Long-term health effects in children exposed in utero to hyperemesis gravidarum

Abstract

Objective: Previously we reported on the increased risk of adverse neurodevelopmental outcomes in children exposed in utero to hyperemesis gravidarum. The purpose of this study is to determine the frequency of non-neurodevelopmental long-term health effects in children exposed in utero to hyperemesis gravidarum and to identify prognostic factors for these disorders. Study design:Long-term outcomes of 312 children from 203 mothers with hyperemesis gravidarum were compared to outcomes from 169 children from 89 unaffected mothers. The clinical profiles of patients having a child with an adverse outcome were then compared to the clinical profiles of patients having a child with a normal outcome to identify prognostic factors. Proportion tests were used to compare outcomes between variables with binary responses. Continuous responses were analyzed using a t-test.Results: Children exposed in utero to hyperemesis gravidarum have a 3.82-fold increase in odds of being diagnosed with a long-term health effect including allergies, chronic constipation, gastroesophageal reflux disease, growth restriction (height and weight below 20 th percentile), lactose intolerance, chronic respiratory or ear infections, or sleep difficulties (p < 0.0005). Among hyperemesis gravidarum patients, women who took promethazine during pregnancy or began gaining weight later in their pregnancy (after 20 weeks) were more likely to have a child that was diagnosed with allergies (p=0.037 for promethazine and p=0.004 for late weight gain). Those who took antidepressants while pregnant were more likely to have a child with chronic constipation (p=0.029). Metoclopramide use during pregnancy was protective against having a child diagnosed with gastroesophageal reflux disease (p=0.014). Preterm delivery was significantly linked to growth restriction in a child (p=0.003). Both herbal medicine and homeopathics were also significantly linked to growth restriction (p=0.006 for herbal medicine and p=0.001 for homeopathics), as well as to sleep difficulties (p=0.017 for herbal medicine and p=0.013 for homeopathics). Peripherally inserted central catheter and Dolasetron use were linked to having a child with respiratory or ear infections (p=0.006 for PICC and p=0.038 for Dolasetron). Conclusion:Women with hyperemesis gravidarum are at a significantly higher risk of having a child with long-term health effects. This study demonstrates the need for further analyses to address whether hyperemesis gravidarum itself or certain herbal and prescribed medications taken during pregnancy are responsible for the increased risk.

Nutritional consequences and management of hyperemesis gravidarum: a narrative review

“…Although causality cannot be proven based on this observational study, there is strong biological plausibility based on the effect of maternal malnutrition on the developing brain at critical time points (31,32) . A study of 312 children exposed in utero to HG found they have a 3•82fold increase of being diagnosed with conditions including allergies, chronic constipation, growth restriction and chronic respiratory infections (33) . The authors postulate that failure to gain enough weight during pregnancy puts the child at risk for intra-uterine growth restriction, which in turn could incur greater risk for other neurodevelopmental and physical problems.…”

Prenatal effects of maternal nutritional stress and mental health on the fetal movement profile

“…One condition likely to cause nutritional deficiency is Hyperemesis gravidarum (HG). HG is defined by weight loss through excessive vomiting during pregnancy and plays a significant role in health outcomes [9,10]. These effects are long term, in that in utero exposure to HG is significantly associated with poor postnatal mental health outcomes for the child [10].…”