Hyperemesis gravidarum: does it increase offspring risk for inflammatory bowel disease and failure to thrive?

Abstract

Hyperemesis gravidarum (HG) affects about 3% of pregnancies and may lead to nutritional deficits and distress. Since maternal malnutrition and stress have been shown to affect fetal intestine and immune system development, we aimed to study the association between HG and the risk for offspring inflammatory bowel disease (IBD) and failure to thrive (FTT).Study Design: A retrospective cohort study was performed comparing incidence of offspring IBD and FTT between mothers with and without HG diagnosis. All singleton deliveries of mothers from the largest HMO in the country between the years 1991-2021 were included. Their offspring were followed until the age of 18 years, and the studied outcomes were based on hospitalization records of the pediatric databases of a large single tertiary center. Multivariable Cox survival models were used to adjust for confounding characteristics.Results: The study population included 232476 pregnancies, of them 3225 (1.4%) were complicated with HG. Mothers with HG were more likely to be smokers, and to deliver preterm and by cesarean delivery (CD). The incidence of FTT was higher among offspring born to mothers with HG (3.4% versus 2.5%, OR=1.36; 1.12-1.65, p=0.002), as well as IBD (13.3% versus 8.1%, OR= 1.74; 1.57-1.93, p< 0.001; Figure, Kaplan-Meier log rank, p< 0.001 for both). In the multivariable Cox model, offspring born following pregnancies complicated with HG were more likely to suffer from IBD (adjusted HR=1.81; 1.64-2.00, p< 0.001), and FTT (adjusted HR=1.49; 1.23-1.80, p< 0.001) while adjusting for gestational age, maternal age, CD and ethnicity.Conclusion: Offspring of pregnancies complicated with HG are at increased risk for FTT and IBD, suggesting this early life exposure may have long-term effects on the offspring, possibly due to maternal stress and malnutrition during critical period of fetal development.View Large Image Figure ViewerDownload Hi-res image Download (PPT)