Medline ® Abstracts for References 69,123-127
of 'Treatment and outcome of nausea and vomiting of pregnancy'
Kallen B. Hyperemesis gravidarum during pregnancy and delivery: A registry study. In: Nausea and Vomiting of Pregnancy: State of the Art 2000, Koren G, Bishai R (Eds), Motherisk, Toronto 2000. p.36.
no abstract available
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. firstname.lastname@example.org
Hyperemesis during pregnancy and delivery outcome: a registry study.
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.
Department of Embryology, University of Lund, Sweden.
Hyperemesis gravidarum. Effects on fetal outcome.
Hallak M, Tsalamandris K, Dombrowski MP, Isada NB, Pryde PG, Evans MI
J Reprod Med. 1996;41(11):871.
OBJECTIVE: To study perinatal outcomes in pregnancies complicated by hyperemesis gravidarum (HG) as compared to controls.
STUDY DESIGN: Between 1984 and 1991, 138 patients were diagnosed with HG according to Fairweather's criteria. Subjects were stratified into groups of mild and severe HG according to the presence of at least one of the following criteria: ketonuria, increased blood urea nitrogen and hematocrit, and/or abnormal electrolytes. All patients without HG on whom records were available and who delivered during the study period were included as controls. Multiple gestations and stillbirths were excluded from the analysis. Student's t test and X2 were used for statistical analysis.
RESULTS: Demographic data were not significantly different between the groups. Forty patients were diagnosed as having mild HG and 98 patients as having severe; 12,335 patients were defined as controls. Mean fetal birth weights were 3,110, 3,093, and 3,160 g in the mild, severe and control groups, respectively. The incidence of congenital anomalies was 2.5%, 2.0% and 1.6%, respectively. The incidence of prematurity was 17.5%, 11.2% and 10.7% in mild and severe HG and controls, respectively. None of the outcome variables for mild or severe HG were significantly different as compared to the controls. Differences in other neonatal outcomes, including frequency of five-minute Apgar score<7 and neonatal intensive care unit admissions, were not significantly different between the three groups.
CONCLUSION: In contrast to previous reports, this study demonstrated that fetuses of gravidas admitted for HG are not at increased risk of growth retardation, congenital anomalies or prematurity. No beneficial effect on pregnancy outcome was detected.
Department of Obstetrics and Gynecology, Wayne State University, School of Medicine, Detroit, Michigan, USA.
Maternal and fetal outcomes in hyperemesis gravidarum.
Tsang IS, Katz VL, Wells SD
Int J Gynaecol Obstet. 1996;55(3):231.
OBJECTIVE: This study sought to evaluate maternal characteristics and pregnancy outcomes among women with hyperemesis gravidarum.
METHODS: We performed a retrospective analysis of pregnancy records of obstetric admissions during a 6-year period. Women treated as out-patients for hyperemesis were also identified. Hyperemesis was defined as excessive nausea and vomiting resulting in dehydration, extensive medical therapy, and/or hospital admission. Statistical analysis was by t-test and chi square.
RESULTS: We identified 193 women (1.5%) who developed hyperemesis among 13,053 women. Racial status, marital status, age, and gravidity were similar between the hyperemesis patients and the general population. However, there were less women with hyperemesis who were para 3 or greater. Forty-six women (24%) required hospitalization for hyperemesis, mean hospital stay 1.8 days, range 1-10 days. One patient required parenteral nutrition, two had yeast esophagitis, none had HIV infection, psychiatric pathology or thyroid disease. Pregnancy outcomes between hyperemesis patients and the general population were similar for mean birth weight, mean gestational age, deliveries less than 37 weeks, Apgar scores, perinatal mortality or incidence of fetal anomalies. Our incidence of hyperemesis (1.5%) is similar to that of other published reports.
CONCLUSION: Women with hyperemesis have similar demographic characteristics to the general obstetric population, and have similar obstetric outcomes.
Department of OB/GYN, UNC School of Medicine, Eugene, OR, USA.
Nausea during pregnancy and congenital heart defects: a population-based case-control study.
Boneva RS, Moore CA, Botto L, Wong LY, Erickson JD
Am J Epidemiol. 1999;149(8):717.
The authors investigated the possible association between a mother's nausea during pregnancy and her child's risk for a congenital heart defect using data from the population-based Atlanta Birth Defects Case-Control Study conducted in 1982-1983. Case infants (n = 998) had nonsyndromic congenital heart defects and control infants (n = 3,029) had no congenital defects. Nausea during pregnancy (NP) was graded in eight levels of "severity" based on its onset, frequency, and duration. Level 1, the most severe NP, was associated with a lower risk for a congenital heart defect in the child (odds ratio (OR) = 0.81, 95% confidence interval (CI) 0.67-0.99) compared with no nausea. The lower risk tended to disappear with less severe levels of nausea, and the trend was statistically significant. Overall, early NP (levels 1 to 4 combined) with use of antinausea medication, particularly Bendectin (doxylamine, dicyclomine (dropped from the formulation in 1976), pyridoxine (vitamin B6)), was associated with a lower risk for congenital heart defects compared with: 1) absence of nausea (OR = 0.67, 95% CI 0.50-0.92), and 2) nausea without medication use (OR = 0.70, 95% CI 0.50-0.94). The results suggest that pregnancy hormones and factors or, alternatively, a component of Bendectin (most probably pyridoxine) may be important for normal heart development. These findings outline potential areas for future research on and prevention of congenital heart defects.
Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA.