Medline ® Abstracts for References 132,161-163
of 'Treatment and outcome of nausea and vomiting of pregnancy'
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.
Hyperemesis gravidarum and long-term mortality: a population-based cohort study.
Fossum S, VikanesÅV, NaessØ, Vos L, Grotmol T, Halvorsen S
BJOG. 2017;124(7):1080. Epub 2016 Dec 15.
OBJECTIVE: To investigate whether exposure to hyperemesis gravidarum (HG) is associated with increased maternal long-term mortality.
DESIGN: Population-based cohort study.
SETTING: Medical Birth Registry of Norway (1967-2002) linked to the Cause of Death Registry.
POPULATION: Women in Norway with singleton births in the period 1967-2002, with and without HG. Women were followed until 2009 or death.
METHODS: Cox proportional hazard regression model was applied to estimate hazard ratios (HRs) with 95% confidence interval (CI).
MAIN OUTCOME MEASURES: The primary outcome was all-cause mortality during follow up. Secondary outcomes were cause-specific mortality (cardiovascular mortality, deaths due to cancer, external causes or mental and behavioural disorders).
RESULTS: Of 999 161 women with singleton births, 13 397 (1.3%) experienced HG. During a median follow up of 26 years (25 902 036 person-years), 43 470 women died (4.4%). Women exposed to HG had a lower risk of long-term all-cause mortality compared with women without HG (crude HR 0.82; 95% CI 0.75-0.90). When adjusting for confounders, this reduction was no longer significant (adjusted HR 0.92; 95% CI 0.84-1.01). Women exposed to HG had a similar risk of cardiovascular death as women not exposed (adjusted HR 1.04; 95% CI 0.83-1.29), but a lower long-term risk of death from cancer (adjusted HR 0.86; 95% CI 0.75-0.98).
CONCLUSION: In this large population-based cohort study, HG was not associated with an increased risk of long-term all-cause mortality. Women exposed to HG had no increase in mortality due to cardiovascular disease, but had a reduced risk of death from cancer.
TWEETABLE ABSTRACT: Population-based cohort study: Hyperemesis was not associated with an increased risk of long-term mortality.
Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway.
Recurrence risk in hyperemesis gravidarum.
Trogstad LI, Stoltenberg C, Magnus P, Skjaerven R, Irgens LM
OBJECTIVES: To compare the risk of hyperemesis gravidarum in second pregnancies in women with and without hyperemesis in their first pregnancy, and to determine if this risk changes with changes in paternity or with the interval between deliveries.
DESIGN: Cohort study.
SETTING: Data from the population-based Medical Birth Registry of Norway, 1967-1998. Sample All women in the registry with records of their first and second singleton delivery, a total of 547,238 women.
METHODS: The relative risk of hyperemesis in the second delivery was estimated as odds ratios (ORs) in logistic regression models, controlling for potential confounding factors.
MAIN OUTCOME MEASURES: The main outcome measure was the risk of hyperemesis in the second pregnancy according to hyperemesis in the first pregnancy, interval between deliveries and change in paternity.
RESULTS: The risk of hyperemesis was 15.2% in the second pregnancy in women with and 0.7% in women without previous hyperemesis [OR=26.4, 95% confidence interval (CI) 24.2, 28.7]. The OR did not change after adjustment for maternal age, change in paternity, period of the first delivery and time interval between deliveries. After a change in paternity, the risk of recurrent hyperemesis was 10.9% compared with 16.0% in women without a change in paternity [adjusted OR (aOR)=0.60, 95% CI 0.39, 0.92]. The risk of hyperemesis in the second pregnancy increased with increasing time interval between deliveries, but only in women with no previous hyperemesis.
CONCLUSIONS: The primary finding was the high risk of recurrence observed in women with hyperemesis in the first pregnancy. The risk was reduced by a change in paternity. For women with no previous hyperemesis, a long interval between births slightly increased the risk of hyperemesis in the second pregnancy. Further studies are needed to explore the relative impact of genetic and environmental factors and their possible interactions in hyperemesis gravidarum.
Department of Obstetrics and Gynecology, Ullevål University Hospital, Oslo, Norway.
Recurrence risk of hyperemesis gravidarum.
Fejzo MS, Macgibbon KW, Romero R, Goodwin TM, Mullin PM
J Midwifery Womens Health. 2011;56(2):132. Epub 2011 Mar 1.
INTRODUCTION: The purpose of this study is to describe the recurrence risk for hyperemesis gravidarum (HG).
METHODS: Women who registered on a Web site sponsored by the Hyperemesis Education and Research Foundation as having had one HG-complicated pregnancy were contacted to follow-up on a subsequent pregnancy. Participants completed an online survey.
RESULTS: One hundred women responded. Fifty-seven had become pregnant again, 2 were trying to conceive, 37 were not willing to get pregnant again because of HG, and 4 did not have a second pregnancy for other reasons. Among the 57 women who responded that they had become pregnant again, 81% reported having severe nausea and vomiting in their second pregnancy. Among the women reporting recurrent HG, 98% reported losing weight and taking prescribed medication for HG, 83% reported treatment with intravenous fluids, 20% reported treatment with total parenteral nutrition or nasogastric tube feeding, and 48% reported hospitalization for HG.
DISCUSSION: This study demonstrates both a high recurrence rate of HG and a large percentage of women who change reproductive plans because of their experiences with HG.
University of California at Los Angeles, Los Angeles, CA, USA. firstname.lastname@example.org