Hyperemesis gravidarum : étude de cohorte rétrospective française (109 patientes)

Abstract

Hyperemesis gravidarum is the most severe form of nausea and vomiting of pregnancy. This condition has been rarely studied in France. To study the clinical and biological features of a French cohort of women with hyperemesis gravidarum. Retrospective data was searched in medical records for all the women admitted for hyperemesis gravidarum in the gynecologic units of the university center of Tours between January 2001 and December 2010. Data were available for 109 women. The prevalence of hyperemesis gravidarum was 3.9 per 1000 deliveries in our center. Half the women were not of French origin. The mean duration of the first hospitalization was 4.6±2.6 days (range: 1-17). Hyperemesis gravidarum was recurrent in 1/3 of the women. Routine liver function tests were found abnormal at admission or during hospitalization in 39.6% of cases with an increased ALT (>35IU/L) in 28.7% of patients. Women with elevated ALAT had more often a body mass index>25kg/m(2) (odds ratio [OR], 3.98; 95% confidence interval [CI], 1.29-12.59; P=0.01), a weight loss ≥6kg (OR, 4.52; CI, 1.53-13.77; P=0.002), and a hospital stay≥6 days (OR, 3.43; CI, 1.19-9.97; P=0.009). There was no difference in pregnancy outcomes between women with normal or increased ALT. Prothrombin time was decreased (<70%) in 25.6% of cases secondary to a vitamin K deficiency. This study shows that hyperemesis gravidarum in our center is frequently associated with a non-French origin, and that abnormal liver function tests and decreases of prothrombin time are common in this condition. Our results suggest that increased ALT is a factor of severity in hyperemesis gravidarum.