Maternal characteristics largely explain poor pregnancy outcome after hyperemesis gravidarum

doi:10.1016/j.ejogrb.2011.01.010

European Journal of Obstetrics & Gynecology and Reproductive Biology

Volume 156, Issue 1, May 2011, Pages 56-59

https://doi.org/10.1016/j.ejogrb.2011.01.010 Get rights and content

Abstract

Objective

To describe the characteristics of women who suffer from hyperemesis gravidarum, and explore the independent effect of hyperemesis gravidarum on pregnancy outcome.

Study design

In The Netherlands Perinatal Registry, we used all data on singleton pregnancies of at least 24 weeks and 500 g without congenital anomalies in the years 2000–2006. We examined the characteristics of women who suffered from hyperemesis gravidarum and their children.

Results

Women who suffered from hyperemesis gravidarum were slightly younger; more often primiparous, of lower socio-economic status, of non-Western descent and substance abusers; had more often conceived through assisted reproduction techniques and more often had pre-existing hypertension, diabetes mellitus and psychiatric diseases than women who did not suffer from hyperemesis gravidarum. Also, their pregnancies were more often complicated by hypertension and diabetes and they more often carried a female fetus. Pregnancies complicated by hyperemesis gravidarum significantly more often had an adverse outcome (prematurity or birth weight below the 10th percentile). The increased risk of adverse pregnancy outcomes after hyperemesis gravidarum was largely explained by the differences in maternal characteristics (crude OR 1.22 (95% CI 1.10–1.36), adjusted OR was 1.07 (95% CI 0.95–1.19)).

Conclusion

Hyperemesis gravidarum is associated with adverse pregnancy outcomes. This is largely explained by differences in maternal characteristics. Given the impact of the early environment on later health (which is independent of size at birth), studies that aim to assess the long-term consequences of hyperemesis gravidarum need to be given high priority.

Introduction

Nausea and vomiting in pregnancy is the most common pregnancy complication, affecting more than half of all women during the first trimester of pregnancy [1]. A more severe form of nausea and vomiting, known as hyperemesis gravidarum, is much less common, occurring in 0.5–3% of pregnancies [2], [3], [4] but is the most common cause of hospitalization in the first half of pregnancy and is the second only to preterm labour for pregnancy overall [5]. Both the aetiology and pathogenesis of hyperemesis gravidarum remain unknown [6], [7].

Hyperemesis gravidarum generally occurs more often among young women in their first pregnancy, and many [2], [4], [8], [9], [10], but not all [7], studies found that babies born after hyperemetic pregnancies had lower birth weights. Young and primiparous women are known to have lighter babies, but none of the previous studies has taken this into account when investigating the outcome of pregnancies complicated by hyperemesis gravidarum. Therefore this study aims to investigate the independent contribution of hyperemesis gravidarum on pregnancy outcome. We describe the characteristics of women who suffer from hyperemesis gravidarum, as well as the neonatal outcomes of their babies, and investigate the independent role of hyperemesis gravidarum on pregnancy outcome.

Section snippets

Netherlands Perinatal Registry

This was a population-based retrospective cohort study of all singleton deliveries after 24 weeks of gestation or more and a birth weight above 500 g in The Netherlands, between 2000 and 2006. Pregnancies with congenital anomalies (2.3%) were excluded. All information for this study was obtained from The Netherlands Perinatal Registry [11], [12], [13], [14], [15]. This registry contains population-based information on pregnancies, deliveries and (re)admissions of newborns. It is based on a

Results

In the period 2000–2006, of the 1,199,218 singleton deliveries after more than 24 weeks of gestation in The Netherlands, 2190 (0.2%) were complicated by hyperemesis gravidarum (753 as indicated by the midwife without hospital admission) and 1437 by a gynecologist as requiring hospital admission (including 607 referrals from midwives).

Table 1 shows the maternal characteristics of the 1,197,028 women without hyperemesis, and those of the 2190 with hyperemesis. Women who suffered from hyperemesis

Comment

Hyperemesis gravidarum is associated with adverse pregnancy outcomes. Women who suffer from hyperemesis gravidarum more often deliver prematurely, and more often have children who are small for gestational age. This is largely explained by differences in age, parity, ethnicity, socio-economic status, substance abuse, and the prevalence of hypertension, diabetes and psychiatric illnesses.

The main strength of this study is the large sample size and its representativeness. With 96% coverage and

Acknowledgements

The Netherlands Perinatal Registry has given permission for the analysis of the data described in this paper. This permission is gratefully acknowledged.

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Cited by (83)

Perinatal outcomes of infants born to mothers with hyperemesis gravidarum: A systematic review and meta-analysis
2023, European Journal of Obstetrics and Gynecology and Reproductive Biology
Hyperemesis gravidarum is the severe form of nausea and vomiting during pregnancy and can lead to undernutrition and low maternal weight gain. Previous epidemiologic and animal studies have shown that undernutrition and low maternal weight gain in pregnancy can increase the risk of unfavorable perinatal outcomes, like shorter gestational age, small for gestational age and lower weight at birth.
To evaluate the effect of hyperemesis gravidarum on perinatal outcomes.
OVID Medline and Embase were searched from inception to February 9th, 2022.
Studies reporting on perinatal outcomes of infants born to mothers with hyperemesis gravidarum or severe nausea and vomiting in pregnancy were included. Case reports, case series, animal studies, reviews, editorials and conference abstracts were excluded.
Two reviewers independently selected and extracted data. Risk of bias was assessed by the Newcastle-Ottawa Quality Assessment Scale. We conducted meta-analyses where possible.
Our search yielded 1387 unique papers, of which 61 studies (n = 20,532,671 participants) were included in our systematic review. Meta-analyses showed that hyperemesis gravidarum was associated with preterm birth < 34 weeks (2 studies n = 2,882: OR 2.81, 95 %CI: 1.69–4.67), birth weight < 1500 g (2 studies, n = 489,141: OR 1.43, 95 %CI: 1.02–1.99), neonatal resuscitation (2 studies, n = 4,289,344: OR 1.07, 95 %CI: 1.05–1.10), neonatal intensive care unit admission (7 studies, n = 6,509,702: OR 1.20, 95 %CI: 1.14–1.26) and placental abruption (6 studies, n = 9,368,360: OR 1.15, 95 %CI: 1.05–1.25). Hyperemesis gravidarum was associated with reductions in birthweight > 4000 g (2 studies, n = 5,503,120: OR 0.74, 95 %CI: 0.72–0.76) and stillbirth (9 studies, n = 3,973,154: OR 0.92, 95 %CI: 0.85–0.99). Meta-analyses revealed no association between hyperemesis gravidarum and Apgar scores < 7 at 1 and 5 min; fetal loss, perinatal deaths and neonatal deaths.
Hyperemesis gravidarum is associated with several adverse perinatal outcomes including low birth weight and preterm birth. We also found that pregnancies complicated by hyperemesis gravidarum less frequently were complicated by macrosomia and stillbirth. We were unable to investigate underlying mechanisms.
Effects of passive smoking on severe nausea and vomiting of pregnancy among urban Chinese nonsmoking women
2023, Heliyon
Nausea and vomiting of pregnancy (NVP) is one of the most common pregnancy-associated symptoms, but little is known about the effects of passive smoking on this symptom. Passive smoking among women is widespread and severe in China due to the high proportion of men who smoke actively. The aim of this study is to examine the association between maternal passive smoking and severe NVP in early pregnancy among nonsmoking women in urban China.
We collected information on passive smoking status and severe NVP in early pregnancy based on an ongoing prospective cohort study conducted from October 2017 to May 2019 in Beijing, China. We used multivariable logistic model to calculate adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) after controlling for confounding factors.
Among 3064 participants who were involved in the final analysis, 7.4% (n = 227) were passive smokers and 9.8% (n = 299) reported severe NVP. After adjusting for potential confounders, passive smoking conferred an increased risk of NVP (adjusted OR = 1.62, 95% CI: 1.08, 2.43). The frequency of exposure to second-hand smoke showed a positive relationship with the risk of severe NVP, and significant subgroup differences were also observed in stratified analyses by parity and education level.
Our results suggested that maternal exposure to second-hand smoke remained to be a major public health problem in urban China, and that passive smoking during the first trimester may increase the risk of severe NVP among nonsmoking pregnant women. Measures should be taken to reduce the impact of second-hand smoke exposure on pregnant women.
Hyperemesis gravidarum and neonatal outcomes: A systematic review of observational studies
2021, Taiwanese Journal of Obstetrics and Gynecology
Citation Excerpt :
The second factor that contributed to the heterogeneity was the characteristics of the samples. Although the majority of the studies had a sample consisting of HG cases and a control group [23,25,26,35,36,39–41,43], there were also studies where their sample was of a different type. The samples of two studies consisted of only HG cases, which were classified according to weight loss [37,38].
Hyperemesis gravidarum (HG) is associated with adverse somatic and psychological effects. The impact of HG on neonatal outcomes is debatable given that disagreeing research results have appeared. The objective of this study was to systematically review, according to the PRISMA guidelines, and synthesize the available evidence from observational studies on the relationship between HG and neonatal outcomes. The PubMed, Scopus, and Science Direct databases were systematically reviewed, with the last search carried out in April 2020. The quality of the studies was estimated using the Newcastle–Ottawa Scale (NOS) for non-randomized studies. The databases search yielded 516 studies 15 of which (n = 112.372 HG cases) matched eligibility criteria while the majority of the studies were of moderate quality (n = 12). We observed heterogeneity among the studies regarding the definition of HG and characteristics of the samples. The results of this systematic review suggest that it is still uncertain whether HG has an adverse impact on neonatal outcomes, fact that requires more studies to be conducted.
Recurrence patterns of hyperemesis gravidarum
2018, American Journal of Obstetrics and Gynecology
Hyperemesis gravidarum, excessive vomiting in pregnancy, affects approximately 0.3–3.0% of all pregnancies, but the risk is considerably higher in pregnancies following a hyperemetic pregnancy. The reported recurrence rate of hyperemesis gravidarum is wide, ranging from 15–81%, depending on study settings. Factors affecting recurrence of hyperemesis gravidarum are as yet insufficiently studied.
We sought to evaluate the recurrence rate of hyperemesis gravidarum in subsequent pregnancies, to elucidate chronological patterns of recurrence of the condition, and to analyze maternal, environmental, and pregnancy-related factors associated with recurring hyperemesis gravidarum.
Out of all pregnancies ending in delivery in Finland from 2004 through 2011, data of women who had at least 1 pregnancy ending in delivery following a pregnancy diagnosed with hyperemesis gravidarum were retrieved from hospital discharge register and medical birth register (1836 women, 4103 pregnancies; 1836 index pregnancies and 2267 subsequent pregnancies). The first pregnancy with hyperemesis gravidarum diagnosis was chosen as the index pregnancy, and recurrence rate was calculated by comparing the number of hyperemetic pregnancies that followed the index pregnancy to the total number of pregnancies that followed the index pregnancy. Recurrence patterns of hyperemesis gravidarum were illustrated by presenting the chronological order of the women’s pregnancies beginning from the index pregnancy to the end of the follow-up period. The associations between recurring hyperemesis and age, parity, prepregnancy body mass index, smoking, marital and socioeconomic status, domicile, month of delivery, assisted reproductive technology, sex, and number of fetuses were analyzed in both the index pregnancies and in pregnancies following the index pregnancy.
There were 544 pregnancies with a hyperemesis diagnosis and 1723 pregnancies without a hyperemesis diagnosis following the index pregnancies. The overall recurrence rate of hyperemesis gravidarum in pregnancies following the index pregnancy was 24%. In case of >1 subsequent pregnancy, 11% of women were diagnosed with hyperemesis in all of their pregnancies. In the index pregnancies, recurrence of hyperemesis gravidarum was more common among women with parity of 2 than parity of 1 (adjusted odds ratio, 1.33, P = .046). Overweight women (adjusted odds ratio, 0.58, P = .036) or women who smoked after the first trimester (adjusted odds ratio, 0.27, P < .001) had lower recurrence of hyperemesis. In the comparison of the subsequent pregnancies, quitting smoking in the first trimester (adjusted odds ratio, 0.32, P = .010) and smoking continued after the first trimester (adjusted odds ratio, 0.38, P = .002) were associated with lower odds of recurring hyperemesis. Female sex of the fetus was associated with higher odds of recurring hyperemesis (adjusted odds ratio, 1.29, P = .012).
In the majority of pregnancies following an earlier hyperemetic pregnancy, hyperemesis gravidarum does not recur, but hyperemetic pregnancies occur in the next pregnancies with little predictability. Only few factors associated with recurring hyperemesis could be identified. Although estimating the probability of recurrence of hyperemesis gravidarum in a subsequent pregnancy based on a woman’s first hyperemetic pregnancy turned out not to be feasible, it is reassuring to know that hyperemesis does not appear to become more likely with each pregnancy and that after 1 pregnancy with hyperemesis, the following pregnancy may be different.
Offspring of women with hyperemesis gravidarum are more likely to have cardiovascular abnormalities
2024, BMC Pregnancy and Childbirth
The timing, duration, and severity of nausea and vomiting of pregnancy and adverse birth outcomes among controls without birth defects in the National Birth Defects Prevention Study
2024, Birth Defects Research

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View full text

Maternal characteristics largely explain poor pregnancy outcome after hyperemesis gravidarum

Abstract

Objective

Study design

Results

Conclusion

Introduction

Section snippets

Netherlands Perinatal Registry

Results

Comment

Acknowledgements

Eur J Obstet Gynecol Reprod Biol

Am J Obstet Gynaecol

Obstet Gynaecol

Am J Obstet Gynaecol

Lancet

Am J Clin Nutr

The management of nausea and vomiting of pregnancy

J Obstet Gynaecol Can

Variations in prevalence of hyperemesis gravidarum by country of birth: a study of 900074 pregnancies in Norway, 1967–2005

Scand J Public Health

Risk factors for hyperemesis gravidarum requiring hospital admission during pregnancy

Obstet Gynaecol

Hyperemesis gravidarum, a literature review

Hum Reprod Update

Outcome of pregnancies complicated by hyperemesis gravidarum

Obstet Gynaecol