Severity of nausea and vomiting in pregnancy and early childhood neurobehavioural outcomes: The Growing Up in Singapore Towards Healthy Outcomes study

Abstract

Background Nausea and vomiting of pregnancy (NVP) affects 50 to 80 per cent of women. The existing literature has examined NVP from the perspective of the mother, and relatively less is known about offspring outcomes. Objectives To study the relationships of NVP with social‐emotional, behavioural, and cognitive outcomes of the offspring in a multi‐ethnic Asian cohort. Methods In the Growing Up in Singapore Towards Healthy Outcomes prospective mother‐offspring cohort study, mothers responded to a structured NVP questionnaire at 26‐28 weeks’ gestation (n = 1172) and participants with severe NVP were confirmed using medical records. Children underwent multiple neurodevelopmental assessments throughout childhood. We conducted multivariable regressions with post‐estimation predictive margins to understand the associations of NVP with offspring neurobehavioural outcomes, which included 1‐year Infant‐Toddler Social and Emotional Assessment, 1.5‐year Quantitative Checklist for Autism in Toddlers, 2‐year Bayley Scales of Infant and Toddler Development, 2‐ and 4‐year Child Behavior Checklist, and 4.5‐year Kaufman Brief Intelligence Test. Analyses were adjusted for household income, birth variables, maternal mental health, and other relevant medical variables. Cohen's d effect sizes were calculated using standardised mean differences (μd). Results Mothers were categorised into no (n = 296, 25.3%), mild‐moderate (n = 686, 58.5%), and severe NVP (n = 190, 16.2%), of whom 67 (5.7%) required admission. Compared to children of mothers who had no or mild‐moderate NVP, children with exposure to severe NVP exhibited more externalising behaviours (μd 2.0, 95% CI 0.3, 3.6; Cohen's d = 0.33) and social communication difficulties before 2 years (μd 4.1, 95% Cl 0.1, 8.0; Cohen's d = 0.38), both externalising (μd 1.5, 95% CI 0.4, 2.6; Cohen's d = 0.43) and internalising behaviours at 2 years (μd 1.2, 95% CI 0.1, 2.2; Cohen's d = 0.35), and only internalising behaviours after 2 years (μd 1.1, 95% CI 0.4, 2.0; Cohen's d = 0.37). Conclusions Severe NVP is highly prevalent in this Asian cohort and may be adversely associated with multiple offspring neurobehavioural outcomes.

Long-term health outcomes of children born to mothers with hyperemesis gravidarum: a systematic review and meta-analysis

“…Two studies (n¼9696 children) found that HG-exposed children had significantly lower cognitive development scores than nonexposed children at ages of 2 32 and 9 to 11 years, respectively. 34 Two studies assessed intelligence by measuring intelligence quotient (IQ) scores: the first study (n¼469 children) did not find any differences in IQ scores at age 4, 32 whereas another study (n¼241 children) found that HGexposed children had significantly lower verbal, performance, and full-scale IQ scores than nonexposed children at 3.5 to 7 years of age.…”

“…Of the studies included, 12 were cohort studies and 8 caseecontrol studies. HG diagnosis was based on self-reports in 7 studies, 2,22,23,25,28,30,37 interviews in 7 studies, 21,27,29,31,32,34,36 International Classification of Diseases (ICD) codes in 5 studies, 24,26,33e35 and medical records in 1 study. 20 In total, 1,814,785 children were included in this systematic review, of whom 36,546 were born to women who experienced HG.…”

“…27 Only the first study adjusted for confounders. 32 Three studies reported on learning difficulties and speech or language impairment/delay. 23,28,32 One of them found that families with at least 1 HGexposed child more often reported learning delays (12.3%) and speech or language impairment/delays (24.1%)…”

“…23 Another study (n¼482 children at age 2) did not find any differences in language skills, measured by the Bayley-III language scale, between HG-exposed and nonexposed children in multivariable regression analysis. 32 The third study (n¼259 adults) did not assess associations per separate outcome, but only stated that 38% of HG-exposed offspring reported having a psychological and/or behavioral disorder (including learning disorders and speech delay), compared with 15% of nonexposed offspring (unadjusted OR, 3.57; 95% CI, 1.87e6.90; P<.001). 28 An association between HG and neurosensory disorders in children was found in 2 studies of Fejzo et al 22,23 including 292 families and 360 children, respectively, at ages of 8 to 9 and 11 to 13.…”

“…One study (N¼1,109,370 children, aged up to 18) reported on developmental problems, including language, learning, and motor-skill problems, and found that they occurred more frequently in HGexposed children than in nonexposed children (adjusted hazard ratio [HR], 1.18; 95% CI, 1.05e1.34), 34 whereas another study (n¼475 children, aged 2) did not find any differences in Bayley-III scores on the subdomain of motor difficulties. 32 A narrative summary of results of included studies reporting on cognitive and motor development is displayed in Supplemental Table 2 4). 28,34 One study assessed affective problems as a subdomain of the Child Behavior Checklist (CBCL) and found higher scores among HGexposed than nonexposed children at 2 and 4 years after adjustments for confounding factors.…”