Search Results (29)

Background: Nausea and Vomiting in Pregnancy (NVP) and Hyperemesis Gravidarum (HG) are common pregnancy-related conditions that can significantly impair maternal quality of life and, in severe cases, impact pregnancy outcomes. This study aimed to assess the prevalence of NVP and HG, evaluate their association with pregnancy progression and neonatal outcomes, and investigate the role of pharmacological therapy. Methods: A prospective observational study was conducted at the University Hospital of Siena between September 2023 and September 2024. Seventy-nine pregnant women aged 28–34 years were enrolled and followed throughout pregnancy. Symptom severity was assessed using the PUQE questionnaire during scheduled outpatient visits. Patients with NVP received pharmacological treatment with doxylamine succinate/pyridoxine hydrochloride. Results: Nausea and Vomiting in Pregnancy was reported by 59% of patients, with all cases categorized as mild or moderate; no severe HG cases were observed. Symptoms resolved by the third trimester. A significant association was observed between NVP and a positive family history of the condition (OR: 3.66, 95% CI: 1.20–11.21; p = 0.025). Logistic regression analysis also revealed that NVP was associated with an increased risk of gestational hypertension (15% vs. 0%, p = 0.04), and a decreased likelihood of gestational diabetes (OR: 0.24, 95% CI: 0.07–0.86) and cesarean section (OR: 0.34, 95% CI: 0.13–0.87). No significant differences were found in neonatal outcomes, including birth weight, Apgar scores, or fetal complications. Conclusions: While NVP may influence maternal outcomes, the condition does not significantly affect neonatal health. Early pharmacological treatment improves maternal well-being and may reduce hospitalization rates. Larger multicenter studies are needed to confirm these findings. Full article

Objectives: This review explores the role of swept-source optical coherence tomography (OCT) in diagnosing and monitoring optic nerve neuropathy in Wernicke’s encephalopathy (WE) due to hyperemesis gravidarum, including a case of neuropathy from intractable vomiting in pregnancy. Methods: A literature search was conducted in the PubMed database to select high-quality reviews and original articles on the use of swept-source OCT for assessing optic nerve involvement in WE due to hyperemesis gravidarum. Results: WE is a potentially fatal neuropsychiatric syndrome caused by thiamine deficiency due to various causes, like alcoholism, malnutrition, and prolonged parenteral nutrition. This condition can cause neurological disorders such as imbalance, altered mental status, nystagmus, and ophthalmoplegia. Sometimes, there is also a deterioration of visual acuity with swelling of the optic disc. OCT is a non-invasive imaging tool that can detect optic nerve involvement in WE by assessing peripapillary retinal nerve fiber layer (pRNFL) thickness. In the acute phase, optic disc edema and increased pRNFL thickness may be observed, while chronic-phase changes include optic nerve atrophy and pRNFL thinning. WE may occur in the course of hyperemesis gravidarum in pregnant women. We present a case of a 23-year-old woman at 14 weeks of gestation with WE due to severe hyperemesis gravidarum, manifesting as visual impairment and neurological deficits. MRI confirmed the diagnosis, while OCT revealed transient pRNFL thickening followed by optic nerve atrophy. Conclusions: Early diagnosis and thiamine supplementation are crucial to preventing severe complications. OCT is a valuable tool for detecting and tracking optic nerve changes in WE. Full article

(1) Background: Diet plays a crucial role in the intake of phytoestrogens, which are closely related to the pathogenesis of some pregnancy complications. However, no studies have explored the potential association between soy isoflavones, a type of phytoestrogen, and the risk of hyperemesis gravidarum (HG). This study aims to investigate the correlation between dietary intake of soy isoflavones and the risk of HG. (2) Methods: As part of the China Birth Cohort Study (CBCS), 2418 pregnant Chinese women (mean age: 31.2 ± 3.4 years) were enrolled between April 2021 and September 2022. Dietary intake was evaluated using a validated 108-item semi-quantitative food frequency questionnaire, with soy isoflavones intake estimated based on five food groups. HG was defined as a condition characterized by a pregnancy-specific vomiting score (PUQE) ≥ 13, weight loss of ≥5% due to severe nausea and vomiting before 16 weeks of gestation, inability to eat or drink normally, significant limitations in daily activities due to severe nausea or vomiting, or the need for hospitalization caused by the condition. The association between soy isoflavones intake and HG was analyzed using binary logistic regression and restricted cubic spline regression. (3) Results: Among all participants, 212 women (8.8%) were diagnosed with HG. The dietary intake of soy isoflavones was 14.56 (IQR: 9.89, 25.36) mg/d. After full adjustment for confounding factors, the results indicated that individuals with the highest dietary intake of soy isoflavones had a lower risk of developing HG (OR: 0.56, 95% CI: 0.36, 0.88. P_trend = 0.012). (4) Conclusions: Higher dietary intake of soy isoflavones is associated with a reduced risk of HG. We advocate for a dietary approach to the management of HG that prioritizes the intake of legume-rich foods, particularly those abundant in soy isoflavones. Full article

Gestational diabetes mellitus (GDM) is a complication that affects 20% of pregnancies worldwide. It is associated with adverse short- and long-term cardiometabolic outcomes for both mother and infant. Effective management of GDM involves lifestyle modifications, including medical nutrition therapy (MNT) and physical activity (PA), with the addition of insulin or metformin if glycaemic control remains inadequate. However, substantial gaps persist in the determination of optimal medical nutrition therapy (MNT) for women with GDM. Challenges in MNT include individual variation in glucose tolerance and changing maternal physiology and dietary requirements during pregnancy. Achieving optimal glycaemic control depends on careful macronutrient balance, particularly the distribution and quality of carbohydrate intake and sufficient protein and fat intake. Additionally, micronutrient deficiencies, such as inadequate vitamin D, calcium, and essential minerals, may exacerbate oxidative stress, inflammation, and glycaemic dysregulation, further impacting foetal growth and development. Cultural beliefs and dietary practices among pregnant women can also hinder adherence to recommended nutritional guidelines. Conditions like hyperemesis gravidarum (HG) affect ~1% to 2% of pregnant women can result in unintended energy and nutrient deficits. This special issue explores the current evidence and major barriers to optimising dietary therapy for women with GDM. It also identifies future research priorities to advance clinical practice, improve maternal and foetal outcomes, and address gaps in personalised nutrition interventions. Full article

(1) Background: Oxidative stress plays a pivotal role in the pathophysiologic of hyperemesis gravidarum (HG). Epidemiological studies have explored the associations of specific antioxidant foods and nutrients with HG. However, evidence regarding the relationship between an antioxidant-rich diet and the risk of HG remains limited. The objective of this research was to explore the relationship between antioxidant-rich diet and HG. (2) Methods: This was a population-based cross-sectional study. A total of 2980 pregnant women were included in our population. A composite dietary antioxidant index (CDAI) was calculated by summing the standardized intakes of vitamins A, C, and E, selenium, zinc, and total carotene. A dietary antioxidant potential score (DAPS) was derived using reduced rank regression. Binary logistic regression models were employed to analyze the associations of CDAI and DAPS with risk of HG. (3) Results: In total, 241 (8.09%) cases of HG were identified in this study. After adjusting for potential confounders, including age, socioeconomic status, ethnicity, physical activity, current smoking status, current alcohol consumption, pre-pregnancy body mass index, nutritional supplement usage, total energy intake, gestational week, menstruation regularity, family history of HG, primigravida status, and quality of life during pregnancy, ORs (95% CIs) of HG in the highest tertiles were 0.31 (0.21–0.47) for CDAI and 0.41 (0.28–0.57) for DAPS when comparing lowest tertiles (all p-trend < 0.001). Such associations remained robust across multiple sensitivity analyses and subgroup analyses. (4) Conclusions: Higher CDAI and DAPS, indicative of greater adherence to an antioxidant-rich diet, were associated with a lower risk of HG. This finding underscores the crucial role of consuming antioxidant-rich foods in the prevention of HG. Full article

Background: Wernicke Encephalopathy (WE), a neurological disorder often linked to alcohol use, can also occur under non-alcoholic conditions, including in pediatric populations. Methods: This systematic review examines 88 pediatric WE cases reported over the past 30 years, encompassing diverse etiologies such as cancer (25 cases), gastrointestinal diseases (19), malnutrition (17), psychiatric disorders (13), obesity surgery (5), renal disease (4), COVID-19 (2), PICU complications (1), hyperemesis gravidarum (1), and a genetic mutation (1). Results: Prodromal symptoms included nausea (60%) and vomiting (55%). In total, 37% of the patients received parenteral nutrition without thiamine before WE diagnosis, often progressing to Wernicke–Korsakoff syndrome (WKS). Key findings revealed the classic triad of WKS, eye movement disorders (80%), mental status changes (75%), and ataxia (63%), with MRI demonstrating high diagnostic sensitivity (85%). Treatment varied widely; higher parenteral thiamine doses correlated with faster recovery and better outcomes, while insufficient dosages led to adverse effects. Full remission was achieved in 61% of cases, with improved outcomes in more recent reports due to refined dosing protocols. Conclusions: These findings underscore the importance of early recognition of nausea and vomiting as predictors of pediatric WE and the critical need to incorporate thiamine in parenteral nutrition for children. Optimal dosing remains vital for recovery, particularly in severe cases. Full article

Nausea and vomiting during pregnancy (NVP) affect up to 85% of pregnant women and usually begin between the 4th and 7th weeks of gestation, and symptoms often peak around the 9th week and generally resolve by the 20th week in most cases, with severe cases termed hyperemesis gravidarum (HG) impacting physical and psychological health. This review aims to provide a structured dietary approach to managing NVP by developing a food pyramid specifically for this population, based on a systematic evaluation of dietary evidence. The findings highlight the beneficial effects of dietary patterns rich in fruits, vegetables, and protein sources in reducing NVP symptoms. Protein intake is shown to alleviate nausea and vomiting by stabilizing gastric motility and addressing nutritional deficiencies. The review also explores the potential benefits of herbal supplements, like ginger and vitamin B6. By integrating these dietary strategies with pharmacological treatments, a more holistic approach to managing NVP can be achieved, enhancing both maternal well-being and fetal health. The proposed food pyramid emphasizes glycemic stability, hydration, and gradual nutrient intake, offering a structured dietary guide for pregnant women experiencing NVP and HG. Full article

Background: In this study, the aim was to investigate blood-based clinical biomarkers of inflammation and nutrition indices in hyperemesis gravidarum (HG). Methods: This retrospective case–control study was conducted at a tertiary hospital between 2018 and 2022. A total of 820 pregnant women were enrolled in this study; 410 pregnant women were diagnosed with HG (HG group) at 6–14 weeks of gestation, and 410 pregnant women were healthy controls (control group) in the same gestational weeks. Patients’ demographic and clinical characteristics and laboratory parameters were recorded. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score, the modified-HALP (m-HALP) score, and the prognostic nutritional index (PNI) were calculated. Results: The HALP score (32.6 (IQR: 24.9–41.5) vs. 39.2 (IQR: 30.8–49.2), p < 0.001) and the PNI score (50 (IQR: 46.3–53.6) vs. 51.3 (IQR: 48.6–53.8), p < 0.001) were significantly lower in the HG group, whereas the m-HALP score was similar between the groups. The HALP score had an AUC of 0.625 (95% CI: 0.586–0.664), with the optimal cut-off value set at 35.8, resulting in a sensitivity of 59.7% and a specificity of 59.5% (p < 0.001). Similarly, the PNI score showed an AUC of 0.580 (95% CI: 0.541–0.619), and the optimal cut-off value was set at 50.6, resulting in a sensitivity of 54.9% and a specificity of 54.9% (p < 0.001). In regression analysis, lower HALP scores (OR: 0.906, 95% CI: 0.833–0.984, p = 0.019) and lower PNI scores (OR: 0.941, 95% CI: 0.891–0.995, p = 0.033) were significantly associated with HG, highlighting their potential as diagnostic markers. Additionally, a negative statistically significant correlation was observed between PNI scores and ketonuria (r = −0.073, p = 0.036). Conclusions: This study demonstrated a decrease in the HALP score and PNI score in cases of HG. However, the m-HALP score was similar in the HG and control groups. Full article

The chief aim of this research is to investigate the causality of air pollutants and adverse pregnancy outcomes. Two-sample Mendelian randomization was conducted, employing genetic variants connected with air pollution as instrumental variables. Sixteen adverse pregnancy outcomes were extracted as the main outcome measures from the genome-wide association study (GWAS). The inverse-variance weighted (IVW) method was conducted as the primary analysis method. This study found that there were causal association between NO₂ and pre-eclampsia (weighted median: OR = 1.30, 95% CI = [1.03–1.64], p = 0.029) and between PM2.5 and placental abruption (IVW: OR = 10.94, 95% CI = [1.28–93.45], p = 0.029). There were potential causal relationships between NO₂ and gestational hypertension (IVW: OR = 1.14, 95% CI = [0.99–1.30], p = 0.060); NO₂ and placental abruption (IVW: OR = 1.97, 95% CI = [0.90–4.28], p = 0.089); NOx and fetal growth restriction (IVW: OR = 0.06, 95% CI = [0.99–1.12], p = 0.089); PM2.5 and slow fetal growth and fetal malnutrition (MR–Egger: OR = 54,240.95, 95% CI = [2.08–1,411,757,729.46], p = 0.059); PM10 and hyperemesis gravidarum (MR–Egger: OR = 0.12, 95% CI = [0.02–0.97], p = 0.086); PM10 and preterm birth (weighted median: OR = 1.60, 95% CI = [0.95–2.70], p = 0.075); and PM10 and spontaneous abortion (weighted median: OR = 1.60, 95% CI = [0.95–2.70], p = 0.075). There was no pleiotropy, but there was some heterogeneity. In conclusion, air pollution has a causal effect on several adverse pregnancy outcomes. Full article

Nausea and vomiting during pregnancy (NVP), particularly its severe form, Hyperemesis gravidarum (HG), affects up to 70% of pregnancies and significantly impacts the quality of life for those with the condition as well as generates a great economic burden, with annual costs exceeding $1.7 billion in the United States. Despite the available treatments targeting neurotransmitters like serotonin and dopamine, many patients experience inadequate relief and suffer from severe side effects, including headaches and dizziness. Recent research has underscored the role of GDF15, a protein mainly produced by the placenta and linked to NVP symptoms. This protein, part of the TGF-β superfamily, has been implicated in appetite and weight regulation and is altered in those with HG due to specific genetic mutations. Addressing the challenges of delivering effective treatments, current innovations focus on targeting GDF15 to reduce symptoms while ensuring fetal safety. Promising therapeutic strategies include non-IgG immunotherapies, small peptide and molecule antagonists, and novel administration methods such as transdermal patches. These approaches aim to optimize dosage and reduce adverse effects. The effective development and testing of these treatments necessitate advanced animal models that closely resemble human pregnancy physiology, highlighting the need for further research and funding. This ongoing research holds significant potential to improve the clinical outcomes for HG patients and decrease the economic impact on healthcare systems, urging a dedicated response from the scientific and medical communities to advance these promising treatments. Full article

(1) Background: Diet holds a pivotal position in exacerbating or ameliorating chronic inflammation, which has been implicated in the pathogenesis of hyperemesis gravidarum (HG). However, no study has explored the association between dietary inflammatory potential and HG. This study aimed to investigate the potential correlation between following a pro-inflammatory diet and the likelihood of developing HG. (2) Methods: A total of 2033 Chinese pregnant women (mean age: 31.3 ± 3.4 years) were included in this cross-sectional study from April 2021 to September 2022 as part of the China Birth Cohort Study (CBCS). Dietary inflammatory index (DII) scores with 23 food components were constructed through dietary intakes collected via a reliable 108-item semi-quantitative food frequency questionnaire. HG was defined as a pregnancy-unique quantification of emesis (PUQE) score ≥13 points, severe nausea and vomiting leading to weight loss ≥5%, or being hospitalized for treatment due to the disease. The relationship between DII and HG was conducted utilizing binary logistic regression and restricted cubic spline regression. (3) Results: Overall, 8.2% (n = 167) of study participants had HG. The DII scores ranged from −4.04 to 3.82. After adjusting for potential confounders, individuals with the highest tertile of DII score had a higher risk of HG (OR = 1.65, 95% CI: 1.04, 2.62, P_trend = 0.032). Such an association was stronger in those with pre-pregnancy overweight/obesity (P_interaction = 0.018). (4) Conclusions: A higher DII score, which serves as a marker for a diet promoting inflammation, is correlated with an elevated risk of developing HG. This finding suggests that dietary recommendations for HG should focus on minimizing the DII through incorporating foods abundant in anti-inflammatory components. Full article

Wernicke Encephalopathy (WE) is a neurological acute syndrome related to vitamin B1 deficiency and is relatively common in patients with chronic alcoholism. In the case of Hyperemesis Gravidarum, thiamine body stores become unable to meet the increased demand, resulting in acute deficiency. WE is associated with typical clinical and radiological findings. Treatment pathways rely on thiamine replacement. The case herein reported is centered around a 33-year-old diabetic patient at 12 weeks of gestation, with WE due to hyperemesis gravidarum. The disease manifested itself with weakness, mental confusion, headache, and impaired vision. The diagnosis was established after the detection of typical findings by MRI. Thirty days after therapy was started, most of the patient’s neurological disorders were resolved. The patient was discharged 40 days later with instructions to continue daily thiamine supplementation. The pregnancy outcome was good. Unfortunately, mild ataxia persisted in 2-year follow-up as a long-term consequence. When diagnosed and treated, WE has a favorable prognosis. However, roughly 80% of patients experience memory loss, which may continue for a long time, while gait disorders reportedly affect about 35% of patients. Mild ataxia and dysmetria may persist, too. We reviewed the scientific literature on WE in women with HG until February 2023. Hardly any authors report data on long-term sequelae. Our report emphasizes how important it is to take into consideration this complication in clinical practice, referring to published guidelines and recommendations. Neurological maternal sequelae can demonstrably persist despite early diagnosis and appropriate management. For this reason, a long-term follow-up is recommended. Wernicke syndrome management cannot yet rely on well-established conclusive guidelines; hence, a cautionary approach ought to be prioritized in order to ensure medicolegal soundness. Full article

The term “Osmotic Demyelination Syndrome” (ODS) is synonymous with central pontine myelinolysis (CPM), denoting a condition characterised by brain damage, particularly affecting the white matter tracts of the pontine region. This damage arises due to the rapid correction of metabolic imbalances, primarily cases of hyponatremia. Noteworthy triggers encompass severe burns, liver transplantations, anorexia nervosa, hyperemesis gravidarum, and hyperglycaemia, all linked to the development of CPM. Clinical manifestations encompass a spectrum of signs and symptoms, including dysphagia, dysarthria, spastic quadriparesis, pseudobulbar paralysis, ataxia, lethargy, tremors, disorientation, catatonia, and, in severe instances, locked-in syndrome and coma. A recent case involving a 45-year-old woman illustrates these complexities. Upon admission to the Medicine Intensive Care Unit, she presented with symptoms indicative of diminished responsiveness and bilateral weakness in the upper and lower limbs. Of significance, the patient had a pre-existing medical history of hyperthyroidism. Extensive diagnostic investigations were undertaken, revealing compelling evidence of profound hyponatremia through blood analyses. Furthermore, magnetic resonance imaging (MRI) was performed, unveiling conspicuous areas of abnormal hyperintensity located in the central pons, intriguingly accompanied by spared peripheral regions. These radiological findings align with the characteristic pattern associated with osmotic demyelination syndrome, illuminating the underlying pathology. Full article

One in 20 births could be affected by hypermobile Ehlers–Danlos syndrome or Hypermobility Spectrum Disorders (hEDS/HSD); however, these are under-diagnosed and lacking research. This study aimed to examine outcomes and complications in people childbearing with hEDS/HSD. A large online international survey was completed by women with experience in childbearing and a diagnosis of hEDS/HSD (N = 947, total pregnancies = 1338). Data were collected on demographics, pregnancy and birth outcomes and complications. Participants reported pregnancies in the UK (N = 771), USA (N = 364), Australia (N = 106), Canada (N = 60), New Zealand (N = 23) and Ireland (N = 14). Incidences were higher in people with hEDS/HSD than typically found in the general population for pre-eclampsia, eclampsia, pre-term rupture of membranes, pre-term birth, antepartum haemorrhage, postpartum haemorrhage, hyperemesis gravidarum, shoulder dystocia, caesarean wound infection, postpartum psychosis, post-traumatic stress disorder, precipitate labour and being born before arrival at place of birth. This potential for increased risk related to maternal and neonatal outcomes and complications highlights the importance of diagnosis and appropriate care considerations for childbearing people with hEDS/HSD. Recommendations include updating healthcare guidance to include awareness of these possible complications and outcomes and including hEDS/HSD in initial screening questionnaires of perinatal care to ensure appropriate consultation and monitoring can take place from the start. Full article

Liver disease is not uncommon during pregnancy and is associated with increased maternal and fetal/neonatal morbidity and mortality. Physiological changes during pregnancy, including a hyperestrogenic state, increase in circulating plasma volume and/or reduction in splanchnic vascular resistance, and hemostatic imbalance, may mimic or worsen liver disease. For the clinician, it is important to distinguish among the first presentation or exacerbation of chronic liver disease, acute liver disease non-specific to pregnancy, and pregnancy-specific liver disease. This last group classically includes conditions such as hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, liver disorders associated with the pre-eclampsia spectrum, and an acute fatty liver of pregnancy. All of these disorders often share pathophysiological mechanisms, symptoms, and laboratory findings (such as elevated liver enzymes), but a prompt and correct diagnosis is fundamental to guide obstetric conduct, reduce morbidity and mortality, and inform upon the risk of recurrence or development of other chronic diseases later on in life. Finally, the cause of elevated liver enzymes during pregnancy is unclear in up to 30–40% of the cases, and yet, little is known on the causes and mechanisms underlying these alterations, or whether these findings are associated with worse maternal/fetal outcomes. In this narrative review, we aimed to summarize pragmatically the diagnostic work-up and the management of subjects with elevated liver enzymes during pregnancy. Full article