Medline ® Abstracts for References 132,161-163
of 'Treatment and outcome of nausea and vomiting of 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
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
Pregnancy nausea related to women's obstetric and personal histories.
Gadsby R, Barnie-Adshead AM, Jagger C
Gynecol Obstet Invest. 1997;43(2):108.
We report the correlation between total hours of nausea in early pregnancy, as a continuous variable, and various factors in women's obstetric and personal histories. Positive correlations for increased nausea were found with heavier placentae (p = 0.005), non-smoking status (p = 0.004), women with nausea in previous pregnancies (p = 0.005), and women whose mothers experienced trouble with nausea in their pregnancies (p = 0.001). 17 other factors did not relate to pregnancy nausea at the p<0.01 level.
General Practice Department, Warwick University, Coventry, UK.