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Medline ® Abstracts for References 123,129-132

of 'Treatment and outcome of nausea and vomiting of pregnancy'

123
TI
Hyperemesis during pregnancy and delivery outcome: a registry study.
AU
Källén B
SO
Eur J Obstet Gynecol Reprod Biol. 1987;26(4):291.
 
Delivery outcome was studied in 3068 pregnancies with the diagnosis of hyperemesis in the Swedish Medical Birth Registry for the years 1973-1981. This diagnosis was present in a little over 3 per thousand deliveries in the registry but its prevalence varied enormously between different hospitals, from over 1% to practically nil. The diagnosis was over-represented at low maternal age and first parity and when the infant was a girl. Twinning occurred at a significantly increased rate. Gestational length was somewhat shorter and birthweight was lower than expected but this had no effect on perinatal survival. Congenital malformations were present slightly more often than expected and this was due to three diagnoses: undescended testicles, hip dysplasia, and Down syndrome. Possible explanations for this excess are discussed.
AD
Department of Embryology, University of Lund, Sweden.
PMID
129
TI
Hyperemesis gravidarum and fetal outcome.
AU
Paauw JD, Bierling S, Cook CR, Davis AT
SO
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.
AD
Spectrum Health Nutrition Support Service, Grand Rapids, MI 49503, USA.
PMID
130
TI
Hyperemesis gravidarium: Epidemiologic findings from a large cohort.
AU
Bailit JL
SO
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.
AD
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cleveland, OH, USA.
PMID
131
TI
Hyperemesis gravidarum in relation to estradiol levels, pregnancy outcome, and other maternal factors: a seroepidemiologic study.
AU
Depue RH, Bernstein L, Ross RK, Judd HL, Henderson BE
SO
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.
AD
PMID
132
TI
Outcomes of pregnancies complicated by hyperemesis gravidarum.
AU
Dodds L, Fell DB, Joseph KS, Allen VM, Butler B
SO
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.
AD
Perinatal Epidemiology Research Unit, Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada. Ldodds@dal.ca
PMID