Kelly Nijsten1,2, Caitlin Dean1,3, Loïs M van der Minnen1, Joke Mj Bais4, Carrie Ris-Stalpers5, Rik van Eekelen1, Henk A Bremer6, David P van der Ham7, Wieteke M Heidema8, Anjoke Huisjes9, Gunilla Kleiverda10, Simone M Kuppens11, Judith Oeh van Laar12, Josje Langenveld13, Flip van der Made14, Dimitri Papatsonis15, Marie-José Pelinck16, Paula J Pernet17, Leonie van Rheenen-Flach18, Robbert J Rijnders19, Hubertina Cj Scheepers20, Tatjana Vogelvang21, Ben W Mol22, Tessa J Roseboom1,2, Marjette H Koot9, Iris J Grooten1, Rebecca C Painter1. 1. Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam Reproduction & Development Research Institute, Amsterdam, the Netherlands. 2. Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands. 3. Pregnancy Sickness Support, Bodmin, UK. 4. Department of Obstetrics and Gynecology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands. 5. Laboratory of Reproductive Biology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands. 6. Department of Obstetrics and Gynecology, Reinier de Graaf Hospital, Delft, the Netherlands. 7. Department of Obstetrics and Gynecology, Martini Hospital, Groningen, the Netherlands. 8. Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands. 9. Department of Obstetrics and Gynecology, Gelre Hospital, Apeldoorn, the Netherlands. 10. Department of Obstetrics and Gynecology, Flevo Hospital, Almere, the Netherlands. 11. Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, the Netherlands. 12. Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, the Netherlands. 13. Department of Obstetrics and Gynecology, Zuyderland Hospital, Heerlen, the Netherlands. 14. Department of Obstetrics and Gynecology, Franciscus Gasthuis, Rotterdam, the Netherlands. 15. Department of Obstetrics and Gynecology, Amphia Hospital, Breda, the Netherlands. 16. Department of Obstetrics and Gynecology, Scheper Hospital, Emmen, the Netherlands. 17. Department of Obstetrics and Gynecology, Spaarne Gasthuis, Haarlem, the Netherlands. 18. Department of Obstetrics and Gynecology, OLVG, Amsterdam, the Netherlands. 19. Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands. 20. Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, the Netherlands. 21. Department of Obstetrics and Gynecology, Diakonessenhuis, Utrecht, the Netherlands. 22. Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia.
Abstract
INTRODUCTION: Hyperemesis gravidarum (HG) complicates 1% of pregnancies and has a major impact on maternal quality of life and wellbeing. We know very little about HG's long-term impact after an affected pregnancy, including recurrence rates in future pregnancies, which is essential information for women considering subsequent pregnancies. In this study, we aimed to prospectively measure the recurrence rate of HG and the number of postponed and terminated subsequent pregnancies due to HG. We also aimed to evaluate if there were predictive factors that could identify women at increased risk for HG recurrence, postponing and terminating subsequent pregnancies. MATERIAL AND METHODS: We conducted a prospective cohort study. A total of 215 women admitted for HG to public hospitals in the Netherlands were enrolled in the original MOTHER randomized controlled trial and associated observational cohort. Seventy-three women were included in this follow-up study. Data were collected via an online questionnaire. Recurrent HG was defined as vomiting symptoms accompanied by any of the following: multiple medication use, weight loss, admission, tube feeding or if nausea and vomiting symptoms were severe enough to affect life and/or work. Outcome measures were recurrence, postponing and termination rates due to HG. Univariable logistic regression analysis was used to identify predictive factors associated with HG recurrence, postponing and terminating subsequent pregnancies. RESULTS: Thirty-five women (48%) became pregnant again of whom 40% had postponed their pregnancy due to HG. HG recurred in 89% of pregnancies. One woman terminated and eight women (23%) considered terminating their pregnancy because of recurrent HG. Twenty-four out of 38 women did not get pregnant again because of HG in the past. Univariable logistic regression analysis identifying possible predictive factors found that having a western background was associated with having weight loss due to recurrent HG in subsequent pregnancies (OR 12.9, 95% CI: 1.3-130.5, P=0.03). CONCLUSIONS: High rates of HG recurrence and a high number of postponed pregnancies due to HG were observed. Women can be informed of a high chance of recurrence to enable informed family planning. This article is protected by copyright. All rights reserved.
INTRODUCTION:Hyperemesis gravidarum (HG) complicates 1% of pregnancies and has a major impact on maternal quality of life and wellbeing. We know very little about HG's long-term impact after an affected pregnancy, including recurrence rates in future pregnancies, which is essential information for women considering subsequent pregnancies. In this study, we aimed to prospectively measure the recurrence rate of HG and the number of postponed and terminated subsequent pregnancies due to HG. We also aimed to evaluate if there were predictive factors that could identify women at increased risk for HG recurrence, postponing and terminating subsequent pregnancies. MATERIAL AND METHODS: We conducted a prospective cohort study. A total of 215 women admitted for HG to public hospitals in the Netherlands were enrolled in the original MOTHER randomized controlled trial and associated observational cohort. Seventy-three women were included in this follow-up study. Data were collected via an online questionnaire. Recurrent HG was defined as vomiting symptoms accompanied by any of the following: multiple medication use, weight loss, admission, tube feeding or if nausea and vomiting symptoms were severe enough to affect life and/or work. Outcome measures were recurrence, postponing and termination rates due to HG. Univariable logistic regression analysis was used to identify predictive factors associated with HG recurrence, postponing and terminating subsequent pregnancies. RESULTS: Thirty-five women (48%) became pregnant again of whom 40% had postponed their pregnancy due to HG. HG recurred in 89% of pregnancies. One woman terminated and eight women (23%) considered terminating their pregnancy because of recurrent HG. Twenty-four out of 38 women did not get pregnant again because of HG in the past. Univariable logistic regression analysis identifying possible predictive factors found that having a western background was associated with having weight loss due to recurrent HG in subsequent pregnancies (OR 12.9, 95% CI: 1.3-130.5, P=0.03). CONCLUSIONS: High rates of HG recurrence and a high number of postponed pregnancies due to HG were observed. Women can be informed of a high chance of recurrence to enable informed family planning. This article is protected by copyright. All rights reserved.