Hyperemesis Gravidarum: Unraveling Its Impact on Maternal Health and Fetal Outcomes, finds study

Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting during pregnancy (NVP), which can lead to maternal health issues and potentially negatively impact the fetus and child. Recent study aims to clarify the relationship between hyperemesis gravidarum (HG) and pregnancy outcomes, particularly how the timing of diagnosis and severity of the condition affect results. Hyperemesis gravidarum is a severe form of nausea and vomiting in pregnancy, impacting maternal health and potentially adverse fetal outcomes. Conducted as a retrospective cohort study, it analyzed data from singleton deliveries at a major health maintenance organization in Israel from 1991 to 2021. Of 232,476 pregnancies evaluated, 3,227 (1.4%) experienced HG.

Key Findings

Key findings indicate that women diagnosed with HG had a heightened risk for adverse outcomes compared to those without, particularly characterizing a dose–response effect regarding severity. Specifically, those experiencing severe HG were more likely to have preterm births (adj. OR = 1.33) and lower birth weights (adj. OR = 1.52, particularly for second-trimester diagnoses). Conversely, there appeared to be a lower likelihood of their newborns being classified as small for gestational age (adj. OR = 0.82). Additionally, HG diagnosis in the second trimester correlated with increased risks of cesarean delivery (adj. OR = 1.20) and perinatal mortality, especially among mild cases (adj. OR = 0.54). The risks for preterm birth escalated with severity: 1.26 for mild and 2.04 for severe cases.

Confounding Factors and Timing

The analysis adjusted for various confounding factors, including maternal age, parity, and health complications. The study further notes that HG's maternal impacts, such as nutrient deficiency and psychological distress, could explain the adverse outcomes observed. The findings suggest significant differences in risks associated with the timing of the HG diagnosis, with later diagnoses (second and third trimesters) linked to worse outcomes, particularly preterm births and cesarean deliveries.

Implications and Future Research

The research highlights HG as a serious condition warranting early diagnosis and intervention to mitigate risks. However, the authors recognize limitations, including potential misclassification of diagnoses and the inability to account for treatment variation among mothers. The study is notable for its size and scope, intending to enhance understanding of HG's complexities to inform pregnant women and healthcare professionals regarding effective management strategies. Future investigations are encouraged to explore the underlying mechanisms connecting HG with pregnancy outcomes more comprehensively.

Key Points

- The study investigated the relationship between hyperemesis gravidarum (HG) and pregnancy outcomes, focusing on the timing of diagnosis and severity of HG among singleton deliveries analyzed from 1991 to 2021, with data extracted from a health maintenance organization in Israel.

- Among 232,476 pregnancies reviewed, 3,227 (1.4%) were diagnosed with HG, revealing a heightened risk for adverse pregnancy outcomes, including preterm births and lower birth weights, with severity leading to a dose-response effect (e.g., severe HG showed an adjusted odds ratio (adj. OR) of 1.33 for preterm births and 1.52 for lower birth weights).

- The timing of HG diagnosis was critical, as diagnoses in the second and third trimesters were associated with worse outcomes, including increased risks of cesarean deliveries (adj. OR = 1.20) and perinatal mortality, particularly in cases of mild HG where the odds ratio was 0.54.

- A notable finding was that while the risk of preterm birth escalated with HG severity (1.26 for mild and 2.04 for severe), there was a reduced likelihood of newborns being classified as small for gestational age in HG cases (adj. OR = 0.82).

- The analysis considered various confounding factors such as maternal age, parity, and health complications, addressing potential maternal impacts of HG, including nutrient deficiencies and psychological distress, in relation to the observed adverse outcomes.

- The authors advocate for the early diagnosis and intervention of HG to mitigate risks and acknowledge study limitations, such as possible misclassification of HG diagnoses and variations in treatment, urging future research to explore the mechanisms linking HG to pregnancy outcomes more thoroughly.

Reference –

Omri Porgador et al. (2024). Pregnancy Outcomes By Hyperemesis Gravidarum Severity And Time Of Diagnosis: A Retrospective Cohort Study.. *International Journal Of Gynaecology And Obstetrics: The Official Organ Of The International Federation Of Gynaecology And Obstetrics*. https://doi.org/10.1002/ijgo.15760.