Medline ® Abstracts for References 123,129-132
of 'Treatment and outcome of nausea and vomiting of pregnancy'
Consequences of hyperemesis gravidarum for offspring: a systematic review and meta-analysis.
Veenendaal MV, van Abeelen AF, Painter RC, van der Post JA, Roseboom TJ
BACKGROUND: There is evidence that hyperemesis gravidarum (HG) is associated with a predominance of female fetuses, lower birthweights and shorter gestational ages at birth. As the adverse effects of prematurity and low birthweight on disease risk in later life have become increasingly clear, the repercussions of HG might not be limited to adverse perinatal outcomes.
OBJECTIVES: To summarise the evidence on short- and long-term outcomes of pregnancies with HG.
SEARCH STRATEGY: A literature search was conducted in the electronic databases Medline and Embase.
SELECTION CRITERIA: Studies were included that reported on the fetal, neonatal and long-term outcome of pregnancies complicated by HG.
DATA COLLECTION AND ANALYSIS: Two authors independently selected studies and extracted data. Meta-analysis was performed using review manager.
MAIN RESULTS: Women with HG during pregnancy were more likely to have a female child (OR 1.27; 95% CI 1.21-1.34). They were also more likely to have a baby with low birthweight (LBW,<2500 kg; OR 1.42; 95% CI 1.27-1.58) that was small for gestational age (SGA; OR 1.28; 95% CI 1.02-1.60), and to deliver prematurely (OR 1.32; 95% CI 1.04-1.68). There was no association with Apgar scores, congenital anomalies or perinatal death. One study described an association between HG and testicular cancer in the offspring.
AUTHOR'S CONCLUSIONS: There is evidence that HG is associated with a higher female/male ratio of offspring and a higher incidence of LBW, SGA and premature babies. Little is known about the long-term health effects of babies born to mothers whose pregnancies were complicated by HG.
Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands. email@example.com
Morning sickness: a mechanism for protecting mother and embryo.
Flaxman SM, Sherman PW
Q Rev Biol. 2000;75(2):113.
Approximately two-thirds of women experience nausea or vomiting during the first trimester of pregnancy. These symptoms are commonly known as morning sickness. Hook (1976) and Profet (1988) hypothesized that morning sickness protects the embryo by causing pregnant women to physically expel and subsequently avoid foods that contain teratogenic and abortifacient chemicals, especially toxic chemicals in strong-tasting vegetables, caffeinated beverages and alcohol. We examined this hypothesis by comprehensively reviewing the relevant medical, psychological and anthropological literature. In its support, (i) symptoms peak when embryonic organogenesis is most susceptible to chemical disruption (weeks 6-18), (ii) women who experience morning sickness are significantly less likely to miscarry than women who do not (9 of 9 studies), (iii) women who vomit suffer fewer miscarriages than those who experience nausea alone, and (iv) many pregnant women have aversions to alcoholic and nonalcoholic (mostly caffeinated) beverages and strong-tasting vegetables, especially during the first trimester. Surprisingly, however, the greatest aversions are to meats, fish, poultry, and eggs. A cross-cultural analysis using the Human Relations Area Files revealed 20 traditional societies in which morning sickness has been observed and seven in which it has never been observed. The latter were significantly less likely to have animal products as dietary staples and significantly more likely to have only plants (primarily corn) as staples than the 20 societies in which morning sickness occurred. Animal products may be dangerous to pregnant women and their embryos because they often contain parasites and pathogens, especially when stored at room temperatures in warm climates. Avoiding foodborne microorganisms is particularly important to pregnant women because they are immunosuppressed, presumably to reduce the chances of rejecting tissues of their own offspring (Haig 1993). As a result, pregnant women are more vulnerable to serious, often deadly infections. We hypothesize that morning sickness causes women to avoid foods that might be dangerous to themselves or their embryos, especially foods that, prior to widespread refrigeration, were likely to be heavily laden with microorganisms and their toxins. The alternative hypotheses that morning sickness is (i) an epiphenomenon of mother-offspring genetic conflict or hormones associated with viable pregnancies, or (ii) an indicator to potential sexual partners and kin that the woman is pregnant, resulting in reduced sexual behavior and increased nepotistic aid, were not well supported. Available data are most consistent with the hypothesis that morning sickness serves an adaptive, prophylactic function.
Department of Neurobiology and Behavior, Cornell University, Ithaca, New York 14853, USA. firstname.lastname@example.org
Hyperemesis gravidarum and fetal outcome.
Paauw JD, Bierling S, Cook CR, Davis AT
JPEN J Parenter Enteral Nutr. 2005;29(2):93.
BACKGROUND: Hyperemesis gravidarum (HG) is reported in 0.5-2% of all pregnancies. The purpose of this research was to evaluate the relationship of maternal HG, neonatal birth weight, and birth outcomes.
METHODS: This is a prospective cohort study of 45 patients diagnosed, by Fairweather's criteria, with HG compared with 306 non-HG control pregnant patients with singleton pregnancies. Sociodemographic and clinical data were obtained from the pregnant patients. Neonatal data were also collected, including indicators of neonatal wellness.
RESULTS: Significantly higher incidences of being nonwhite (33% vs 16%; p<.05) and of attaining post-high school education (60% vs 38%) were noted in the HG group, relative to controls. Mothers in the control group experienced greater gestational weight gain, 14.9 +/- 0.3 kg (mean +/- SEM) relative to mothers in the HG group (10.6 +/- 1.3 kg). Infants from HG pregnancies manifested significantly lower birth weight (3.23 +/- 0.09 kg vs 3.52 +/- 0.03 kg), younger gestational age (38.4 +/- 0.3 weeks vs 39.7 +/- 0.1 weeks), and a greater length of hospital stay (2.9 +/- 0.5 days vs 1.8 +/- 0.1 day), relative to infants from the control group. After undergoing multivariate analysis, HG was a significant predictor of decreased gestational age and increased hospital length of stay.
CONCLUSIONS: Infants born of women who had HG are more likely to experience decreased gestational age and increased length of hospital stay. Efficacy of early and aggressive treatment of HG, including nutrition support, in minimizing these outcomes needs to be studied.
Spectrum Health Nutrition Support Service, Grand Rapids, MI 49503, USA.
Hyperemesis gravidarium: Epidemiologic findings from a large cohort.
Am J Obstet Gynecol. 2005;193(3 Pt 1):811.
OBJECTIVE: This study was undertaken to quantify the frequency, clinical course, charges, and outcomes of hyperemesis gravidarum.
STUDY DESIGN: California birth certificate data linked with maternal and neonatal hospital discharge data in 1999 were used (N=520,739). Hyperemesis was defined by ICD-9 codes. The frequency, estimated charges, and demographic characteristics associated with hyperemesis patients were assessed. Maternal and neonatal perinatal outcomes were compared by maternal hyperemesis status.
RESULTS: Hyperemesis complicated 2,466 of 520,739 births. The average length of stay was 2.6 days and the average charge was $5,932. Singleton hyperemesis infants were smaller (3,255 vs 3,380 g; P<.0001 and more likely to be small for gestational age (29.21% vs 20.8%; P<.0001).
CONCLUSION: Hyperemesis occurs in 473 of 100,000 live births and is associated with significant charges. Infants of mothers with hyperemesis have lower birth weights and the mothers are more likely to have infants that are small for gestational age.
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cleveland, OH, USA.
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.