Diagnostic markers for hyperemesis gravidarum: a systematic review and metaanalysis

Niemeijer, Maartje N.; Grooten, Iris J.; Vos, Nikki; Bais, Joke; Post, Joris A. M. van der; Mol, Ben Willem J.; Roseboom, Tessa J.; Leeflang, Mariska; Painter, Rebecca C.

doi:10.1016/j.ajog.2014.02.012

Cited by 129 publications

(155 citation statements)

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“…The prevalence of HG varies between 0.3 and 3.2%, depending on the maternal country of birth 14, 15. The aetiology is poorly understood, and previous studies suggest different causal mechanisms, involving placental dysfunction, gastrointestinal pathology, immunologic factors and endocrine and metabolic factors 16, 17, 18, 19, 20, 21. Although HG is the most common reason for hospitalisation during the first trimester,22 little is known about the long‐term consequences of HG exposure.…”

Section: Introductionmentioning

confidence: 99%

Hyperemesis gravidarum and long‐term mortality: a population‐based cohort study

Fossum

Vikanes

Næss

et al. 2016

BJOG

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ObjectiveTo investigate whether exposure to hyperemesis gravidarum (HG) is associated with increased maternal long‐term mortality.DesignPopulation‐based cohort study.SettingMedical Birth Registry of Norway (1967–2002) linked to the Cause of Death Registry.PopulationWomen in Norway with singleton births in the period 1967–2002, with and without HG. Women were followed until 2009 or death.MethodsCox proportional hazard regression model was applied to estimate hazard ratios (HRs) with 95% confidence interval (CI).Main outcome measuresThe 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).ResultsOf 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).ConclusionIn 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 abstractPopulation‐based cohort study: Hyperemesis was not associated with an increased risk of long‐term mortality.

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Section: Introductionmentioning

confidence: 99%

Hyperemesis gravidarum and long‐term mortality: a population‐based cohort study

Fossum

Vikanes

Næss

et al. 2016

BJOG

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“…16,26 Goodwin et al, reported severe vomiting in pregnant patients with high level of hCG and in thyroid stimulation and Niemeijer et al, confirmed a relationship between increased thyroid activity and HG. 24,27 It has been pointed out that suggestions of a relationship between hCG or thyroxine levels and NVP are possibly inaccurate since in cases of elevated hCG levels e.g. choriocarcinoma do not align with nausea and vomiting, equally some pregnant women with elevated hCG levels do not experience NVP and hyperthyroidism does not cause nausea or vomiting and patients with HG do not all develop hyperthyroidism.…”

Section: Hormonalmentioning

confidence: 99%

“…23 The effect of progesterone on NVP is not clear and it has been reported that in NVP patients, 40% had low and 40% had increased progesterone levels while in 20% there was no association. 24 Studies have demonstrated a relationship between oestradiol levels and NVP 28 and it has been noted that considering that physiological levels of oestrogens rise during the entirety of pregnancy, it is prudent to question why HG and NVP are most severe during the first trimester. 23 An association between ACTH and cortisol via the HPA in HG has been proposed 29 and corticosteroids are used to treat nausea and vomiting in oncology patients.…”

Section: Hormonalmentioning

confidence: 99%

“…11,16 hCG has a positive correlation with HG and it is suggested that it influences the centre of the brain that controls nausea via thyroxine since hCG acts on maternal thyroid gland stimulating the release of thyroxines. 24,25 In early pregnancy, hCG levels are high and TSH are low in blood and since hCG cross-reacts with TSH receptors stimulating the thyroid gland, increased hCG and/or thyroxine levels therefore influence severity and onset of nausea and emesis. 16,26 Goodwin et al, reported severe vomiting in pregnant patients with high level of hCG and in thyroid stimulation and Niemeijer et al, confirmed a relationship between increased thyroid activity and HG.…”

Section: Hormonalmentioning

confidence: 99%

See 1 more Smart Citation

Morning sickness in pregnancy: mini review of possible causes with proposal for monitoring by diagnostic methods

Wylde

Nwose

Bwititi

2016

Int J Reprod Contracept Obstet Gynecol

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“…There are commonly used diagnostic modalities with low sensitivity, such as clinical findings of patients, weight loss, dehydration, and/or electrolyte imbalance, and ketonuria (3). Urine ketone dipstick tests are used in the ED to screen for ketonuria in patients with PINV to detect metabolic derangements in the early phases.…”

Section: Introductionmentioning

confidence: 99%