JOURNAL OF Journal of Contemporary CONTEMPORARY MEDICINE Medicine DOI: 10.16899/jcm.870631 J Contemp Med 2021;11(4):428-432 Orjinal Araştırma / Original Article The Effect of Hyperemesis Gravidarum on Pregnancy Outcomes Hiperemezis Gravidarumun Gebelik Sonuçlarına Etkisi Zekiye Soykan Sert1 1Department of Gynecology and Obstetrics, Aksaray University Education and Research Hospital, Aksaray, Turkey Abstract Öz Objective: We evaluated the clinical characteristics of the patients Amaç: Hiperemezis gravidarum (HG) tanısı ile takip edilen hastaların followed with the diagnosis of hyperemesis gravidarum (HG). We klinik özelliklerini değerlendirdik. Bu hastalarda HG'nin gebelik aimed to determine the effects of HG on pregnancy outcomes in sonuçları üzerindeki etkilerini belirlemeyi amaçladık. this study. Material and Method: This retrospective study was conducted in Gereç ve Yöntem: Bu retrospektif çalışma 2018-2020 yılları arasında the department of obstetrics and gynecology between January hastanemiz kadın hastalıkları bölümünde gerçekleştirildi. Çalışma 2018–2020. The study group consisted of pregnant women who grubu, 20. gebelik haftasından önce HG tanısı alan ve hastanemizde were diagnosed with HG before the 20th gestational week and tedavi edilerek doğum yapılan gebelerden oluşturuldu. Hastalar HG were treated and delivered at our hospital. The patients were varlığına göre iki gruba ayrıldı. Her iki grup plasental disfonksiyon divided into two groups based on the presence of HG. Both groups were compared in terms of placental dysfunction and ve yenidoğan sonuçları açısından karşılaştırıldı. HG'nin şiddeti newborn outcomes. The severity of the HG was assessed and değerlendirildi ve sınıflandırıldı. Hafif ve ağır vakaları karşılaştıran HG classified. A sub-analysis of the HG group comparing mild and grubunun bir alt analizi yapıldı. severe cases was performed. Bulgular: Çalışmaya HG tanısı almış 213 hasta ve HG tanısı olmayan Results: The study included 213 patients diagnosed with HG and 218 sağlıklı gebe dahil edildi. Preterm doğum (p=0.034) ve 218 healthy pregnant women without HG diagnosis. Preterm birth (p=0.034) and small for gestational age (SGA) (p=0.016) gestasyonel yaşa göre küçük (SGA) (p=0.016) HG grubunda kontrol were significantly higher in the HG group compared to the control grubuna göre anlamlı olarak yüksek bulundu. HG tanısı alan gebelerin group. 78.8% of the pregnant women diagnosed with HG were % 78,8'i hafif,% 21,1'i ağır HG idi. Ağır HG grubundaki kadınlar ile hafif mild and 21.1% were severe HG. When women in the severe HG HG grubundaki kadınlar karşılaştırıldığında, şiddetli HG'nin daha group and mild HG group were compared, we found that severe yüksek SGA (p=0,042), erken doğum (p=0,001) ve Yenidoğan Yoğun HG is associated with a higher chance of SGA (p=0.042), preterm birth (p=0.001) and admission to Neonatal Intensive Care Unit Bakım Ünitesine yatış (p=0,031) ile ilişkili olduğunu bulduk. (p=0.031). Sonuçlar: Hiperemetik hamile kadınlardan doğan bebekler, sağlıklı Conclusions: Babies born from hyperemetic pregnant women hamile kadınlardan doğan bebeklere kıyasla SGA ve erken doğum are at a significant risk for SGA and preterm birth compared to için önemli bir risk altındadır. Özellikle ağır HG'li gebelerde bu risk babies born from healthy pregnant women. This risk increases artar. especially in pregnant women with severe HG. Keywords: Hyperemesis gravidarum, pregnancy outcomes, small Anahtar Kelimeler: Hiperemezis gravidarum, gebelik sonuçları, for gestational age, gebelik yaşına göre küçük, Corresponding (İletişim): Zekiye Soykan Sert, Aksaray Üniversitesi Eğitim ve Araştırma Hastanesi Yeni Sanayi Mahallesi, 68200, Aksaray, Türkiye E-mail (E-posta): [email protected] Received (Geliş Tarihi): 29.01.2021 Accepted (Kabul Tarihi): 25.03.2021 Zekiye Soykan Sert, Hyperemesis Gravidarum and Pregnancy Outcomes 429 INTRODUCTION and complications, fetal weight at birth, Apgar score, laboratory Hyperemesis gravidarum (HG) is a syndrome characterized results, and obstetric ultrasonography results were recorded. by nausea, vomiting and dehydration, ketosis, electrolyte and While benign nausea and vomiting in early pregnancy are acid-base imbalances, and sometimes hepatic and renal failure, closely related to temporarily increased human chorionic resulting in weight loss (≥5% of body weight).[1] HG is seen in gonadotropin (hCG) levels, it has been argued that in approximately 0.3-2% of pregnant women and is one of the women with hyperemesis, the persistently high hCG level most common reasons for hospital admission during the first dysregulates normal stimulation of trophoblast migration, half of pregnancy.[1] Although the HG clinics differ, this disorder which consequently alters placentation. Ultimately abnormal is generally manifested by nausea and vomiting that starts in placentation could lead to placental dysfunction that clinically the 6-8th week of pregnancy, peaks around the 12th week and manifests as gestational hypertension, preeclampsia, as well disappears until the 16-20th week. However, symptoms may as miscarriage, stillbirth and IUGR.[12-14] The patients were continue in 5% of patients until delivery.[2] divided into two groups based on the presence of HG. Patients It is often difficult to clarify the etiology in these patients diagnosed with HG were included in the first group, and healthy given the increasing number of HG admissions today, but pregnant women followed in our clinic were in the second may be attributed to hormones, gastrointestinal dysfunction, group. Both groups were compared in terms of placental thyrotoxicosis, serotonin, hepatic abnormalities, autonomic dysfunction (gestational diabetes, preeclampsia, and stillbirth), nervous dysfunction, nutritional deficiencies, asthma, allergies, and newborn outcomes (birth weight, SGA, Apgar score at the helicobacter pylori infection, or psychosomatic causes.[3,4] 5th minute, and gestational week at birth). The results differ among different studies in the literature Definitions investigating the effect of HG on pregnancy outcomes. The Severe HG was defined as a process accompanied by at least studies have shown that HG may be associated with increased two of the following criteria in addition to severe vomiting small for gestational age (SGA) and preterm birth and increases three or more times per day before the 20th gestational [5-8] the length of hospitalization in newborns. On the other week. These criteria are as follows: 1) Three or more days of hand, some studies show that HG is not associated with adverse hospitalization due to HG, 2) Finding of dehydration in physical pregnancy outcomes. These studies have found that HG is not a examination, 3) At least one hepatic enzyme elevation (alanine risk factor for preterm birth, SGA, intrauterine growth restriction aminotransferase [ALT], aspartate aminotransferase [AST]), 4) [8-11] (IUGR), and low Apgar score. Having sodium or potassium abnormality at least once, 5) Total The present study has evaluated the clinical characteristics of weight gain being below 7kg during the whole pregnancy, 6) the patients followed with the diagnosis of HG based on the Urine ketone level being ≥2+.[5,10] Mild HG was defined as lack of conflicting results in the literature. We aimed to determine the severe HG criteria. SGA was defined as a situation where birth effects of HG on pregnancy outcomes in these patients. weight is below 10 percentiles at a certain gestational age.[15] Preterm delivery was defined as giving birth before the 37th MATERIAL AND METHOD gestational week while stillbirth refers to babies born without a heartbeat after the 24th gestational week.[16] Patient selection Statistical Methods This retrospective study was conducted in the department of All statistical data were analyzed using SPSS for Windows version Obstetrics and Gynecology of our hospital between January 15.0 (SPSS Inc.; Chicago, IL, USA). First of all, descriptive statistics 2018 and January 2020. Local ethics committee approval was (number (n), frequencies (%), mean, and standard deviation) obtained for the study (Ethics committee number: 2020/03- of the variables in the study group were calculated. Pearson's 53). The study group consisted of pregnant women who were Chi-Square or Fisher's test was used for the comparison of the diagnosed with HG before the 20th gestational week and were categorical data. The normal distribution of data was tested treated and delivered at our hospital. with the Kolmogorov-Smirnov test. Student's t-test was used to Inaccessibility to full medical records, births before 24th compare the normally distributed data, and the Mann-Whitney week, gestational week or birth weight being less than 500g, U test was used to compare the non-normally distributed data. hypertension, diabetes mellitus, thyroid hormone disorder, P values of <0.05 were regarded as statistically significant. psychiatric disease, multiple pregnancy, gastrointestinal system disease, and fetal congenital malformation were reasons for patients to be excluded from the study. RESULTS Data collection and processing The study included 213 patients diagnosed with HG and 218 healthy pregnant women without HG diagnosis. The The study population was determined using the electronic mean age of the HG cases was 26.8±4.7, and the mean age medical database of the obstetrics clinic. Patients age, parity, of the control group was 25.6±4.6. There was no statistically pre-pregnancy body mass index, maternal weight at birth, significant