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Fan J, Yin M. Offspring of women with hyperemesis gravidarum are more likely to have cardiovascular abnormalities. BMC Pregnancy Childbirth 2024; 24:119. [PMID: 38331740 PMCID: PMC10854153 DOI: 10.1186/s12884-024-06293-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/26/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Hyperemesis gravidarum (HG) is a severe form of pregnancy-related nausea and vomiting affecting 0.3-2.3% of pregnancies, which can lead to fluid, electrolyte, and acid-base imbalances, nutritional deficiencies, and weight loss, and is usually severe enough to require hospitalization. Abnormally elevated urinary ketones are commonly seen in patients with HG, and ketone bodies are free to pass through the placenta, and maternal hyperketonemia, with or without acidosis, is associated with an increased rate of stillbirth, an increased incidence of congenital anomalies, and impaired neurophysiologic development of the infant. This study investigates the obstetric outcomes of patients with HG and whether HG increases the incidence of cardiovascular disease in the offspring. METHODS This study included 1020 pregnant women who were hospitalized in our hospital for HG and ultimately delivered in our hospital as well as pregnant women without HG in early gestation and delivered in our hospital from January 2019-January 2020, and we collected and followed up the clinical information of the pregnant women and their offspring. RESULTS Pregnant women with HG were more likely to have severe urinary ketones, the rate of early miscarriage and mid-term miscarriage was significantly higher in women with HG compared to pregnant women without HG. Fetal and neonatal head and abdominal circumferences were smaller in HG group than in control group. Neonatal birth weight and length were also lower in the HG group and cardiovascular anomalies were more likely to occur in the offspring of women with HG when all births were followed up for 3 years. CONCLUSIONS HG may cause poor obstetric outcomes and was associated with the development of cardiovascular disease in the offspring of women with HG.
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Affiliation(s)
- Jiao Fan
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Minghong Yin
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
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Jansen LAW, Nijsten K, Limpens J, van Eekelen R, Koot MH, Grooten IJ, Roseboom TJ, Painter RC. Perinatal outcomes of infants born to mothers with hyperemesis gravidarum: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2023; 284:30-51. [PMID: 36924660 DOI: 10.1016/j.ejogrb.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND 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. OBJECTIVE To evaluate the effect of hyperemesis gravidarum on perinatal outcomes. SEARCH STRATEGY OVID Medline and Embase were searched from inception to February 9th, 2022. STUDY ELIGIBILITY 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. DATA COLLECTION AND ANALYSIS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Larissa A W Jansen
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Department of Obstetrics and Gynecology, Amphia Hospital, Breda, The Netherlands; Department of Obstetrics and Gynecology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.
| | - Kelly Nijsten
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Department of Obstetrics and Gynecology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Jacqueline Limpens
- Medical Library, Research Support - Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rik van Eekelen
- Department of Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands
| | - Marjette H Koot
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Iris J Grooten
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Tessa J Roseboom
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Department of Obstetrics and Gynecology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands; Department of Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands
| | - Rebecca C Painter
- Department of Obstetrics and Gynecology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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Aktulay A, Engin-Ustun Y, Kaymak O, Ozgu-Erdinc AS, Demirtas C, Kara M, Danisman N, Erkaya S. Levels of glucagon-like peptide 1 in hyperemesis gravidarum. Interv Med Appl Sci 2021; 11:213-215. [PMCID: PMC9467383 DOI: 10.1556/1646.2020.00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/18/2018] [Indexed: 11/19/2022] Open
Abstract
Objective Glucagon-like peptide 1 (GLP-1), a gut-derived peptide has been reported to have insulin-like effects. Our aim is to examine GLP1 levels in hyperemesis gravidarum (HEG). Materials-methods The study population consisted of 2 groups: Group 1 (control subjects) consisted of 22 women with uncomplicated singleton pregnancies in the first trimester. Group 2 consisted of 22 singleton pregnancies complicated by HEG. Glucose and GLP1 levels were determined. Enzyme-linked Immunosorbent Assay Kit for Glucagon like Peptide 1 (GLP1) was used (Uscn, Life Science Inc.). Results No significant differences in maternal age, gestational age and gravida were observed between hypermetric and control groups. Maternal serum GLP1 levels were significantly higher in HEG compared with control group (P = 0.004). Conclusion The results of our study revealed that the presence of increased GLP1 levels in women with HEG could contribute to the pathogenesis of the disease. Our results indicated that increased GLP1 levels may be associated with hyperemesis gravidarum. The limitation of our study was the restricted number of patients. Large prospective and randomized studies are required to evaluate the effect of GLP1 levels on hyperemesis gravidarum.
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Affiliation(s)
- Ayla Aktulay
- 1Obstetrics and Gynecology Department, Zekai Tahir Burak Women Health Training and Research Hospital, Ankara, Turkey
| | - Y Engin-Ustun
- 1Obstetrics and Gynecology Department, Zekai Tahir Burak Women Health Training and Research Hospital, Ankara, Turkey
| | - O Kaymak
- 1Obstetrics and Gynecology Department, Zekai Tahir Burak Women Health Training and Research Hospital, Ankara, Turkey
| | - Ayse Seval Ozgu-Erdinc
- 1Obstetrics and Gynecology Department, Zekai Tahir Burak Women Health Training and Research Hospital, Ankara, Turkey
| | - Canan Demirtas
- 2Biochemistry Department, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Mustafa Kara
- 1Obstetrics and Gynecology Department, Zekai Tahir Burak Women Health Training and Research Hospital, Ankara, Turkey
| | - Nuri Danisman
- 1Obstetrics and Gynecology Department, Zekai Tahir Burak Women Health Training and Research Hospital, Ankara, Turkey
| | - Salim Erkaya
- 1Obstetrics and Gynecology Department, Zekai Tahir Burak Women Health Training and Research Hospital, Ankara, Turkey
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Tan GN, Tan PC, Hong JGS, Kartik B, Omar SZ. Rating of four different foods in women with hyperemesis gravidarum: a randomised controlled trial. BMJ Open 2021; 11:e046528. [PMID: 33986063 PMCID: PMC8126296 DOI: 10.1136/bmjopen-2020-046528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate four foods in women with hyperemesis gravidarum (HG) on their agreeability and tolerability. DESIGN Prospective, randomised, within-subject cross-over trial. SETTING Single-centre, tertiary, university hospital in Malaysia. PARTICIPANTS 72 women within 24-hour of first admission for HG who were 18 years or above, with confirmed clinical pregnancy of less than 16 weeks' gestation were recruited and analysed. Women unable to consume food due to extreme symptoms, known taste or swallowing disorder were excluded. INTERVENTIONS Each participant chewed and swallowed a small piece of apple, watermelon, cream cracker and white bread in random order and was observed for 10 min after each tasting followed by a 2 min washout for mouth rinsing and data collection. OUTCOME MEASURES Primary outcome was food agreeability scored after 10 min using an 11-point 0-10 Visual Numerical Rating Scale (VNRS). Nausea was scored at baseline (prior to tasting) and 2 and 10 min using an 11-point VNRS. Intolerant responses of gagging, heaving and vomiting were recorded. RESULTS On agreeability scoring, apple (mean±SD 7.2±2.4) ranked highest followed by watermelon (7.0±2.7) and crackers (6.5±2.6), with white bread ranked lowest (6.0±2.7); Kruskal-Wallis H test, p=0.019. Apple had the lowest mean nausea score and mean rank score, while white bread had the highest at both 2 and 10 min; the Kruskal-Wallis H test showed a significant difference only at 10 min (p=0.019) but not at 2 min (p=0.29) in the ranking analyses. The intolerant (gagged, heaved or vomited) response rates within the 10 min study period were apple 3/72 (4%), watermelon 7/72 (10%), crackers 8/72 (11%) and white bread 12/72 (17%): χ2 test for trend p=0.02. CONCLUSION Sweet apple had the highest agreeability score, the lowest nausea severity and intolerance-emesis response rate when tasted by women with HG. White bread consistently performed worst.
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Affiliation(s)
- Gi Ni Tan
- Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur, Malaysia
| | - Peng Chiong Tan
- Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Balaraman Kartik
- Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Zawiah Omar
- Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur, Malaysia
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Koot MH, Grooten IJ, van der Post JAM, Bais JMJ, Ris-Stalpers C, Leeflang MMG, Bremer HA, van der Ham DP, Heidema WM, Huisjes A, Kleiverda G, Kuppens SM, van Laar JOEH, Langenveld J, van der Made F, van Pampus MG, Papatsonis D, Pelinck MJ, Pernet PJ, van Rheenen-Flach L, Rijnders RJ, Scheepers HCJ, Vogelvang TE, Mol BW, Roseboom TJ, Painter RC. Determinants of disease course and severity in hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol 2019; 245:162-167. [PMID: 31923736 DOI: 10.1016/j.ejogrb.2019.12.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/10/2019] [Accepted: 12/23/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We aimed to identify determinants that predict hyperemesis gravidarum (HG) disease course and severity. STUDY DESIGN For this study, we combined data of the Maternal and Offspring outcomes after Treatment of HyperEmesis by Refeeding (MOTHER) randomized controlled trial (RCT) and its associated observational cohort with non-randomised patients. Between October 2013 and March 2016, in 19 hospitals in the Netherlands, women hospitalised for HG were approached for study participation. In total, 215 pregnant women provided consent for participation. We excluded women enrolled during a readmission (n = 24). Determinants were defined as patient characteristics and clinical features, available to clinicians at first hospital admission. Patient characteristics included i.e. age, ethnicity, socio-economic status, history of mental health disease and HG and gravidity. Clinical features included weight loss compared to pre-pregnancy weight and symptom severity measured with Pregnancy Unique Quantification of Emesis (PUQE-24) questionnaire and the Nausea and Vomiting in Pregnancy specific Quality of Life questionnaire (NVPQoL). Outcome measures were measures of HG disease severity present at 1 week after hospital admission, including weight change, PUQE-24 and NVPQoL scores. Total days of admission hospital admission and readmission were also considered outcome measures. RESULTS We found that high PUQE-24 and NVPQoL scores at hospital admission were associated with those 1 week after hospital admission (difference (β) 0.36, 95 %CI 0.16 to 0.57 and 0.70,95 %CI 0.45-1.1). PUQE-24 and NVPQoL scores were not associated with other outcome measures. None of the patient characteristics were associated with any of the outcome measures. CONCLUSION Our findings suggest that the PUQE-24 and NVPQoL questionnaires can identify women that maintain high symptom scores a week after admission, but that patient characteristics cannot be used as determinants of HG disease course and severity.
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Affiliation(s)
- Marjette H Koot
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Iris J Grooten
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Obstetrics and Gynaecology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Joris A M van der Post
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Joke M J Bais
- Department of Obstetrics and Gynaecology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Carrie Ris-Stalpers
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Laboratory of Reproductive Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mariska M G Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Henk A Bremer
- Department of Obstetrics and Gynecology, Reinier de Graaf Hospital, Delft, the Netherlands
| | - David P van der Ham
- Department of Obstetrics and Gynecology, Martini Hospital, Groningen, the Netherlands
| | - Wieteke M Heidema
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anjoke Huisjes
- Department of Obstetrics and Gynecology, Gelre Hospital, Apeldoorn, the Netherlands
| | - Gunilla Kleiverda
- Department of Obstetrics and Gynecology, Flevo Hospital, Almere, the Netherlands
| | - Simone M Kuppens
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, the Netherlands
| | - Judith O E H van Laar
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, the Netherlands
| | - Josje Langenveld
- Department of Obstetrics and Gynecology, Zuyderland Hospital, Heerlen, the Netherlands
| | - Flip van der Made
- Department of Obstetrics and Gynecology, Franciscus Gasthuis, Rotterdam, the Netherlands
| | | | - Dimitri Papatsonis
- Department of Obstetrics and Gynecology, Amphia Hospital, Breda, the Netherlands
| | - Marie-José Pelinck
- Department of Obstetrics and Gynecology, Scheper Hospital, Emmen, the Netherlands
| | - Paula J Pernet
- Department of Obstetrics and Gynecology, Spaarne Gasthuis, Haarlem, the Netherlands
| | | | - Robbert J Rijnders
- Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, 's, Hertogenbosch, the Netherlands
| | - Hubertina C J Scheepers
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Tatjana E Vogelvang
- Department of Obstetrics and Gynecology, Diakonessenhuis, Utrecht, the Netherlands
| | - Ben W Mol
- Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia
| | - Tessa J Roseboom
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Rebecca C Painter
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Abstract
Nausea and vomiting of pregnancy (NVP) is a common condition that affects as many as 70% of pregnant women. Although no consensus definition is available for hyperemesis gravidarum (HG), it is typically viewed as the severe form of NVP and has been reported to occur in 0.3-10.8% of pregnant women. HG can be associated with poor maternal, fetal and child outcomes. The majority of women with NVP can be managed with dietary and lifestyle changes, but more than one-third of patients experience clinically relevant symptoms that may require fluid and vitamin supplementation and/or antiemetic therapy such as, for example, combined doxylamine/pyridoxine, which is not teratogenic and may be effective in treating NVP. Ondansetron is commonly used to treat HG, but studies are urgently needed to determine whether it is safer and more effective than using first-line antiemetics. Thiamine (vitamin B1) should be introduced following protocols to prevent refeeding syndrome and Wernicke encephalopathy. Recent advances in the genetic study of NVP and HG suggest a placental component to the aetiology by implicating common variants in genes encoding placental proteins (namely GDF15 and IGFBP7) and hormone receptors (namely GFRAL and PGR). New studies on aetiology, diagnosis, management and treatment are under way. In the next decade, progress in these areas may improve maternal quality of life and limit the adverse outcomes associated with HG.
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Mitsuda N, Eitoku M, Maeda N, Fujieda M, Suganuma N. Severity of Nausea and Vomiting in Singleton and Twin Pregnancies in Relation to Fetal Sex: The Japan Environment and Children's Study (JECS). J Epidemiol 2018; 29:340-346. [PMID: 30416162 PMCID: PMC6680056 DOI: 10.2188/jea.je20180059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background Some studies have indicated that female birth and multiple births were risk factors for nausea and vomiting during pregnancy (NVP). The results, however, were conflicting. Our study was conducted to evaluate the association of maternal NVP with fetal sex in singleton and twin pregnancies. Methods We used the data set from a birth cohort study, the Japan Environment and Children’s Study (JECS). In the self-administered questionnaire, participants were asked whether they experienced NVP prior to 12 gestational weeks. Main outcome measures were the presence of NVP and severity of NVP. We estimated the association of fetal sex and birth plurality with NVP using logistic regression analysis, followed by interaction analysis. Results Of 91,666 women, 75,828 (82.7%) experienced at least some symptoms of NVP and 10,159 (11.1%) experienced severe NVP. Women with female pregnancies and twin pregnancies had higher odds for the presence of NVP and severe NVP compared to women with male pregnancies and singleton pregnancies, respectively. Moreover, of mothers with twin pregnancies, higher odds for the presence of NVP and severe NVP were reported when one or both infants were female, compared to those in which both infants were male. There was no significant interaction between fetal sex and birth plurality. Conclusions Female sex birth and multiple births are risk factors for the presence of NVP, and especially for severe NVP without interaction. These findings suggest that a factor abundant in the female fetus associates with the severity of NVP.
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Affiliation(s)
- Naomi Mitsuda
- Department of Environmental Medicine, Kochi Medical School, Kochi University
| | - Masamitsu Eitoku
- Department of Environmental Medicine, Kochi Medical School, Kochi University
| | - Nagamasa Maeda
- Department of Obstetrics and Gynecology, Kochi Medical School, Kochi University
| | - Mikiya Fujieda
- Department of Pediatrics, Kochi Medical School, Kochi University
| | - Narufumi Suganuma
- Department of Environmental Medicine, Kochi Medical School, Kochi University
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Schalekamp-Timmermans S, Arends LR, Alsaker E, Chappell L, Hansson S, Harsem NK, Jälmby M, Jeyabalan A, Laivuori H, Lawlor DA, Macdonald-Wallis C, Magnus P, Myers J, Olsen J, Poston L, Redman CW, Staff AC, Villa P, Roberts JM, Steegers EA. Fetal sex-specific differences in gestational age at delivery in pre-eclampsia: a meta-analysis. Int J Epidemiol 2018; 46:632-642. [PMID: 27605586 PMCID: PMC5837300 DOI: 10.1093/ije/dyw178] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2016] [Indexed: 12/27/2022] Open
Abstract
Background: Pre-eclampsia (PE) is a major pregnancy disorder complicating up to 8% of pregnancies. Increasing evidence indicates a sex-specific interplay between the mother, placenta and fetus. This may lead to different adaptive mechanisms during pregnancy. Methods: We performed an individual participant data meta-analysis to determine associations of fetal sex and PE, with specific focus on gestational age at delivery in PE. This was done on 219 575 independent live-born singleton pregnancies, with a gestational age at birth between 22.0 and 43.0 weeks of gestation, from 11 studies participating in a worldwide consortium of international research groups focusing on pregnancy. Results: Of the women, 9033 (4.1%) experienced PE in their pregnancy and 48.8% of the fetuses were female versus 51.2% male. No differences in the female/male distribution were observed with respect to term PE (delivered ≥ 37 weeks). Preterm PE (delivered < 37 weeks) was slightly more prevalent among pregnancies with a female fetus than in pregnancies with a male fetus [odds ratio (OR) 1.11, 95% confidence interval (CI) 1.02–1.21]. Very preterm PE (delivered < 34 weeks) was even more prevalent among pregnancies with a female fetus as compared with pregnancies with a male fetus (OR 1.36, 95% CI 1.17–1.59). Conclusions: Sexual dimorphic differences in the occurrence of PE exist, with preterm PE being more prevalent among pregnancies with a female fetus as compared with pregnancies with a male fetus and with no differences with respect to term PE.
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Affiliation(s)
| | | | - Lidia R Arends
- Institute of Psychology, and Department of Pedagogical Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands, and Erasmus Medical Centre, Department of Biostatistics, Rotterdam, The Netherlands
| | - Elin Alsaker
- Norwegian Institute of Public Health, Oslo, Norway
| | - Lucy Chappell
- Women's Health Academic Centre, King's College London and King's Health Partners, London, UK
| | - Stefan Hansson
- Lund University, Department of Clinical Sciences, Obstetrics and Gynecology, Lund, Sweden, and Skåne University Hospital, Perinatal Unit, Malmo, Sweden
| | - Nina K Harsem
- Oslo University Hospital, Department of Obstetrics, Oslo, Norway
| | - Maya Jälmby
- Lund University, Department of Clinical Sciences, Obstetrics and Gynecology, Lund, Sweden, and Skåne University Hospital, Department of Obstetrics and Gynecology, Malmo, Sweden
| | - Arundhathi Jeyabalan
- University of Pittsburgh School of Medicine, Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Pittsburgh, PA, USA
| | - Hannele Laivuori
- Medical and Clinical Genetics and Obstetrics and Gynecology, and Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, School of Social and Community Medicine, Bristol, UK
| | - Corrie Macdonald-Wallis
- MRC Integrative Epidemiology Unit at the University of Bristol, School of Social and Community Medicine, Bristol, UK
| | - Per Magnus
- Norwegian Institute of Public Health, Oslo, Norway
| | - Jenny Myers
- Maternal & Fetal Health Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Jørn Olsen
- Aarhus University, Institute of Clinical Epidemiology, Aarhus, Denmark, and UCLA Los Angeles, Los Angeles, CA, USA
| | - Lucilla Poston
- Women's Health Academic Centre, King's College London and King's Health Partners, London, UK
| | - Christopher W Redman
- Nuffield Department of Obstetrics and Gynecology, John Radcliffe Hospital, Oxford, UK
| | - Anne C Staff
- Oslo University Hospital, Department of Obstetrics and Department of Gynecology, University of Oslo, Oslo, Norway
| | - Pia Villa
- Obstetrics and Gynecology, and Clinical Graduate School in Pediatrics and Obstetrics/Gynecology, University of Helsinki, Helsinki, Finland
| | - James M Roberts
- Department of Obstetrics, Gynecology and Reproductive Sciences, Epidemiology and Clinical and Translational Research University of Pittsburgh, Pittsburgh, PA, USA
| | - Eric A Steegers
- Erasmus Medical Centre, Department of Obstetrics and Gynecology, Rotterdam, The Netherlands
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Fossum S, Vikanes ÅV, Næss Ø, Vos L, Grotmol T, Halvorsen S. Hyperemesis gravidarum and long-term mortality: a population-based cohort study. BJOG 2017; 124:1080-1087. [PMID: 27981734 PMCID: PMC5484313 DOI: 10.1111/1471-0528.14454] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2016] [Indexed: 12/27/2022]
Abstract
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.
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Affiliation(s)
- S Fossum
- Department of CardiologyOslo University Hospital UllevalOsloNorway
- Epidemiological DivisionNational Institute of Public HealthOsloNorway
| | - ÅV Vikanes
- The Intervention CenterOslo University HospitalOsloNorway
| | - Ø Næss
- University of OsloOsloNorway
- Epidemiological DivisionNational Institute of Public HealthOsloNorway
| | - L Vos
- Cancer Registry of NorwayOsloNorway
| | | | - S Halvorsen
- Department of CardiologyOslo University Hospital UllevalOsloNorway
- University of OsloOsloNorway
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Kasap E, Aksu EE, Gur EB, Genc M, Eskicioğlu F, Gökduman A, Güçlü S. Investigation of the relationship between salivary cortisol, dehydroepiandrosterone sulfate, anxiety, and depression in patients with hyperemesis gravidarum. J Matern Fetal Neonatal Med 2016; 29:3686-9. [PMID: 26752270 DOI: 10.3109/14767058.2016.1140741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this study was to determine the relationship of the salivary levels of dehydroepiandrosterone sulfate (DHEA-S) and cortisol with factors related to depression and anxiety in patients with hyperemesis gravidarum (HG). METHODS Forty patients with a diagnosis of HG were selected for the study and matched with 40 control patients according to body mass index, parity, and age. Symptoms of depression and anxiety were investigated using the Beck Depression Inventory and Beck Anxiety Inventory for Adults, respectively. Saliva samples were collected in the morning and at night and subjected to enzyme-linked immunosorbent assay for the determination of DHEA-S and cortisol levels. RESULTS We observed a positive correlation between increased levels of depression and anxiety and increased salivary levels of cortisol and DHEA-S in patients with HG. CONCLUSIONS Salivary cortisol and DHEA-S levels, as well as mood disorders, should be monitored in patients with HG, although further large, prospective studies are needed to confirm our results.
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Affiliation(s)
- Esin Kasap
- a Department of Obstetrics and Gynecology
| | - Ebru Emine Aksu
- b Department of Psychiatry , Sifa University School of Medicine , İzmir , Turkey
| | | | - Mine Genc
- a Department of Obstetrics and Gynecology
| | - Fatma Eskicioğlu
- c Department of Obstetrics and Gynecology , Merkez Efendi State Hospital , Manisa , Turkey , and
| | - Ayşe Gökduman
- d Department of Biochemistry , Sifa University School of Medicine , İzmir , Turkey
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11
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Disgust in pregnancy and fetus sex—Longitudinal study. Physiol Behav 2015; 139:177-81. [DOI: 10.1016/j.physbeh.2014.11.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 11/08/2014] [Accepted: 11/10/2014] [Indexed: 01/21/2023]
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Hyperemesis gravidarum: a holistic overview and approach to clinical assessment and management. J Perinat Neonatal Nurs 2015; 29:12-22; quiz E1. [PMID: 25534678 DOI: 10.1097/jpn.0000000000000075] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hyperemesis gravidarum (HG) is a rare and severe form of nausea and vomiting of pregnancy associated with significant costs and psychosocial impacts. The etiology of HG remains largely unknown, although maternal genetics and placental factors are suspected. Prompt recognition and treatment of HG are essential to minimize associated maternal and fetal morbidity. Diagnosis is made on the basis of typical presentation, with exclusion of other causes of severe nausea and vomiting of pregnancy. Validated clinical tools are available to assess severity of symptoms and guide plans of care. Evidence to guide management of HG is limited, but many nonpharmacologic and pharmacologic interventions are available with published guidelines to inform implementation. Care of the woman with HG requires compassion and acknowledgement of individual needs and responses to interventions.
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Abstract
Hyperemesis gravidarum is a complex condition with a multifactorial etiology characterized by severe intractable nausea and vomiting. Despite a high prevalence, studies exploring underlying etiology and treatments are limited. We performed a literature review, focusing on articles published over the last 10 years, to examine current perspectives and recent developments in hyperemesis gravidarum.
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Affiliation(s)
- Fergus P McCarthy
- The Irish Centre for Fetal and Neonatal Translational Research, University College Cork, Cork, Ireland
| | - Jennifer E Lutomski
- National Perinatal Epidemiology Centre, Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Richard A Greene
- National Perinatal Epidemiology Centre, Cork University Maternity Hospital, Wilton, Cork, Ireland
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Tan PC, Zaidi SN, Azmi N, Omar SZ, Khong SY. Depression, anxiety, stress and hyperemesis gravidarum: temporal and case controlled correlates. PLoS One 2014; 9:e92036. [PMID: 24637791 PMCID: PMC3956867 DOI: 10.1371/journal.pone.0092036] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 02/19/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the temporal and case-controlled correlations of anxiety, depression and stress with hyperemesis gravidarum. STUDY DESIGN We performed a longitudinal cohort study of women with hyperemesis gravidarum using the Depression, Anxiety and Stress Scale (DASS-21) to evaluate psychological distress at hospitalization and in the third trimester of pregnancy (from 28 weeks gestation). Third pregnancy trimester controls were recruited from routine antenatal clinic attendees who were matched to gestational age at the second DASS-21 assessment in the HG cohort. RESULTS The prevalences of nausea and vomiting, depression, anxiety and stress caseness in newly hospitalised hyperemesis gravidarum women were 100% and 100%, 19%, 69% and 21% which by the third trimester had fallen to 15.7% and 9.9%, 4%, 19% and 3% and in third trimester controls were 15.9% and 14.2%, 14%, 61% and 20% respectively. Within the hyperemesis gravidarum cohort, nausea, vomiting depression, anxiety and stress reduced significantly by an absolute 84.3% (95% CI 76.2%-89.8%), 90.1% (82.8%-94.2%), 14.9% (7.2%-23.0%), 49.6% (38.6%-58.7%) and 18.2% (10.4%-26.4%) respectively between hospitalization for hyperemesis gravidarum and at the third trimester. In the third trimester, when comparing the hyperemesis gravidarum cohort to controls, the risk of nausea or vomiting was similar but depression, anxiety and stress were significantly lower: adjusted odds ratio AOR 0.10 (95% CI 0.03-0.5), 0.11 (0.05-0.23) and 0.08 (0.02-0.33) respectively. CONCLUSION Our study revealed a reassuring pattern of a strong rebound from depression, anxiety and stress in women with hyperemesis gravidarum such that by the third pregnancy trimester the level of psychological distress was even lower than in controls. This observation imply that much of the psychological distress in acute hyperemesis gravidarum is self-limiting and probably in the causal pathway of hyperemesis gravidarum. Care in women with hyperemesis gravidarum should focus on the relief of nausea and vomiting.
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Affiliation(s)
- Peng Chiong Tan
- Department of Obstetrics and Gynaecology, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
- * E-mail:
| | - Syeda Nureena Zaidi
- Department of Obstetrics and Gynaecology, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Noor Azmi
- Department of Obstetrics and Gynaecology, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Siti Zawiah Omar
- Department of Obstetrics and Gynaecology, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Su Yen Khong
- Department of Obstetrics and Gynaecology, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
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Helseth R, Ravlo M, Carlsen SM, Vanky EE. Androgens and hyperemesis gravidarum: a case-control study. Eur J Obstet Gynecol Reprod Biol 2014; 175:167-71. [PMID: 24472692 DOI: 10.1016/j.ejogrb.2014.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 11/28/2013] [Accepted: 01/05/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The pathogenesis of hyperemesis gravidarum (HG) is probably multifactorial, involving several hormones. Androgen concentrations are reported to correlate positively with emesis gravidarum. Hypothesizing a continuum between emesis gravidarum and HG, we investigated androgen concentrations in women with HG. STUDY DESIGN In a case-control study, 32 women hospitalized for HG were compared with 29 control women scheduled for elective surgical abortion. Control women were matched for age, gestational length, body mass index (BMI) and parity. Patient characteristics and concentrations of dehydroepiandrosterone sulphate (DHEAS), androstenedione, testosterone, sex hormone binding globulin (SHBG), free testosterone index (FTI), androstanediol glucuronide (ADG), progesterone, TSH, free T3 and T4, beta-hCG, ferritin, insulin, estradiol and estriol were compared using Mann-Whitney tests and multivariate linear regression analyses. RESULTS Women with HG had higher concentrations of ADG (8.49±4.19 vs. 6.19±1.77pmol/L; p=0.015), estradiol (2.39±1.36 vs. 1.60±9.30nmol/L; p=0.009) and ferritin (186±138 vs. 117±94pmol/L; p=0.040) compared with control women. Androstenedione (5.34±2.82 vs. 6.86±2.67; p=0.004) and insulin (63.7±35.0 vs. 75.3±25.8; p=0.050) concentrations were lower in women with HG. DHEAS, testosterone, FTI, SHBG, estriol, progesterone, beta-hCG, TSH, free T3 and free T4 concentrations did not differ between the groups. In multivariate regression analyses HG was associated with high concentrations of ADG (p=0.026) and low concentrations of androstenedione (p=0.018). CONCLUSION Steroid hormone homeostasis may be altered in women with HG. HG may be associated with high ADG and low androstenedione concentrations.
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Affiliation(s)
- Ragnhild Helseth
- Department of Internal Medicine, Drammen Hospital, Vestre Viken, 3004 Drammen, Norway.
| | - Merethe Ravlo
- Department of Obstetrics and Gynecology, St. Olav's Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Sven M Carlsen
- Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, 7489 Trondheim, Norway; Department of Endocrinology, St. Olav's Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - E Eszter Vanky
- Department of Obstetrics and Gynecology, St. Olav's Hospital, Trondheim University Hospital, 7006 Trondheim, Norway; Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, 7489 Trondheim, Norway
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Peled Y, Melamed N, Hiersch L, Hadar E, Wiznitzer A, Yogev Y. Pregnancy outcome in hyperemesis gravidarum--the role of fetal gender. J Matern Fetal Neonatal Med 2013; 26:1753-7. [PMID: 23611752 DOI: 10.3109/14767058.2013.798293] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine whether the incidence, severity and effects of hyperemesis gravidarum (HEG) are related to fetal gender. METHOD A retrospective study of all pregnant women who were admitted with the diagnosis of HEG between 1994 and 2008 (N = 545). The association between fetal gender and pregnancy outcome in pregnancies complicated by HEG was compared to that of a control group of women with singleton pregnancies matched by maternal age and parity in a 3:1 ratio (N = 1635). RESULTS Women with HEG with a female fetus were younger (28.2 ± 4.8y versus 29.5 ± 5.5y, p = 0.003), were admitted earlier in pregnancy for HEG (admission < 10w: 62.3% versus 53.4%, p = 0.04), and were more likely to require TPN support (35.6% versus 26.9%, p = 0.03) compared to women with HEG having a male fetus. Compared to controls, women with HEG were more likely to have a female rather than a male fetus (odds ratio (OR) = 1.20) although this difference reached statistical significance only for the subgroup of women with HEG who were admitted prior to 10 weeks of gestation (OR = 1.40, 95%-confidence interval (CI) 1.03-1.70) or who required TPN support (OR = 1.593, 95% CI 1.15-2.0263). The presence of a male fetus in pregnancies complicated by HEG was associated with an increased risk for preterm delivery (OR = 0.49, 95% CI 0.27-0.87), and composite neonatal morbidity (OR = 0.38, 95% CI 0.20-0.74). CONCLUSION Although HEG appears to be more common and more severe in the presence of a female fetus, male fetuses appear to be more susceptible to the adverse effects of HEG on pregnancy outcome.
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Affiliation(s)
- Yoav Peled
- Helen Schneider Hospital for Women, Rabin Medical Center , Petach Tikva , Israel and
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Dextrose saline compared with normal saline rehydration of hyperemesis gravidarum: a randomized controlled trial. Obstet Gynecol 2013; 121:291-298. [PMID: 23232754 DOI: 10.1097/aog.0b013e31827c5e99] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare 5% dextrose-0.9% saline against 0.9% saline solution in the intravenous rehydration of hyperemesis gravidarum. METHODS Women at their first hospitalization for hyperemesis gravidarum were enrolled on admission to the ward and randomly assigned to receive either 5% dextrose-0.9% saline or 0.9% saline by intravenous infusion at a rate 125 mL/h over 24 hours in a double-blind trial. All participants also received thiamine and an antiemetic intravenously. Oral intake was allowed as tolerated. Primary outcomes were resolution of ketonuria and well-being (by 10-point visual numerical rating scale) at 24 hours. Nausea visual numerical rating scale scores were obtained every 8 hours for 24 hours. RESULTS Persistent ketonuria rates after the 24-hour study period were 10 of 101 (9.9%) compared with 11 of 101 (10.9%) (P>.99; relative risk 0.9, 95% confidence interval 0.4-2.2) and median (interquartile range) well-being scores at 24 hours were 9 (8-10) compared with 9 (8-9.5) (P=.73) in the 5% dextrose-0.9% saline and 0.9% saline arms, respectively. Repeated measures analysis of variance of the nausea visual numerical rating scale score as assessed every 8 hours during the 24-hour study period showed a significant difference in favor of the 5% dextrose-0.9% saline arm (P=.046) with the superiority apparent at 8 and 16 hours, but the advantage had dissipated by 24 hours. Secondary outcomes of vomiting, resolution of hyponatremia, hypochloremia and hypokalemia, length of hospitalization, duration of intravenous antiemetic, and rehydration were not different. CONCLUSIONS Intravenous rehydration with 5% dextrose-0.9% saline or 0.9% saline solution in women hospitalized for hyperemesis gravidarum produced similar outcomes. CLINICAL TRIAL REGISTRATION ISRCTN Register, www.controlled-trials.com/isrctn, ISRCTN65014409. LEVEL OF EVIDENCE I.
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18
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Rashid M, Rashid MH, Malik F, Herath RP. Hyperemesis gravidarum and fetal gender: a retrospective study. J OBSTET GYNAECOL 2012; 32:475-8. [PMID: 22663323 DOI: 10.3109/01443615.2012.666580] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This retrospective study of 9,980 women who delivered at the James Paget Hospital, Norfolk, UK, over 5 years, aimed to primarily determine whether the incidence of hyperemesis gravidarum (HG) is higher in the presence of a female fetus. The results showed that more women with HG had a female fetus compared with women without HG. Also found was that heavy ketonuria was more prevalent in women with a female fetus compared with women with a male fetus, and the mean number of admissions per woman was also higher in women with a female fetus compared with women with a male fetus. It can be concluded that women presenting with HG are more likely to have a female fetus and that women with HG and a female fetus tend to a higher level of ketonuria and an increased number of hospital admissions.
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Affiliation(s)
- M Rashid
- Department of Obstetrics and Gynaecology, James Paget Hospital, Great Yarmouth, UK.
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McCarthy FP, Khashan AS, North RA, Moss-Morris R, Baker PN, Dekker G, Poston L, Kenny LC. A prospective cohort study investigating associations between hyperemesis gravidarum and cognitive, behavioural and emotional well-being in pregnancy. PLoS One 2011; 6:e27678. [PMID: 22125621 PMCID: PMC3220681 DOI: 10.1371/journal.pone.0027678] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 10/22/2011] [Indexed: 11/26/2022] Open
Abstract
Objectives To investigate the association between hyperemesis gravidarum and altered cognitive, behavioural and emotional well-being in pregnancy. Methods The study cohort consisted of 3423 nulliparous women recruited in the Screening for Pregnancy Endpoints (SCOPE) study performed in Auckland, New Zealand; Adelaide, Australia; Cork, Ireland; Manchester and London, United Kingdom between November 2004 and August 2008. Women were interviewed at 15±1 weeks' gestation and at 20±1weeks' gestation. Women with a diagnosis of hyperemesis gravidarum (HG) were compared with women who did not have a diagnosis of HG. Main outcome measures included the Short form State- Trait Anxiety Inventory (STAI) score (range 6–24), Perceived Stress Scale score (PSS, range 0–30), Edinburgh Postnatal Depression Scale (EPDS) score (range 0–30 or categories a–c) and behavioural responses to pregnancy score (limiting/resting [range 0–20] and all-or-nothing [range 0–28]). Results During the study period 164 women suffered from HG prior to their 15 week interview. Women with HG had significantly higher mean STAI, PSS, EPDS and limiting response to pregnancy scores compared to women without HG. These differences were observed at both 15±1 and 20±1 weeks' of gestation. The magnitude of these differences was greater in women with severe HG compared to all women with HG. Women with severe HG had an increased risk of having a spontaneous preterm birth compared with women without HG (adjusted OR 2.6 [95% C.I. 1.2, 5.7]). Conclusion This is the first large prospective study on women with HG. Women with HG, particularly severe HG, are at increased risk of cognitive, behavioural and emotional dysfunction in pregnancy. Women with severe HG had a higher rate of spontaneous preterm birth compared to women without HG. Further research is required to determine whether the provision of emotional support for women with HG is beneficial.
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Affiliation(s)
- Fergus P McCarthy
- Department of Obstetrics and Gynecology, The Anu Research Centre, Cork University Maternity Hospital, University College Cork, Cork, Ireland.
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Tan PC, King ASJ, Omar SZ. Screening for urinary tract infection in women with hyperemesis gravidarum. J Obstet Gynaecol Res 2011; 38:145-53. [DOI: 10.1111/j.1447-0756.2011.01652.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Veenendaal MVE, van Abeelen AFM, Painter RC, van der Post JAM, Roseboom TJ. Consequences of hyperemesis gravidarum for offspring: a systematic review and meta-analysis. BJOG 2011; 118:1302-13. [PMID: 21749625 DOI: 10.1111/j.1471-0528.2011.03023.x] [Citation(s) in RCA: 134] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- M V E Veenendaal
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
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Sanu O, Lamont RF. Hyperemesis gravidarum: pathogenesis and the use of antiemetic agents. Expert Opin Pharmacother 2011; 12:737-48. [DOI: 10.1517/14656566.2010.537655] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Zhang Y, Cantor RM, MacGibbon K, Romero R, Goodwin TM, Mullin PM, Fejzo MS. Familial aggregation of hyperemesis gravidarum. Am J Obstet Gynecol 2011; 204:230.e1-7. [PMID: 20974461 DOI: 10.1016/j.ajog.2010.09.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 07/06/2010] [Accepted: 09/20/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study was undertaken to determine whether there is familial aggregation of hyperemesis gravidarum (HG), making it a disease amenable to genetic study. STUDY DESIGN Cases with severe nausea and vomiting in a singleton pregnancy treated with intravenous hydration and unaffected friend controls completed a survey regarding family history. RESULTS Sisters of women with HG have a significantly increased risk of having HG themselves (odds ratio, 17.3; P = .005). Cases have a significantly increased risk of having a mother with severe nausea and vomiting; 33% of cases reported an affected mother compared to 7.7% of controls (P < .0001). Cases reported a similar frequency of affected second-degree maternal and paternal relatives (18% maternal lineage, 23% paternal lineage). CONCLUSION There is familial aggregation of HG. This study provides strong evidence for a genetic component to HG. Identification of the predisposing gene(s) may determine the cause of this poorly understood disease of pregnancy.
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Affiliation(s)
- Yafeng Zhang
- Department of Human Genetics, David Geffen School of Medicine, University of California-Los Angeles, CA 90095, USA
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Peck JD, Leviton A, Cowan LD. A review of the epidemiologic evidence concerning the reproductive health effects of caffeine consumption: a 2000-2009 update. Food Chem Toxicol 2010; 48:2549-76. [PMID: 20558227 DOI: 10.1016/j.fct.2010.06.019] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 06/08/2010] [Accepted: 06/10/2010] [Indexed: 01/27/2023]
Abstract
This review of human studies of caffeine and reproductive health published between January 2000 and December 2009 serves to update the comprehensive review published by Leviton and Cowan (2002). The adverse reproductive outcomes addressed in this review include: (1) measures of subfecundity; (2) spontaneous abortion; (3) fetal death; (4) preterm birth; (5) congenital malformations; and (6) fetal growth restriction. Methodologic challenges and considerations relevant to investigations of each reproductive endpoint are summarized, followed by a brief critical review of each study. The evidence for an effect of caffeine on reproductive health and fetal development is limited by the inability to rule out plausible alternative explanations for the observed associations, namely confounding by pregnancy symptoms and smoking, and by exposure measurement error. Because of these limitations, the weight of evidence does not support a positive relationship between caffeine consumption and adverse reproductive or perinatal outcomes.
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Affiliation(s)
- Jennifer David Peck
- University of Oklahoma Health Sciences Center, College of Public Health, USA.
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Promethazine compared with metoclopramide for hyperemesis gravidarum: a randomized controlled trial. Obstet Gynecol 2010; 115:975-981. [PMID: 20410771 DOI: 10.1097/aog.0b013e3181d99290] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To compare the effects of promethazine with those of metoclopramide for hyperemesis gravidarum. METHODS Women at their first hospitalization for hyperemesis gravidarum were approached when intravenous antiemetic therapy was needed. They were randomly assigned to receive 25 mg promethazine or 10 mg metoclopramide every 8 hours for 24 hours in a double-blind study. Primary outcomes were vomiting episodes by diary and well-being visual numerical rating scale score (10-point scale) in the 24-hour main study period. Participants also filled out an adverse-effects questionnaire at 24 hours and a nausea visual numerical rating scale score at recruitment and at 8, 16, and 24 hours. RESULTS A total of 73 and 76 women, randomized to metoclopramide and promethazine, respectively, were analyzed. Median vomiting episodes were one (range 0-26) compared with two (range 0-26) (P=.81), and well-being visual numerical rating scale scores were 8 (range 1-10) compared with 7 (range 2-10) (P=.24) for metoclopramide and promethazine, respectively. Repeat-measures analysis of variance of the nausea visual numerical rating scale scores showed no significant difference between study drugs (F score=0.842, P=.47). Reported drowsiness (58.6% compared with 83.6%, P=.001, number needed to treat to benefit [NNTb] 5), dizziness (34.3% compared with 71.2%, P<.001, NNTb 3), dystonia (5.7% compared with 19.2%, P=.02, NNTb 8), and therapy curtailment owing to adverse events (0 of 73 [0%] compared with 7 of 76 [9.2%], P=.014) were encountered less frequently with metoclopramide. CONCLUSION Promethazine and metoclopramide have similar therapeutic effects in patients who are hospitalized for hyperemesis gravidarum. The adverse effects profile was better with metoclopramide.
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Anxiety and depression in hyperemesis gravidarum: prevalence, risk factors and correlation with clinical severity. Eur J Obstet Gynecol Reprod Biol 2010; 149:153-8. [PMID: 20097465 DOI: 10.1016/j.ejogrb.2009.12.031] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Revised: 10/20/2009] [Accepted: 12/22/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate prevalence, risk factors and clinical severity correlates of anxiety and depression caseness in hyperemesis gravidarum (HG). STUDY DESIGN A prospective study of self-assessment using the Hospital Anxiety and Depression Scale (HADS) was performed. Women at their first hospitalization for HG were recruited as soon as possible after hospital admission. Cut-off at the score of 7/8 was used for both the anxiety and depression subscales of HADS to denote anxiety and depression caseness respectively. Risk factors for anxiety and depression caseness were identified using Chi-square test, Fisher's exact test, Mann-Whitney's U-test or the Student's t-test. Multivariable logistic regression analysis incorporating all co-variables with crude P<0.1 was performed to identify independent risk factors. Bivariate analyses were performed to identify associations between clinical markers of severity and anxiety and depression caseness. Prolonged hospitalization and a number of biochemical and hematological abnormalities were used as clinical markers of HG severity. RESULTS Criteria for anxiety and depression caseness were fulfilled in 98/209 (46.9%) and 100/209 (47.8%) women respectively. 78 (37.3%) participants fulfilled the criteria for both anxiety and depression caseness, 89 (42.6%) neither, 20 (9.6%) anxiety caseness only and 22 (10.5%) depression caseness only. Gestational age at commencement of vomiting, duration of vomiting leading up to hospitalization and paid employment status had crude P<0.1 in association with anxiety caseness. After adjustment, only paid employment was independently associated with anxiety caseness (AOR 2.9 95% CI 1.3-6.5; P=0.009). Previous miscarriage, gestational age at commencement of vomiting and duration of vomiting leading up to hospitalization all had P<0.1 in association with depression caseness. After adjustment, only previous miscarriage was negatively associated with depression caseness (AOR 0.4 95% CI 0.2-0.9; P=0.022). There was no marker of HG severity associated with anxiety caseness on bivariate analysis. High hematocrit was associated with depression caseness (OR 2.1 95% CI 1.1-3.9; P=0.027). CONCLUSION Anxiety and depression caseness is common in HG and risk factors can be identified. There is no convincing association between anxiety and depression and more severe illness. Psychological symptoms may be a response to physical illness but further studies are needed.
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Abstract
Hyperemesis gravidarum occurs in 0.3% to 2% of pregnant women, although populations with significantly higher rates have been reported. In clinical practice, hyperemesis gravidarum is identified by otherwise unexplained intractable vomiting and dehydration. This article discusses the causes, presentation, diagnosis, and management of hyperemesis gravidarum.
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Affiliation(s)
- T Murphy Goodwin
- Division of Maternal-Fetal Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
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Hepburn IS, Schade RR. Pregnancy-associated liver disorders. Dig Dis Sci 2008; 53:2334-58. [PMID: 18256934 DOI: 10.1007/s10620-007-0167-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Accepted: 11/26/2007] [Indexed: 12/14/2022]
Abstract
Liver disorders associated with pregnancy include hyperemesis gravidarum (HG), intrahepatic cholestasis of pregnancy (ICP), preeclampsia, syndrome of hemolysis, elevated liver enzymes and low platelets (HELLP), and acute fatty liver of pregnancy (AFLP). These conditions are relatively common and unique to pregnancy and are more likely to occur at certain terms of gestation specific to each condition. They can be associated with significant maternal and fetal morbidity and mortality. Although managing such patients may be very challenging, spontaneous resolution of the disease occurs shortly after termination of the pregnancy, usually without hepatic sequellae. Early diagnosis and timely treatment is a key to therapeutic success. This article explores the clinical features, pathophysiology, and management of these disorders.
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Affiliation(s)
- Iryna S Hepburn
- Department of Medicine, Medical College of Georgia, 1120 15th Street, Augusta, GA 30912, USA.
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Fejzo MS, Ingles SA, Wilson M, Wang W, MacGibbon K, Romero R, Goodwin TM. High prevalence of severe nausea and vomiting of pregnancy and hyperemesis gravidarum among relatives of affected individuals. Eur J Obstet Gynecol Reprod Biol 2008; 141:13-7. [PMID: 18752885 DOI: 10.1016/j.ejogrb.2008.07.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Revised: 04/01/2008] [Accepted: 07/03/2008] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The goal of this study was to determine the prevalence of severe nausea and vomiting of pregnancy/hyperemesis gravidarum among relatives of affected individuals. STUDY DESIGN Family history data were obtained on 1224 self-reported cases of hyperemesis gravidarum. Cases completed an online survey administered by the Hyperemesis Education and Research Foundation between 2003 and 2006. RESULTS Approximately 28% of cases reported their mother had severe nausea and vomiting or hyperemesis gravidarum while pregnant with them. Of the 721 sisters with a pregnancy history, 137 (19%) had hyperemesis gravidarum. Among the most severe cases, those requiring total parenteral nutrition or nasogastric feeding tube, the proportion of affected sisters was even higher, 49/198 (25%). Nine percent of cases reported having at least two affected relatives including sister(s), mother, grandmother, daughters, aunt(s), and cousin(s). CONCLUSION There is a high prevalence of severe nausea and vomiting of pregnancy/hyperemesis gravidarum among relatives of hyperemesis gravidarum cases in this study population. Because the incidence of hyperemesis gravidarum is most commonly reported to be 0.5%, this study provides strong but preliminary evidence for a genetic component to extreme nausea and vomiting of pregnancy.
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Affiliation(s)
- Marlena S Fejzo
- Keck School of Medicine, University of Southern California, Department of Obstetrics and Gynecology, Los Angeles, USA.
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Abstract
Hyperemesis gravidarum is severe, intractable nausea and vomiting affecting 0.3-2% of pregnancies. It has a complex multifactorial aetiology. This review explores the current literature relating to the clinical manifestations, differential diagnosis, epidemiology, possible aetiology, maternal and fetal complications, and evidence-based management of hyperemesis.
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Tan PC, Jacob R, Quek KF, Omar SZ. Pregnancy outcome in hyperemesis gravidarum and the effect of laboratory clinical indicators of hyperemesis severity. J Obstet Gynaecol Res 2007; 33:457-64. [PMID: 17688612 DOI: 10.1111/j.1447-0756.2007.00552.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine pregnancy outcome in hyperemesis gravidarum and the effect of metabolic, biochemical, hematological and clinical indicators of disease severity on outcome. STUDY DESIGN A retrospective study based on 166 women hospitalized for confirmed hyperemesis gravidarum from January 2004 to January 2005. For each woman, three controls matched for age, parity and ethnicity were obtained from our 2004 birth register. The effects of laboratory indicators of hyperemesis severity were separately analyzed within the hyperemesis gravidarum study group. Outcome measures include stillbirths, Apgar score, mode of delivery, low birthweight, preterm delivery, labor induction, pregnancy induced hypertension and gestational diabetes. Analysis was by t-test, Fisher's exact test and multivariable logistic regression analysis. RESULTS Women with hyperemesis had similar pregnancy outcome compared to controls. In the analysis of laboratory indicators of hyperemesis severity and pregnancy outcomes, hypokalemia (adjusted odds ratio [AOR] 2.7: 95% confidence interval [CI] 1.0-6.8) was associated with emergency operative delivery, high creatinine (odds ratio 4.4: 95% CI 1.3-15) with labor induction and raised gamma glutamyltransferase (AOR 7.5: 95% CI 1.2-46) with the development of gestational diabetes. CONCLUSIONS Hyperemesis gravidarum per se was not associated adverse pregnancy outcome. Hypokalemia, high creatinine and raised gamma glutamyltransferase in women with hyperemesis gravidarum were associated with adverse pregnancy outcome.
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Affiliation(s)
- Peng C Tan
- Department of Obstetrics and Gynecology, University of Malaya, Kuala Lumpur.
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