuria, dehydration, and weight loss. Our aim was to investigate bone loss in patients with HG. METHODS In our study, we investigated decreased bone mineral density (BMD)in a total of 79 patients (40 HG and 39 control) by means of dual energy X-ray absorptiometry (DEXA) measurements and laboratory parameters related to HG. All patients received DEXA measurement during the early postpartum period (usually two days after delivery, prior to discharge).This study was registered in the database via the Protocol Registration and Results System (PRS) (NCT03127293). RESULTS There was no significant difference in DEXA results (lumbar spine and total hip) and laboratory parameters between case and control groups, although a significant difference in vitamin intake was identified between cases and controls (65% vs. 92%, respectively, p = 0.003). Except for low serum levels of vitamin D, other laboratory parameters were in normal range in both groups. CONCLUSION Pregnancies complicated by HG did not have decreased bone mineral density compared to those without HG. There is no evidence to relate HG to future osteoporosis.
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Affiliation(s)
- Gulsum Uysal
- Department of Obstetrics and Gynecology, University of Health Science, Adana City Hospital, Adana, Turkey.
| | - Fulya Cagli
- Department of Obstetrics and Gynecology, University of Health Science, Training and Research Hospital, Kayseri, Turkey
| | - Hatice Akkaya
- Department of Obstetrics and Gynecology, University of Health Science, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey
| | - Hakan Nazik
- Department of Obstetrics and Gynecology, University of Health Science, Adana City Hospital, Adana, Turkey
| | - Cigdem Karakukcu
- Department of Biochemistry, University of Health Science, Training and Research Hospital, Kayseri, Turkey
| | - Serap Sutbeyaz
- Department of Physical Medicine and Rehabilitation, University of Health Science, Training and Research Hospital, Kayseri, Turkey
| | - Esra S Yilmaz
- Department of Obstetrics and Gynecology, University of Health Science, Adana City Hospital, Adana, Turkey
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Affiliation(s)
- David Harvie
- Intensive care unit, Royal Melbourne Hospital, Melbourne, Australia
- Intensive care unit, University Hospital Southampton, Southampton, UK
| | - Brendan Murfin
- Intensive care unit, Royal Melbourne Hospital, Melbourne, Australia
- Intensive care unit, Guys and St Thomas Hospital, London, UK
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Madsen LRF, Søgaard M. [Rhabdomyolysis caused by hyperemesis gravidarum]. Ugeskr Laeger 2017; 179:V10160731. [PMID: 28263150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Hyperemesis gravidarum (HG) is a condition of severe nausea and vomiting during pregnancy, accompanied by dehydration, electrolyte derangement and lack of nutrition. We describe a 26-year-old woman pregnant at 29 weeks of gestation, complaining about muscle pain and difficulties standing up after suffering from long-term HG followed by a weight loss of 35 kg. She had severe hypokalaemia and abnormally elevated muscle enzyme concentrations as a result of a massive catabolic process. We discuss severe HG as a rare cause of rhabdomyolysis and the importance of early aggressive resuscitation to avoid renal failure.
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Kjeldgaard HK, Eberhard-Gran M, Benth JŠ, Vikanes ÅV. Hyperemesis gravidarum and the risk of emotional distress during and after pregnancy. Arch Womens Ment Health 2017; 20:747-756. [PMID: 28842762 PMCID: PMC5691116 DOI: 10.1007/s00737-017-0770-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 08/07/2017] [Indexed: 12/11/2022]
Abstract
Hyperemesis gravidarum (HG) is a pregnancy condition characterised by severe nausea and vomiting. Previous studies have shown an association between HG and depressive symptoms during pregnancy, but little is known about the risk of maternal psychological distress following an HG pregnancy. The objective of the current study was therefore to assess the association between HG and emotional distress during and after pregnancy. This was a population-based pregnancy cohort study using data from the Norwegian Mother and Child Cohort Study. A total of 851/92,947 (0.9%) had HG. Emotional distress was measured by the Hopkins Symptom Checklist (SCL-5) in gestational weeks 17 and 32 and 6 and 18 months postpartum. The generalised estimating equations model was estimated for assessing time trends in emotional distress. Adjustments were made for previous HG, lifetime history of depression, maternal age, parity, BMI, smoking before pregnancy, physical activity, length of education, and pelvic girdle pain. Women with HG had higher odds for emotional distress than women without HG at the 17th (p < 0.001) and 32nd gestational weeks (p = 0.001) in addition to 6 months postpartum (p = 0.005) but not 18 months postpartum (p = 0.430). Adjusted odds for emotional distress varied significantly over time for women with and without HG (p = 0.035). Women with HG were more likely to report emotional distress compared to women without HG during pregnancy and 6 months postpartum, but the difference between the groups disappeared 18 months after birth. The results suggest that the increased risk of developing emotional distress may primarily be a consequence of HG.
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Affiliation(s)
- Helena Kames Kjeldgaard
- HØKH, Akershus University Hospital, Post Box 1000, 1478, Lørenskog, Norway.
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway.
| | - Malin Eberhard-Gran
- HØKH, Akershus University Hospital, Post Box 1000, 1478, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jūratė Šaltytė Benth
- HØKH, Akershus University Hospital, Post Box 1000, 1478, Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
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Germes-Piña F, Acosta-Orozco DM, Flores-Franco RA, Verdugo-Castro PN. [Pneumomediastinum associated with hyperemesis gravidarum: a case report]. Ginecol Obstet Mex 2016; 84:586-592. [PMID: 29424979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The hyperemesis gravidarum is a severe illness of nauseas and vomit that is present in the first trimester of the pregnancy, it has an incidence of 0.3 to 2%, it has been associated to weight loss, electrolytic disturbances, ketonuria, dehydration and in very seldom cases spontaneous pneumomediastinum. CLINICAL CASE A 21 years old female patient, primigest, in the first trimester of gestation, she started her disease with nauseas and vomiting more than 15 times during 6 hours period, odynophagia, dysphonia and pain in the cervical region, loss of 5 kilograms in the last month. The physical examination showed the patient in bad conditions, dehydration, neck with volume increased and emphysema subcutaneus, crakles until torax. Laboratory findings with hypokalemia, leukocytosis, acute kidney failure, and elevation of hepatic enzymes. The initial treatment was with intravenous fluids resuscitation, hydroelectrolytic balance restoration, antiemetic treatment and rest, it was taken TC of neck and torax, and was exclude any laryngeal and esophageal injury and perforation, but it showed air in the mediastinum. Conservative management with favorable evolution and completed resolution in 7 days. CONCLUSION It is very important that the medical doctor must keep in mind the different diagnosis of and take an opportune decision in case of present those complications potentially fatal to the mother.
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Anwar J, Soomro S, Javed K, Omer S. MRI Findings In Acute Wernicke's Encephalopathy, Caused By Hyperemesis Gravidarum. J Ayub Med Coll Abbottabad 2016; 28:409-410. [PMID: 28718572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 25-year old pregnant female with history of confusion and drowsiness for 02 days was referred by neurophysician for MRI brain. MRI demonstrated T2W/FLAIR hyper intensities in medial thalami, periaqueductal areas with variable diffusion restriction, apparent as hyper intense signal on DWI and no signal change on ADC mapping that was typically consistent with Wernicke's encephalopathy. A high index of suspicion is necessary, as delayed or lack of treatment can lead to high morbidity and mortality.
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Affiliation(s)
- Javed Anwar
- Department of Radiology, Combined Military Hospital, Multan, Pakistan
| | - Sanaullah Soomro
- Department of Radiology, Combined Military Hospital, Multan, Pakistan
| | - Koukab Javed
- Department of Radiology, Combined Military Hospital, Multan, Pakistan
| | - Saima Omer
- Department of Radiology, Combined Military Hospital, Multan, Pakistan
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Coulon AL, Savagner F, Briet C, Vernin M, Munier M, Chabre O, Rodien P. Prolonged and Severe Gestational Thyrotoxicosis Due to Enhanced hCG Sensitivity of a Mutant Thyrotropin Receptor. J Clin Endocrinol Metab 2016; 101:10-1. [PMID: 26580241 DOI: 10.1210/jc.2015-3670] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Gestational thyrotoxicosis, whether associated with hyperemesis gravidarum or not, is thought to be due to excessive human chorionic gonadotropin (hCG) secretion. CASE DESCRIPTION We report here the second case of gestational thyrotoxicosis associated with hyperemesis gravidarum due to a mutation of the TSH receptor, providing thyroid hypersensitivity to hCG. CONCLUSION Severe and lasting gestational thyrotoxicosis with normal hCG concentration should lead to sequencing of the TSH receptor gene.
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Affiliation(s)
- Anne Laure Coulon
- Endocrinologie (A.L.C., O.C.), Centre Hospitalier Universitaire de Grenoble, 38700, La Tronche, France; Département de Biochimie et Génétique (F.S.), Centre Hospitalier Universitaire d'Angers, 49000 Angers, France; Centre National de la Recherche Scientifique 6214/Institut National de la Sante et de la Recherche Medicale 1083 (C.B., M.M., P.R.), Université d'Angers, 49000 Angers, France; Endocrinologie (C.B., M.M., P.R.), Centre de Référence des Maladies Rares de la Réceptivité Hormonale, Centre Hospitalier Universitaire d'Angers, 49000 Angers, France; and Groupe Hospitalier Mutualiste des Eaux-Claires (M.V.), 38028 Grenoble, France
| | - Frédérique Savagner
- Endocrinologie (A.L.C., O.C.), Centre Hospitalier Universitaire de Grenoble, 38700, La Tronche, France; Département de Biochimie et Génétique (F.S.), Centre Hospitalier Universitaire d'Angers, 49000 Angers, France; Centre National de la Recherche Scientifique 6214/Institut National de la Sante et de la Recherche Medicale 1083 (C.B., M.M., P.R.), Université d'Angers, 49000 Angers, France; Endocrinologie (C.B., M.M., P.R.), Centre de Référence des Maladies Rares de la Réceptivité Hormonale, Centre Hospitalier Universitaire d'Angers, 49000 Angers, France; and Groupe Hospitalier Mutualiste des Eaux-Claires (M.V.), 38028 Grenoble, France
| | - Claire Briet
- Endocrinologie (A.L.C., O.C.), Centre Hospitalier Universitaire de Grenoble, 38700, La Tronche, France; Département de Biochimie et Génétique (F.S.), Centre Hospitalier Universitaire d'Angers, 49000 Angers, France; Centre National de la Recherche Scientifique 6214/Institut National de la Sante et de la Recherche Medicale 1083 (C.B., M.M., P.R.), Université d'Angers, 49000 Angers, France; Endocrinologie (C.B., M.M., P.R.), Centre de Référence des Maladies Rares de la Réceptivité Hormonale, Centre Hospitalier Universitaire d'Angers, 49000 Angers, France; and Groupe Hospitalier Mutualiste des Eaux-Claires (M.V.), 38028 Grenoble, France
| | - Marie Vernin
- Endocrinologie (A.L.C., O.C.), Centre Hospitalier Universitaire de Grenoble, 38700, La Tronche, France; Département de Biochimie et Génétique (F.S.), Centre Hospitalier Universitaire d'Angers, 49000 Angers, France; Centre National de la Recherche Scientifique 6214/Institut National de la Sante et de la Recherche Medicale 1083 (C.B., M.M., P.R.), Université d'Angers, 49000 Angers, France; Endocrinologie (C.B., M.M., P.R.), Centre de Référence des Maladies Rares de la Réceptivité Hormonale, Centre Hospitalier Universitaire d'Angers, 49000 Angers, France; and Groupe Hospitalier Mutualiste des Eaux-Claires (M.V.), 38028 Grenoble, France
| | - Mathilde Munier
- Endocrinologie (A.L.C., O.C.), Centre Hospitalier Universitaire de Grenoble, 38700, La Tronche, France; Département de Biochimie et Génétique (F.S.), Centre Hospitalier Universitaire d'Angers, 49000 Angers, France; Centre National de la Recherche Scientifique 6214/Institut National de la Sante et de la Recherche Medicale 1083 (C.B., M.M., P.R.), Université d'Angers, 49000 Angers, France; Endocrinologie (C.B., M.M., P.R.), Centre de Référence des Maladies Rares de la Réceptivité Hormonale, Centre Hospitalier Universitaire d'Angers, 49000 Angers, France; and Groupe Hospitalier Mutualiste des Eaux-Claires (M.V.), 38028 Grenoble, France
| | - Olivier Chabre
- Endocrinologie (A.L.C., O.C.), Centre Hospitalier Universitaire de Grenoble, 38700, La Tronche, France; Département de Biochimie et Génétique (F.S.), Centre Hospitalier Universitaire d'Angers, 49000 Angers, France; Centre National de la Recherche Scientifique 6214/Institut National de la Sante et de la Recherche Medicale 1083 (C.B., M.M., P.R.), Université d'Angers, 49000 Angers, France; Endocrinologie (C.B., M.M., P.R.), Centre de Référence des Maladies Rares de la Réceptivité Hormonale, Centre Hospitalier Universitaire d'Angers, 49000 Angers, France; and Groupe Hospitalier Mutualiste des Eaux-Claires (M.V.), 38028 Grenoble, France
| | - Patrice Rodien
- Endocrinologie (A.L.C., O.C.), Centre Hospitalier Universitaire de Grenoble, 38700, La Tronche, France; Département de Biochimie et Génétique (F.S.), Centre Hospitalier Universitaire d'Angers, 49000 Angers, France; Centre National de la Recherche Scientifique 6214/Institut National de la Sante et de la Recherche Medicale 1083 (C.B., M.M., P.R.), Université d'Angers, 49000 Angers, France; Endocrinologie (C.B., M.M., P.R.), Centre de Référence des Maladies Rares de la Réceptivité Hormonale, Centre Hospitalier Universitaire d'Angers, 49000 Angers, France; and Groupe Hospitalier Mutualiste des Eaux-Claires (M.V.), 38028 Grenoble, France
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Vandraas KF, Vikanes ÅV, Støer NC, Troisi R, Stephansson O, Sørensen HT, Vangen S, Magnus P, Grjibovski AM, Grotmol T. Hyperemesis gravidarum and risk of cancer in offspring, a Scandinavian registry-based nested case-control study. BMC Cancer 2015; 15:398. [PMID: 25963309 PMCID: PMC4430929 DOI: 10.1186/s12885-015-1425-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 05/06/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hyperemesis gravidarum is a serious condition affecting 0.8-2.3% of pregnant women and can be regarded as a restricted period of famine. Research concerning potential long-term consequences of the condition for the offspring, is limited, but lack of nutrition in-utero has been associated with chronic disease in adulthood, including some cancers. There is growing evidence that several forms of cancer may originate during fetal life. We conducted a large study linking the high-quality population-based medical birth- and cancer registries in Norway, Sweden and Denmark, to explore whether hyperemesis is associated with increased cancer risk in offspring. METHODS A registry-based nested case-control study. Twelve types of childhood cancer were selected; leukemia, lymphoma, cancer of the central nervous system, testis, bone, ovary, breast, adrenal and thyroid gland, nephroblastoma, hepatoblastoma and retinoblastoma. Conditional logistic regression models were applied to study associations between hyperemesis and risk of childhood cancer, both all types combined and separately. Cancer types with five or more exposed cases were stratified by age at diagnosis. All analysis were adjusted for maternal age, ethnicity and smoking, in addition to the offspring's Apgar score, placental weight and birth weight. Relative risks with 95% confidence intervals were calculated. RESULTS In total 14,805 cases and approximately ten controls matched on time, country of birth, sex and year of birth per case (147,709) were identified. None of the cancer types, analyzed combined or separately, revealed significant association with hyperemesis. When stratified according to age at diagnosis, we observed a RR 2.13 for lymphoma among adolescents aged 11-20 years ((95% CI 1.14-3.99), after adjustment for maternal ethnicity and maternal age, RR 2.08 (95% CI 1.11-3.90)). The finding was not apparent when a stricter level of statistical significance was applied. CONCLUSIONS The main finding of this paper is that hyperemesis does not seem to increase cancer risk in offspring. The positive association to lymphoma may be by chance and needs confirmation.
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Affiliation(s)
- Kathrine F Vandraas
- Department of Genes and Environment, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, Norway.
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, PO box 4950, Nydalen, Oslo, Norway.
| | - Åse V Vikanes
- Department of Genes and Environment, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, Norway.
- The Intervention Center, Oslo University Hospital, PO Box 4950, Nydalen, Oslo, Norway.
| | - Nathalie C Støer
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Rebecca Troisi
- Divisions of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, 9000 Rockville Pike, Bethesda, MD, 20892, USA.
| | - Olof Stephansson
- Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Institute, SE-141 86, Stockholm, Sweden.
- Department of Women and Children's Health, Division of Obstetrics and Gynecology Karolinska University Hospital and Institute, SE-141 86, Stockholm, Sweden.
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, 44 Norrebrogade, 8000, Aarhus, Denmark.
| | - Siri Vangen
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, PO box 4950, Nydalen, Oslo, Norway.
| | - Per Magnus
- Department of Genes and Environment, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, Norway.
| | - Andrej M Grjibovski
- Department of International Public Health, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, Norway.
- International School of Public Health, Northern State Medical University, Troitsky av.51, Arkhangelsk, Russia, 163000.
- Department of Preventive Medicine, International Kazakh-Turkish University, Esimkhan str.2, Turkestan, Kazakhstan.
| | - Tom Grotmol
- Cancer Registry of Norway, PO Box 5313, Majorstuen, N-0304, Oslo, Norway.
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Fejzo MS, Magtira A, Schoenberg FP, Macgibbon K, Mullin PM. Neurodevelopmental delay in children exposed in utero to hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol 2015; 189:79-84. [PMID: 25898368 DOI: 10.1016/j.ejogrb.2015.03.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 03/20/2015] [Accepted: 03/23/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The purpose of this study is to determine the frequency of emotional, behavioral, and learning disorders in children exposed in utero to hyperemesis gravidarum (HG) and to identify prognostic factors for these disorders. STUDY DESIGN Neurodevelopmental outcomes of 312 children from 203 mothers with HG were compared to neurodevelopmental outcomes from 169 children from 89 unaffected mothers. Then the clinical profiles of patients with HG and a normal child outcome were compared to the clinical profiles of patients with HG and a child with neurodevelopmental delay to identify prognostic factors. Binary responses were analyzed using either a Chi-square or Fisher Exact test and continuous responses were analyzed using a t-test. RESULTS Children exposed in utero to HG have a 3.28-fold increase in odds of a neurodevelopmental diagnosis including attention disorders, learning delay, sensory disorders, and speech and language delay (P<0.0005). Among characteristics of HG pregnancies, only early onset of symptoms (prior to 5 weeks gestation) was significantly linked to neurodevelopmental delay. We found no evidence for increased risk of 13 emotional, behavioral, and learning disorders, including autism, intellectual impairment, and obsessive-compulsive disorder. However, the study was not sufficiently powered to detect rare conditions. Medications, treatments, and preterm birth were not associated with an increased risk for neurodevelopmental delay. CONCLUSION Women with HG are at a significantly increased risk of having a child with neurodevelopmental delay. Common antiemetic treatments were not linked to neurodevelopmental delay, but early symptoms may play a role. There is an urgent need to address whether aggressive treatment that includes vitamin and nutrient supplementation in women with early symptoms of severe nausea of pregnancy decreases the risk of neurodevelopmental delay.
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Affiliation(s)
- Marlena S Fejzo
- University of California, Los Angeles, Department of Obstetrics, Gynecology, and Medicine, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Department of Maternal-Fetal Medicine, Los Angeles, CA, USA.
| | - Aromalyn Magtira
- University of California, Los Angeles, Department of Statistics, Los Angeles, CA, USA
| | | | - Kimber Macgibbon
- Hyperemesis Education and Research Foundation, Leesburg, VA, USA
| | - Patrick M Mullin
- Keck School of Medicine, University of Southern California, Department of Maternal-Fetal Medicine, Los Angeles, CA, USA
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Tan PC, Zaidi SN, Azmi N, Omar SZ, Khong SY. Depression, anxiety, stress and hyperemesis gravidarum: temporal and case controlled correlates. PLoS One 2014; 9:e92036. [PMID: 24637791 PMCID: PMC3956867 DOI: 10.1371/journal.pone.0092036] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 02/19/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the temporal and case-controlled correlations of anxiety, depression and stress with hyperemesis gravidarum. STUDY DESIGN We performed a longitudinal cohort study of women with hyperemesis gravidarum using the Depression, Anxiety and Stress Scale (DASS-21) to evaluate psychological distress at hospitalization and in the third trimester of pregnancy (from 28 weeks gestation). Third pregnancy trimester controls were recruited from routine antenatal clinic attendees who were matched to gestational age at the second DASS-21 assessment in the HG cohort. RESULTS The prevalences of nausea and vomiting, depression, anxiety and stress caseness in newly hospitalised hyperemesis gravidarum women were 100% and 100%, 19%, 69% and 21% which by the third trimester had fallen to 15.7% and 9.9%, 4%, 19% and 3% and in third trimester controls were 15.9% and 14.2%, 14%, 61% and 20% respectively. Within the hyperemesis gravidarum cohort, nausea, vomiting depression, anxiety and stress reduced significantly by an absolute 84.3% (95% CI 76.2%-89.8%), 90.1% (82.8%-94.2%), 14.9% (7.2%-23.0%), 49.6% (38.6%-58.7%) and 18.2% (10.4%-26.4%) respectively between hospitalization for hyperemesis gravidarum and at the third trimester. In the third trimester, when comparing the hyperemesis gravidarum cohort to controls, the risk of nausea or vomiting was similar but depression, anxiety and stress were significantly lower: adjusted odds ratio AOR 0.10 (95% CI 0.03-0.5), 0.11 (0.05-0.23) and 0.08 (0.02-0.33) respectively. CONCLUSION Our study revealed a reassuring pattern of a strong rebound from depression, anxiety and stress in women with hyperemesis gravidarum such that by the third pregnancy trimester the level of psychological distress was even lower than in controls. This observation imply that much of the psychological distress in acute hyperemesis gravidarum is self-limiting and probably in the causal pathway of hyperemesis gravidarum. Care in women with hyperemesis gravidarum should focus on the relief of nausea and vomiting.
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Affiliation(s)
- Peng Chiong Tan
- Department of Obstetrics and Gynaecology, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
- * E-mail:
| | - Syeda Nureena Zaidi
- Department of Obstetrics and Gynaecology, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Noor Azmi
- Department of Obstetrics and Gynaecology, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Siti Zawiah Omar
- Department of Obstetrics and Gynaecology, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Su Yen Khong
- Department of Obstetrics and Gynaecology, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
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Affiliation(s)
- C Justin
- Vadamalayan Multispeciality Hospitals, Madurai, Tamil Nadu 625 002, India.
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Abstract
Nausea and vomiting in pregnancy are common complaints and vary considerably in duration and severity. Hyperemesis gravidarum represents the extreme end of the spectrum associated with dehydration and weight loss. As embryonic organogenesis occurs during the first trimester, pharmacological intervention for any condition during this period poses a significant clinical dilemma requiring careful assessment of risks and benefits. In the UK, there are no formal national guidelines for the management of hyperemesis gravidarum. In addition, no high-quality evidence exists for i.v. fluid and electrolyte replacement in hyperemesis gravidarum, and a Cochrane review on interventions for the treatment of nausea and vomiting in pregnancy specifically excluded studies on hyperemesis gravidarum. In this article, we review the evidence for the efficacy and safety of different management options for hyperemesis gravidarum.
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Ayyavoo A, Derraik JGB, Hofman PL, Biggs J, Bloomfield FH, Cormack BE, Stone P, Cutfield WS. Severe hyperemesis gravidarum is associated with reduced insulin sensitivity in the offspring in childhood. J Clin Endocrinol Metab 2013; 98:3263-8. [PMID: 23750032 DOI: 10.1210/jc.2013-2043] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hyperemesis gravidarum alters maternal (and possibly fetal) nutrition throughout pregnancy, but there are no data on long-term effects on offspring metabolism. Thus, we aimed to assess whether severe hyperemesis gravidarum (SHG) affects glucose homeostasis and body composition in the offspring in childhood. METHODS Healthy prepubertal children (aged 4-11 years) born at term were studied: offspring of mothers who were admitted to hospital with SHG (n = 36) and offspring of mothers from control pregnancies (n = 42). Primary outcome was insulin sensitivity measured using iv glucose tolerance tests and Bergman's minimal model. Other assessments included lipid and hormonal profiles and body composition using whole-body dual-energy x-ray absorptiometry. RESULTS Insulin sensitivity in SHG children was 20% lower than in controls (8.49 vs 10.60 × 10(-4)·min(-1)·(mU/L); P = .014). SHG children also had higher fasting insulin (6.88 vs 5.04 mIU/L; P = .024) and lower IGF binding protein 1 (11.8 vs 19.0 ng/mL; P = .004) concentrations than controls. Baseline cortisol concentrations were 22% higher in SHG offspring (256 vs 210 nmol/L; P = .021). Children in both groups were anthropometrically similar. CONCLUSION Children born to mothers who experienced SHG have lower insulin sensitivity, which may increase their long-term risk of developing diabetes mellitus. Follow-up of SHG offspring is essential to determine later risk of metabolic disease.
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Affiliation(s)
- Ahila Ayyavoo
- Liggins Institute, University of Auckland, Private Bag 92019, Auckland, New Zealand
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Abstract
Current research shows that women tend to receive less dental care than usual when they are pregnant. In 2012, the first national consensus statement on oral health care during pregnancy was issued, emphasizing both the importance and safety of routine dental care for pregnant women. This article reviews the current recommendations for perinatal oral health care and common oral manifestations during pregnancy. Periodontal disease and its association with preterm birth and low birth weight are also discussed, as is the role played by dental intervention in these adverse outcomes.
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Harpsøe MC, Jørgensen KT, Frisch M, Jess T. Risk of inflammatory bowel disease according to self-rated health, pregnancy course, and pregnancy complications: a study within the Danish National Birth Cohort. PLoS One 2013; 8:e59698. [PMID: 23527254 PMCID: PMC3602009 DOI: 10.1371/journal.pone.0059698] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 02/17/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Poor self-rated health (SRH) has been connected to immunological changes, and pregnancy complications have been suggested in the etiology of autoimmune diseases including inflammatory bowel disease (IBD). We evaluated the impact of self-rated pre-pregnancy health and pregnancy course, hyperemesis, gestational hypertension, and preeclampsia on risk of IBD. METHODS Information was collected by questionnaires from The Danish National Birth Cohort (enrolment 1996-2002) at 16(th) and 30(th) week of pregnancy and 6 months postpartum. A total of 55,699 women were followed from childbirth until development of IBD (using validated National Hospital Discharge Register diagnoses), emigration, death, or end of follow-up, 31(st) of October, 2011. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Cox proportional hazards models adjusting for age and evaluating pre-pregnancy BMI, parity, alcohol and tobacco consumption, and socio-occupational status as potential confounders. RESULTS Risk of IBD increased with decreasing level of self-rated pre-pregnancy health (p = 0.002) and was elevated in women with poor self-rated pregnancy course (HR, 1.61, 95% CI 1.22-2.12). Associations persisted for more than 5 years postpartum. Hyperemesis and preeclampsia were not significantly associated with risk of IBD. CONCLUSIONS This is the first prospective observational study to suggest that poor self-rated health--in general and in relation to pregnancy--is associated with increased risk of IBD even in the long term though results needs further confirmation. Symptoms of specific pregnancy complications were, on the other hand, not significantly associated with risk of IBD.
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Affiliation(s)
- Maria C Harpsøe
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
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Pilone V, Di Micco R, Monda A, Villamaina E, Gentile M, Forestieri P. LAGB in pregnancy: slippage after hyperemesis gravidarum. Report of a case. Ann Ital Chir 2012; 83:429-432. [PMID: 23064305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Bariatric surgery procedures are more and more performed in women of reproductive age, whose fertility often increases after weight loss, so they frequently become pregnant. In this condition they require appropriate management, according to the type of procedure, malabsorptive or restrictive. If health risks related to obesity (gestational diabetes, pregnancy induced hypertension, pre-eclampsia) decrease after weight loss, other risks related to bariatric procedures could appear. LAGB is a safe and well-tolerated procedure, but some complications could appear more frequently during pregnancy; some symptoms could be suggestive for important complications, that if not treated in the best way could threaten mother and child's health. Emesis of the first trimester could favor slippage, thus influencing feeding and fetal growth. The slippage of the band is a common complication of LAGB, that usually does not lead to serious conditions, but in our case the pregnant risked a lot because of malnutrition. The purpose of this article is to present an obstetric case study of a woman who experienced this complication postbariatric surgery and the implications for mother and child. A correct diagnosis and management of the clinical case led to a positive conclusion, thus underlining bariatric surgery and its complications should be known and taken into account by every physician.
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Affiliation(s)
- Vincenzo Pilone
- Department of General, Geriatric, Oncology Surgery, University Federico II, Naples, Italy
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Daaloul W, Jlili L, Ouerdiane N, Masmoudi A, Ben Hamouda S, Bouguerra B, Sfar R. [Fatal complication of hyperemesis gravidarum: Wernicke's encephalopathy]. Tunis Med 2012; 90:663. [PMID: 22987369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Huang W, Zhu P, Gao R, Lu Y, Liang Z, Tao F. [Association between hyperemesis gravidarum and fetal growth restriction]. Wei Sheng Yan Jiu 2012; 41:602-608. [PMID: 23057324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To estimate the association between hyperemesis gravidarum (HG) and the risk of fetal growth restriction (FGR), and the possible mechanisms by which HG contributing to the risk of FGR. METHODS The maternal socio-demographic characteristics, hyperemesis gravidarum, food intake changes and psychological stress during pregnancy of 2 522 women were assessed through questionnaires. The neonatal outcome data were obtained from medical records. RESULTS Women with HG were combined with higher psychological stress, including pregnancy related anxiety during first trimester, anxiety and depression in the third trimester, and with lower gestational weight gain compared with women without HG. In the multiple logistic regression model, FGR was significantly associated with premature delivery (RR = 1.94, 95% CI 1.05-3.56), female infants (RR = 2.50, 95% CI 1.67-3.76), less milk products intake during pregnancy (RR = 1.87, 95% CI 1.10-3.18), lower scores of anxiety during first trimester (RR = 2.05, 95% CI 1.27-3.31), higher scores of depression in the third trimester (RR = 1.85, 95% CI 1.05-3.25), and lower gestational weight gain (RR = 1.75, 95% CI 1.04-2.95). Path model showed that women with HG are predisposed to experience less milk products intake and more psychological stress during pregnancy, which could reduced maternal weight gain, and finally result in increasing the risk of FGR. CONCLUSION Hyperemesis gravidarum could not independently increase the risk of FGR. However, HG is significantly associated with multiple risk factors, through which HG indirectly increased the risk of FGR. Psychological stress and food intake during pregnancy mediated the negative effects of HG on FGR.
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Affiliation(s)
- Wen Huang
- Department of Maternal and Child Health, Anhui Medical University, Hefei 230032, China.
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Mullin PM, Ching C, Schoenberg F, MacGibbon K, Romero R, Goodwin TM, Fejzo MS. Risk factors, treatments, and outcomes associated with prolonged hyperemesis gravidarum. J Matern Fetal Neonatal Med 2012; 25:632-6. [PMID: 21916750 PMCID: PMC3560915 DOI: 10.3109/14767058.2011.598588] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To identify factors associated with prolonged Hyperemesis Gravidarum (HG). STUDY DESIGN About 395 women completed a survey regarding pre-existing conditions, treatments and outcomes. Responses were compared using two-sided t-tests or the F-test. RESULTS Participants with prolonged HG are slightly younger and weigh more. Pre-existing factors associated with prolonged HG include allergies and a restrictive diet. Prolonged HG is associated with hematemesis, dizziness, fainting and antiemetic treatment. Following pregnancy, those with prolonged HG reported more posttraumatic stress, motion sickness, muscle weakness and infants with irritability, severe colic and growth restriction. CONCLUSION Multiple pre-existing conditions and poor maternal and infant outcomes were associated with prolonged HG. The most significant condition prior to pregnancy was allergies suggesting a possible autoimmune component affecting duration of HG. In addition, the most significant lifestyle choice linked to prolonged HG was a restrictive diet. Future research is needed to determine whether a change in diet prior to pregnancy may lead to a shorter duration of HG and its associated outcomes.
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Affiliation(s)
- Patrick M Mullin
- Keck School of Medicine, University of Southern California, Department of Maternal-Fetal Medicine, Los Angeles, CA 90095, USA
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Chitra S, Lath KVS. Wernicke's encephalopathy with visual loss in a patient with hyperemesis gravidarum. J Assoc Physicians India 2012; 60:53-56. [PMID: 23029727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE We describe a case of Wernicke's encephalopathy associated with visual loss that was caused by hyperemesis gravidarum. METHODS A 25 year old lady in her 20th week of her pregnancy consulted us. She had history of nausea and vomiting for 3 months with resultant weight loss. She now presented with sub-acute onset of visual loss in both her eyes, and gait disturbance with unsteadiness. Upon ophthalmologic examination she was found to have a visual acuity of 6/60 in both eyes; abduction restriction, nystagmus and retinal hemorrhages and macular oedema in both eyes. She also had truncal, stance and gait ataxia. RESULTS She was treated with parenteral thiamine and her visual loss reversed and her ataxia improved dramatically. Magnetic resonance imaging (MRI) brain with diffusion weighted imaging showed findings consistent with Wernicke's Encephalopathy. CONCLUSION Wernicke's Encephalopathy can occur in many hitherto under-recognised clinical scenarios associated with inadequate oral intake like hyperemesis gravidarum, after gastric bypass surgeries and those on total parenteral nutrition. Visual loss is increasingly being recognized as the additional, reversible feature of Wernicke's Encephalopathy. The changes that occur on MRI brain, especially on the diffusion weighted images, are characteristic and considered diagnostic of Wernicke's Encephalopathy.
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Affiliation(s)
- S Chitra
- Institute of Internal Medicine, Madras Medical College, Chennai
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Anaforoğlu İ, Yildiz B, İnceçayir Ö, Algün E. A woman with thyrotoxicosis- and hyperemesis gravidarum-associated Wernicke's encephalopathy. Neuro Endocrinol Lett 2012; 33:285-289. [PMID: 22635085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 05/14/2012] [Indexed: 06/01/2023]
Abstract
Although hyperthyroidism arising from primary thyroid disease is rare in pregnancy, transient gestational hyperthyroidism is not uncommon. This condition can be associated with hyperemesis gravidarum (HG), and Wernicke's encephalopathy. We present the case of a woman with toxic nodular goiter complicating HG-associated Wernicke's encephalopathy. A 38-year-old Caucasian woman, who had received a diagnosis of hyperthyroidism and HG early in her pregnancy, had intrauterine fetal death at Week 16 of gestation. One day after undergoing therapeutic abortion, she was admitted to our clinic with persistent thyrotoxicosis, nausea, and vomiting. A toxic thyroid nodule was detected. She was given antithyroid medication, total parenteral nutrition. On Day 10 of hospitalization, she developed ataxia, aphasia, and somnolence. Cranial magnetic resonance imaging showed increased bilateral thalamic signalization. She was given a diagnosis of Wernicke's metabolic encephalopathy, for which she received thiamine and multivitamin preparations. She responded dramatically on the second day of thiamine therapy. Her consciousness improved rapidly and she began to speak. Her muscle tone was slightly weak and she had paresthesias in both legs. Absorption of thiamine may be particularly impaired in pregnant women with hyperemesis and hyperthyroid disease. Wernicke's encephalopathy should be considered in hyperthyroid women with HG who develop neurological abnormalities.
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Affiliation(s)
- İnan Anaforoğlu
- Department of Endocrinology and Metabolism, Trabzon Numune Education and Research Hospital, Trabzon, Turkey.
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Abstract
With 80% of pregnant women suffering from some degree of "morning sickness," or nausea and vomiting of pregnancy (NVP), symptom management is a major challenge. A recent Cochrane systematic review of randomized controlled trials concluded that, to date, there is no strong evidence of effectiveness for practically any therapeutic agent used for management of NVP. Because of fears of teratogenicity and litigation, RCTs are rarely conducted in pregnancy. In the absence of the best possible evidence from RCTs, well planned and executed prospective observational studies should be used as the best available evidence to guide clinical practice.
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Affiliation(s)
- Gideon Koren
- Motherisk Program, Hospital for Sick Children, Toronto ON
| | | | - Rachel Gow
- Motherisk Program, Hospital for Sick Children, Toronto ON
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Roh JH, Lee BH, Chin J, Kim GH, Na DL. Graphabulation: a graphic form of confabulation. Cortex 2011; 48:356-9. [PMID: 21679936 DOI: 10.1016/j.cortex.2011.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 08/06/2010] [Accepted: 05/04/2011] [Indexed: 11/18/2022]
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