Medline ® Abstracts for References 112,132,133
of 'Treatment and outcome of nausea and vomiting of pregnancy'
Hyperemesis gravidarum, nutritional treatment by nasogastric tube feeding: a 10-year retrospective cohort study.
Stokke G, Gjelsvik BL, Flaatten KT, Birkeland E, Flaatten H, Trovik J
Acta Obstet Gynecol Scand. 2015 Apr;94(4):359-67. Epub 2015 Feb 17.
OBJECTIVE: To investigate maternal and fetal outcome in hyperemesis gravidarum comparing enteral tube feeding of the mothers with other fluid/nutrition regimens.
DESIGN: Retrospective hospital-based cohort.
SETTING: University hospital, Norway.
SAMPLE: All 558 women treated for hyperemesis gravidarum 2002-2011; 273 received water/electrolytes intravenously, 177 received nutritional supplements by peripheral line, 107 received enteral feeding by gastroscopically positioned nasojejunal tube and 10 received total parenteral nutrition.
METHODS: Different fluid/nutritional groups were compared by chi-squared or non-parametric tests. The influence (odds ratio) of nutritional regimens on having small-for-gestational-age infants was evaluated by binary logistic regression.
MAIN OUTCOME MEASURES: Maternal weight gain during hospitalization and pregnancy, birthweight and gestational age at delivery.
RESULTS: Women receiving enteral nutrition had significantly greater weight loss on admission (median 5.0 kg) and at start of nutrition (5.5 kg) than the other treatment groups (4.0 kg) (p < 0.001). Enteral nutrition was administered for up to 41 days (median 5 days) during hospitalization, leading to 0.8 kg weight gain (95% CI 0.5-1.0, p = 0.005). The tube-fed women achieved similar weight gain during pregnancy and experienced similar incidence of preterm birth or small-for-gestational age compared with the other treatment groups. Women with<7 kg total weight gain had increased risk of birthweight<2500 g and small-for-gestational-age infants (odds ratio 3.68, 95% CI 1.89-7.18, p < 0.001). The nutritional regimen used was not an independent risk factor.
CONCLUSION: Compared with other fluid/nutrition regimens, enteral tube feeding for women affected by severe hyperemesis gravidarum is associated with adequate maternal weight gain and favorable pregnancy outcomes.
Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.
Hyperemesis gravidarum in relation to estradiol levels, pregnancy outcome, and other maternal factors: a seroepidemiologic study.
Depue RH, Bernstein L, Ross RK, Judd HL, Henderson BE
Am J Obstet Gynecol. 1987;156(5):1137.
Two studies were conducted to assess factors associated with increased risk of hyperemesis gravidarum during pregnancy with data and serum samples collected from participants in the Collaborative Perinatal Study. In the case-control study, 419 pregnant women with hyperemesis gravidarum were matched on medical center, date of study registration, and race with 836 pregnant women who did not vomit during the index pregnancy. Younger age, nulliparity, and high body weight were significantly associated with increased risk of hyperemesis. Women with hyperemesis had significantly reduced risk of fetal loss; however, their infants had higher risk of central nervous system malformations. In the second study, first-trimester pregnancy hormones were measured in the serum of 35 women with hyperemesis and 35 control women who were individually matched to cases on age, parity, and medical center. After adjusting for length of gestation, mean levels of total estradiol were 26% higher and mean levels of sex hormone binding-globulin binding capacity were 37% higher in patients with hyperemesis gravidarum than in control subjects. These differences were statistically significant. Although human chorionic gonadotropin concentrations were higher in control pregnancies, the differences were not statistically significant. The average amount of estradiol that was nonprotein bound (adjusted for length of gestation) was also higher in patients than in control subjects. These resultsare consistent with the hypothesis that elevated estrogen levels are responsible for excessive vomiting in pregnancy.
Outcomes of pregnancies complicated by hyperemesis gravidarum.
Dodds L, Fell DB, Joseph KS, Allen VM, Butler B
Obstet Gynecol. 2006;107(2 Pt 1):285.
OBJECTIVE: To evaluate maternal and neonatal outcomes among women with hyperemesis during pregnancy.
METHODS: A population-based retrospective cohort study was conducted among women with singleton deliveries between 1988 and 2002. Hyperemetic pregnancies were defined as those requiring one or more antepartum admissions for hyperemesis before 24 weeks of gestation. Severity of hyperemesis was evaluated according to the number of antenatal hospital admissions (1 or 2 versus 3 or more) and according to weight gain during pregnancy (<7 kg [15.4 lb]versus>or = 7 kg). Maternal outcomes evaluated included weight gain during pregnancy, gestational diabetes, gestational hypertension, labor induction, and cesarean delivery. Neonatal outcomes included 5-minute Apgar score of less than 7, low birth weight, small for gestational age, preterm delivery, and perinatal death. Logistic regression was used to generate adjusted odds ratios for all outcomes, and the odds ratios were converted to relative risks.
RESULTS: Of the 156,091 singleton pregnancies, 1,270 had an admission for hyperemesis. Compared to women without hyperemesis, infants born to women with hyperemesis and with low pregnancy weight gain (<7 kg [15.4 lb]) were more likely to be low birth weight, small for gestational age (SGA), born before 37 weeks of gestation, and have a 5-minute Apgar score of less than 7. Compared with infants born to women without hyperemesis, rates of low birth weight and preterm delivery were substantially higher among infants born to women with hyperemesis and low pregnancy weight gain (4.2% versus 12.5% and 4.9% versus 13.9%, respectively). The outcomes among infants born to women with hyperemesis with pregnancy weight gain of 7 kg (15.4 lb) or more were not different from the outcomes among women without hyperemesis.
CONCLUSION: The results of this study suggest that the adverse infant outcomes associated with hyperemesis are a consequence of, and mostly limited to, women with poor maternal weight gain.
LEVEL OF EVIDENCE: II-2.
Perinatal Epidemiology Research Unit, Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada. Ldodds@dal.ca