Severity Of Hyperemesis Gravidarum Research Articles

Relationship between combined systemic inflammatory indices with presence and severity of hyperemesis gravidarum.

Our study aims to determine the levels of systemic inflammation markers and the combined systemic inflammation indices in hyperemesis gravidarum (HG) patients and to investigate the association between the severity of the disease. The study population consisted of 83 pregnant women with HG and 100 healthy pregnant women matched for gestational age as a control group. We grouped the HG patients according to the Modified Pregnancy Unique Quantification of Emesis/Nausea (PUQE) scoring system as mild, moderate, and severe. We calculated the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), MPV-to-lymphocyte ratio (MPVLR), RDW-to-platelet ratio (RPR), Systemic immune-inflammation index (SII), Systemic Inflammation Response Index (SIRI), and Aggregate Systemic Inflammation Index (AISI). NLR, PLR, SII, SIRI, and AISI levels were significantly higher in the HG group. These indices tended to increase as the severity of the disease increased. We found NLR, PLR, SII, SIRI, and AISI indices as the independent risk factors for the presence and severity of HG. The SIRI index, which has the highest area under the curve (AUC), sensitivity, and specificity values, was determined as the most powerful diagnostic tool in the diagnostic evaluation of the presence (AUC: 0.695; p < 0.001; sensitivity: 54%; specificity: 75%; cut-off: 3.14) and severity (AUC: 0.785; p < 0.001, sensitivity: 82%; specificity: 68%; cut-off: 2.74) of HG. Our study results showed that combined systemic inflammatory indices (NLR, PLR, SII, SIRI, and AISI) are associated and correlated with the presence and severity of HG. These indices are independent risk factors for the presence and severity of HG. Combined systemic inflammatory indices are diagnostic in determining the severity of HG. The SIRI index has the best diagnostic power for both the diagnosis of HG and the determination of the severity of HG.

The Role Of Systemic Immune-Inflammation Index In The Severity Of Hyperemesis Gravidarum.

Hyperemesis gravidarum(HEG) is one of the severe health problems in early pregnancy. Obstetricians should be aware of systemic inflammation in HEG patients to provide better preventive strategies. Hyperemesis gravidarum(HEG) is one of the most common causes of hospitalization in early pregnancy. Complete blood count parameters can be used as inflammatory markers in patients with HEG. We aimed to investigate the Systemic Immune-Inflammation Index (SII)in predicting the severity of HEG. This cross-sectional study was performed with 469 pregnant women diagnosed and hospitalized with HEG. The study parameters were calculated from complete blood count tests and urine analysis. Demographic characteristics, the Pregnancy Unique Quantification of Emesis (PUQE) scale values, and ketonuria levels at hospital admission were recorded. The neutrophil‑to‑lymphocyte ratio (NLR), platelet‑to‑lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and SII, calculated by the formula (neutrophil × platelet/lymphocyte), were evaluated for predicting the severity of HEG. There was a positive correlation between the increased degree of ketonuria and SII. The cut-off value of SII for predicting the severity of HEG was 1071.8 (AUC 0.637, 95% CI (0.582-0.693), p<.001), and sensitivity and specificity were 59% and 59%, respectively. The cut-off value of SII to predict the length of hospitalization was 1073.6(AUC: 0.565, 95% CI: (0.501-0.628), p= 0.039); sensitivity and specificity were 56.3% and 55.5%, respectively CONCLUSIONS: : The clinical utility of SII in predicting HEG severity is limited due to relatively low sensitivity and specificity. Further research is needed to determine the importance of inflammatory indices in HEG patients.

Hyperemesis gravidarum severity, enteral tube feeding and cardiometabolic markers in offspring cord blood.

The present study aimed to investigate the association between hyperemesis gravidarum (HG) severity and the effect of early enteral tube feeding on cardiometabolic markers in offspring cord blood. We included women admitted for HG, who participated in the MOTHER randomized controlled trial (RCT) and observational cohort. The MOTHER RCT showed that early enteral tube feeding in addition to standard care did not affect symptoms or birth outcomes. Among RCT and cohort participants, we assessed how HG severity affected lipid, c-peptide, glucose and free thyroxine cord blood levels. HG severity measures were: severity of vomiting at inclusion and three weeks after inclusion, pregnancy weight gain and 24-hour energy intake at inclusion, readmissions and duration of hospital admissions. Cord blood measures were also compared between RCT participants allocated to enteral tube feeding and those receiving standard care. Between 2013-2016, 215 women were included: 115 RCT and 100 cohort participants. Eighty-one cord blood samples were available. Univariable, not multivariable regression analysis showed that lower maternal weight gain was associated with higher cord blood glucose levels (β:-0.08, 95% CI:-0.16;-0.00). Lower maternal weight gain was associated with higher apolipoprotein-B cord blood levels in multivariable regression analysis (β:-0.01, 95% CI:-0.02;-0.01). No associations were found between other HG severity measures or allocation to enteral tube feeding and cord blood cardiometabolic markers. In conclusion, while lower maternal weight gain was associated with higher apolipoprotein-B cord blood levels, no other HG severity measures were linked with cord blood cardiometabolic markers, nor were these markers affected by enteral tube feeding.

Severity of Hyperemesis Gravidarum and Associated Maternal factors.

Hyperemesis gravidarum is the most severe form of nausea and vomiting in pregnancy. It is one of the most common cause of early pregnancy admissions and associated with various maternal risk factors . Very few studies have been conducted among Nepalese women with hyperemesis gravidarum. This study aims to identify various maternal risk factors among Nepalese women and its severity using pregnancy unique quantification of emesis scoring. This is a cross sectional observational study conducted at Paropakar Maternity and Women's Hospital. Total duration of the study period was for one year from February 2018 to Janurary 2019. A total of 144 patients meeting the inclusion criteria were included in the study.The severity of the hyperemesis gravidarum was assessed and classified using pregnancy unique quantification of emesis scoring. Various maternal demographic, obstetric and personal factors were studied in relation to the incidence and severity of hyperemesis gravidarum. Moderate (49.30%) to severe(50.69%) hyperemesis gravidarum were admitted in the hospital. Most women were nulliparous from 20-24 years age group. Among all categories of BMI, underweight had more severe hyperemesis gravidarum (63.63%) and overweight patient had increased incidence of moderate hyperemesis gravidarum (66.66%). Women with previous dysmenorrhea had severe hyperemesis gravidarum (54.05%) and non-smoker had severe hyperemesis gravidarum (52.03%) while smoker had moderate hyperemesis gravidarum (57.14%). Pregnant women of age group of 20-24 years, nulliparity and underweight were associated with severe hyperemesis gravidarum.

Biotin deficiency in hyperemesis gravidarum

The aim of this study was to determine the serum biotin levels in patients with hyperemesis gravidarum (HG). Ninety pregnant women with HG (mild (n = 30), moderate (n = 30) and severe (n = 30)), and 80 pregnant women without HG were included for this study. In both groups, serum biotin levels were measured. There were no statistically significant differences in demographic and clinical characteristics between the HG groups and the control group except for PUQE scores. Serum biotin levels in all hyperemesis gravidarum groups were statistically significantly lower than control group. Negative statistically significant correlation between hyperemesis gravidarum severity and serum biotin levels was noted. This is the first study that shows low serum biotin levels in women with hyperemesis gravidarum.Impact statementWhat is already known on this subject? Almost 80% of pregnant women have nausea and vomiting. If nausea and vomiting became severe and the symptoms combined with weight loss and ketonuria; the diagnosis should be hyperemesis gravidarum (HG). The etiopathogenetic factors of this unwanted condition have not been exactly known. Biotin is an essential water-soluble vitamin. Biotin catabolism increases in pregnancy. Marginal biotin deficiency occurs in approximately 50% of the gestations despite the “normal” biotin intake on the diet.What do the results of this study add? Current study results elucidated that serum biotin levels were lower in HG cases compared to non HG cases. This study is the first study that reports the association between low serum level of biotin and HG.What are the implications of these findings for clinical practice and/or further research? Further research is needed to show the importance of biotin supplementation in women with hyperemesis gravidarum.

Association between platelet to lymphocyte ratio, plateletcrit and the presence and severity of hyperemesis gravidarum.

Hyperemesis gravidarum (HG) can be defined as intractable nausea and vomiting leading to electrolyte imbalance, ketonuria, nutrition deficiency and weight loss. Inflammation is known to play a crucial role in HG and many inflammatory markers have been studied to achieve early diagnosis. We investigated the association of the platelet to lymphocyte ratio and plateletcrit with the presence and severity of HG. We retrospectively enrolled 433 pregnant women with a diagnosis of HG and 160 gestational age matched healthy pregnant women, who were admitted to a large tertiary research and training hospital between January and December 2015. Patients were divided into three groups: mild (n = 147), moderate (n = 153) and severe (n = 133), according to HG severity. Age, gestational age, gravida, parity, height, weight and laboratory parameters, including complete blood count, were recorded from patients' medical records. The platelet to lymphocyte ratio and plateletcrit were both higher in the HG groups compared with controls (p < 0.001). There was statistically significant difference in plateletcrit between the mild-moderate and moderate-severe HG groups (p < 0.001). The area under curve for neutrophil to lymphocyte ratio, platelet to lymphocyte ratio and plateletcrit were 0.64, 0.68 and 0.68, respectively, with p < 0.001. Neutrophil to lymphocyte ratio > 3.9, platelet to lymphocyte ratio > 121.2 and plateletcrit > 0.20 were significantly related with an increased risk of HG. The platelet to lymphocyte ratio and plateletcrit are effective inflammatory markers for predicting the presence of HG. Plateletcrit level could also be used to determine HG severity.

Effect of high levels of human chorionic gonadotropin and estradiol on the severity of hyperemesis gravidarum

Serum human chorionic gonadotropin (hCG) and estradiol levels are higher in women with hyperemesis gravidarum (HG) than in unaffected pregnant controls. We postulated that higher levels of these hormones may be associated with clinically more severe HG. The aim of this study was to evaluate the effect of maternal hCG and estradiol levels on the severity of HG. A prospective study was performed on 167 first trimester women hospitalized for HG. Venous blood was taken for hCG and estradiol levels. Scattergrams were plotted for hCG or estradiol levels vs. gestational age. A curve of best fit was drawn. Women were categorized into two groups according to their position above or below the curve. Prolonged hospital stay (> or =4 days) was used as a marker for HG severity. Multivariable logistic regression analysis was used to control for differences in characteristics, laboratory results on admission, and treatment received. After adjustment, high hCG level adjusted odds ratio (AOR) (2.2, 95% CI 1.0-4.9, p=0.04) and hyponatremia AOR (2.8, 95% CI 1.2-6.6, p=0.02) were independently associated with prolonged hospital stay. With bivariate analysis, high estradiol level was not associated with prolonged stay. High hCG but not estradiol is associated with more severe HG.

Relationship between severity of hyperemesis gravidarum and fetal DNA concentration in maternal plasma.

Cell-free fetal DNA is present in maternal plasma (1), where its concentration increases during some abnormal conditions that can occur during pregnancy, including preterm delivery (2), preeclampsia (3)(4)(5), invasive placenta (6), and fetal trisomy 21 (7)(8). The origin of fetal DNA is not clear, but a body of evidence in the literature suggests that it comes mainly from the destruction of villous trophoblasts that border the intervillous space filled with maternal blood (5)(9). Although the pathogenesis of hyperemesis gravidarum (HG) is obscure, activation of natural killer and cytotoxic T cells is higher in the blood and uterine decidua of women with HG with respect to healthy pregnant women (10). Thus, if HG and DNA concentrations were correlated, one possible common pathway that could explain these conditions might be an overactivated maternal immune system that destroys trophoblasts, causing both HG and higher concentrations of cell-free fetal DNA. The aim of this study was to investigate a possible correlation between HG and fetal DNA concentrations. We also evaluated the relationship between the cell-free fetal DNA concentration and the severity of HG. A total of 202 pregnant women (gestational age, 6–16 weeks) bearing a single male fetus, who presented at Showa University Hospital between July 2000 and July 2002 were enrolled in this study. Forty-five consecutive pregnant women with HG were classified into three groups based on the severity of the condition and matched for gestational age with 157 controls. All samples were analyzed blindly without knowledge of case-control status. The three HG groups were generated according to the following criteria: mild HG (nausea and vomiting but no need for admission), moderate HG (admission for HG with dehydration that needed infusion therapy but lacking all of the criteria that define severe HG), and severe HG …

IS ER EEN RELATIE TUSSEN HYPEREMESIS GRAVIDARUM EN HYPERTHYROIDIE?

This retrospective study evaluates the incidence and degree of thyroidal stimulation in patients with hyperemesis, and the correlation between thyroid function, the hCG level and the severity of the hyperemesis gravidarum.. The role of antithyroidea is discussed in patients with a gestational hyperthyroidism. The degree of thyroid stimulation on the outcome of the pregnancy was studied.At admission hCG, TSH, FT4, FT3, TSI, anti-TPO and anti-Tg were determined. The severity of the hyperemesis gravidarum was evaluated by the degree of ketonuria, % weight loss, and the electrolytes and the liver function disorders. An ultrasound to confirm the gestational age and to exclude a multiple pregnancy or a trophoblastic disease was carried out.Results : In a period of 1 January ‘91 to 31 January ‘94, 48 hyperemesis gravidarumpatients were admitted at the maternity. 22.9% of the hyperemesispatients had thyroid stimulation; 4 patients had a decreased TSH and an increased FT4 (group 2) and 7 patients had a decreased TSH, an increased FT4 and FT3 (group 3). The age of the mother, the parity and the gestational age at admission are comparable, and do not differ from the patients without thyroid disorders (group 1). Parameters, determining the severity of hyperemesis gravidarum, are not significantly different in the 3 groups. Treatment with antithyroidea in the group with proven hyperthyroidism (decreased TSH, increased FT4 and FT3) does not only lead to normalisation of the thyroid tests, but also to an improvement of the symptomatology. The gestational age at delivery and the birthweight of the babies are comparable in the 3 groups.Conclusion : In patients admitted with hyperemesis gravidarum, we found 23% of the women to present a thyroid stimulation. This hyperthyroidism differs from the auto-immune hyperthyroidism, i.e. the patients have no thyroid antibodies, no classic clinical signs of thyrothoxicosis. Probably, the absolute hCG concentration and its biological activity plays a crucial role in the thyroid stimulation. This degree of thyroid stimulation has no influence on the severity of the hyperemesis gravidarum, neither on the outcome of the pregnancy.

Severity of hyperemesis gravidarum correlates with serum levels of reverse T 3

To investigate the possible physiological relevance of extra-thyroidal production of reverse T3 (rT3) in hyperemesis gravidarum, measurements of serum rT3, free T3 (FT3), free T4, (FT4), and nonesterified fatty acids (NEFA) were correlated with weight loss of hyperemetic women. All the thyroid hormones, NEFAs and weight loss were significantly higher in hyperemesis gravidarum than in control subjects, and also higher than in those with milder symptoms of morning sickness (p < 0.05). Elevations of FT3, FT4 and NEFAs correlated with the extent of weight loss, the latter taken as the index of the severity of hyperemesis gravidarum (p < 0.05). Only rT3 correlated with both weight loss and the rate of lipolysis, as reflected by elevations of NEFAs (p < 0.05). The data are consistent with a shift from T3 to rT3 as products of 5'-monodeiodination of thyroxine in hyperemesis gravidarum. Because reverse T3 is physiologically inactive a control mechanism may be postulated wherein T3 production is minimized, thereby reducing weight loss and lipolysis in patients with hyperemesis gravidarum.