Search Results (37)

Background: Nausea and vomiting in pregnancy affects up to 80% of pregnant women and may progress to hyperemesis gravidarum, leading to maternal morbidity and adverse pregnancy outcomes. Despite numerous pharmacological and non-pharmacological options, the comparative efficacy and safety of these interventions remain unclear. Methods: We conducted a systematic review and network meta-analysis of randomized controlled trials assessing pharmacological and non-pharmacological interventions for nausea and vomiting in pregnancy. The databases searched included CENTRAL, PubMed, and EMBASE (up to 28 May 2024). Eligible trials compared interventions with a placebo in pregnant women with nausea and vomiting in pregnancy. The primary outcomes were symptom severity, assessed using validated tools. Safety outcomes included adverse effects. Data were pooled using frequentist pairwise and network meta-analyses. The risk of bias was assessed using the RoB2 tool, and the certainty of evidence was evaluated using the CINeMA framework. Results: Of 9844 records screened, 24 randomized controlled trials (3017 participants) met the inclusion criteria, encompassing 16 intervention categories. Network analysis ranked quince, vitamin B6 with pomegranate and mint, acupressure P6, dimenhydrinate, and acupuncture combined with doxylamine–pyridoxine as the most effective interventions for reducing symptoms of nausea and vomiting in pregnancy, with considerable uncertainty and low-to-moderate quality of evidence. Reporting of adverse events was limited. Risk of bias was low to moderate. Discussion: Most interventions demonstrated significant benefit over a placebo. However, high heterogeneity and sparse reporting of adverse effects warrant caution when translating these results into clinical practice. Conclusions: This study indicates that both pharmacological (vitamin B6, metoclopramide, dimenhydrinate) and non-pharmacological (ginger, quince, acupressure, acupuncture) interventions might be effective in reducing symptoms of nausea and vomiting in pregnancy. Full article

Objective: Nausea and vomiting in pregnancy (NVP) have a negative impact on quality of life and nutritional status and may progress to hyperemesis gravidarum (HG). We explored the incidence, severity, clinical evolution, and management of NVP. Methods: In accordance with the Italian Society of Gynecology and Obstetrics (SIGO), we conducted a multicentric prospective cohort study at eighteen Italian hospitals, from October 2022 to November 2024. We enrolled pregnant women before 13 weeks of gestation. The severity of NVP and its management were assessed during pregnancy. Results: A total 890 pregnant participants completed the follow-up. NVP prevalence was 70.0% and was classified as 54.4% mild, 42.3% moderate, and 3.2% severe according to the PUQE score; 2.4% required hospitalization. Severe NVP was more frequent in multiparous women (90.0%; p < 0.001); NVP history was independently associated with NVP recurrence, OR 3.20 (2.12–4.83; p < 0.001). NVP cases showed a low rate of smoking (3.9% vs. 7.1%; p = 0.04). After the first consultation, pharmacological treatment, primarily doxylamine–pyridoxine, was prescribed to 50.7% of mild, 67.0% of moderate, and 50.0% of severe PUQE scores. Dosages of ≥3 capsules/day were common in moderate (51.0%) and severe (70.0%) NVP cases (p < 0.001). By the second visit, continuation of therapy did not differ among PUQE classes, although reasons for discontinuation varied (p < 0.001). By the third visit, therapy continuation dropped to 32.1% in moderate cases (p = 0.03). Conclusions: NVP is a common disorder in pregnancy, with a predominance of mild and moderate symptoms. Prior NVP increases the recurrence risk threefold. Despite the high prevalence of NVP, the therapy remains inconsistent and delayed. Full article

Objective: To investigate the association between inflammatory indices derived from complete blood count, including the systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and pan-immune inflammation value (PIV), in predicting nausea and vomiting in pregnancy (NVP). Methods: Women diagnosed and treated for NVP at a tertiary care hospital between 2016 and 2021 were retrospectively analyzed. A total of 278 eligible patients with NVP and 278 gestational age-matched healthy pregnant women were included. Patients with NVP were categorized as having mild (n = 58), moderate (n = 140), or severe NVP (n = 80). Patients with moderate and severe NVP, who almost always required hospitalization, were grouped together and assigned to the inpatient treatment group. The groups were then compared. Results: SII and PIV were significantly higher in the NVP group than in the control group (p < 0.001 for both). In addition to SIRI, SII and PIV were also significantly higher in both the moderate NVP and HG groups compared to the mild NVP group (p = 0.017, 0.040, and 0.038, respectively, and p = 0.003, 0.009, and 0.006, respectively). SII, with a cut-off value of >966 × 10³/μL (63.67% sensitivity, 68.35% specificity), showed the best discriminatory performance for predicting NVP (p < 0.001), but there was no significant difference among SII, SIRI, and PIV in predicting the need for hospitalization. Conclusions: Our results show that there may be an association between high SII and PIV and an increased risk of developing NVP. In the future, after sufficient research, among these complete blood count-based inflammatory indices, SII may become an important component of regression models used as a screening tool to predict NVP, particularly in cases requiring inpatient care. Full article

Background: The aim of this study was to evaluate the diagnostic and prognostic performance of albumin-based inflammatory–nutritional indices in hyperemesis gravidarum (HG) and to determine their associations with disease severity and risk of re-hospitalization. Methods: This retrospective case–control study included 246 women with HG and 246 gestational-age-matched healthy pregnant controls at 6–16 weeks of gestation. Disease severity was classified as mild, moderate, or severe using the Pregnancy-Unique Quantification of Emesis (24 h scale) (PUQE-24) score. A comprehensive panel of albumin-based inflammatory indices—including C-reactive protein-to-albumin ratio (CAR), fibrinogen-to-albumin ratio (FAR), neutrophil-to-albumin ratio (NAR), leukocyte-to-albumin ratio (LAR), neutrophil percentage-to-albumin ratio (NPAR), monocyte-to-albumin ratio (MAR), hemoglobin–albumin–lymphocyte–platelet (HALP) score, modified HALP (m-HALP) score, prognostic nutritional index (PNI) score, systemic immune-inflammation index-to-albumin (SII/Alb), and systemic inflammatory response index-to-albumin (SIRI/Alb)—was calculated from routine complete blood count and serum biochemistry results obtained at diagnosis. Receiver operating characteristic analysis, along with univariate and multivariate logistic regression models, was performed to evaluate diagnostic performance and identify predictors of severe HG and re-hospitalization. Results: Albumin-based indices exhibited severity-associated alterations, with an overall trend toward worsening immuno-nutritional status across increasing HG severity. Among these, m-HALP score demonstrated the strongest inverse correlations with PUQE-24 score, ketonuria grade, length of hospital stay, and re-hospitalization risk (r = −0.74 to −0.52; all p < 0.001) and achieved the highest discriminative accuracy for both severe HG (AUC 0.864, 95% CI 0.836–0.892, p < 0.001) and re-hospitalization (AUC 0.722, 95% CI 0.675–0.766, p < 0.001). In multivariable analysis, higher HALP, m-HALP, and PNI were independently associated with a lower likelihood of severe HG. For re-hospitalization, higher m-HALP and HALP were independently associated with a lower risk, whereas higher NPAR, higher ketonuria grade, and higher PUQE-24 score were independently associated with an increased risk of re-hospitalization. Conclusions: Albumin-based indices, particularly m-HALP, demonstrated robust diagnostic and prognostic performance in HG compared with conventional biomarkers. These readily available, cost-neutral composite biomarkers enable objective severity stratification and accurate identification of patients at elevated risk of recurrent hospitalization, offering immediate potential to guide personalized, evidence-based clinical management. Full article

Background/Objectives: Eating disorders (EDs) often affect fertility, yet many women with ED still become mothers. The pattern of ED symptoms during pregnancy and postpartum, along with their effects on maternal and child health, is not yet fully understood. This longitudinal study aimed to (1) examine the course of ED symptoms from conception to postpartum, (2) evaluate pregnancy outcomes and children’s health and developmental milestones, and (3) assess ED status approximately four years after the initial evaluation. Methods: Thirty women with a prior ED diagnosis (21 with anorexia nervosa, 9 with bulimia nervosa) were evaluated at two time points. Time 1 with the Eating Disorders Examination and the Oxford Risk Factors for Eating Disorders: Interview Schedule; Time 2, approximately four years later, with the Eating Disorders Examination and the Clinical Interview on Reproductive History and Eating Behavior that also included clinical data related to mother’s health and baby’s health and development accessed through the Pregnant Women’s Health Bulletin and the Child and Youth Health Bulletin using the national health records. Results: ED symptoms (dietary restriction, self-induced vomiting, laxative misuse) persisted from conception through postpartum. BN participants reported more severe symptoms and higher rates of pregnancy complications (hyperemesis gravidarum, gestational diabetes, preeclampsia), while premature births occurred only in AN participants. Children of mothers with AN more frequently showed delays in developmental milestones (sitting, walking, speaking, sphincter control) compared to those of BN mothers. Conclusions: A substantial proportion of women with prior ED continued to experience symptoms during and after pregnancy, and nearly half still met diagnostic criteria four years later and are still in treatment. Cognitive features such as body dissatisfaction persisted despite partial symptom remission. These findings highlight the chronicity of ED and underscore the need for systematic screening, psychological support, and interdisciplinary follow-up during pregnancy and early motherhood. Full article

Background and Clinical Significance: The occurrence of acute myeloid leukemia (AML) in pregnancy represents a diagnostic and management challenge in the attempt to balance and achieve both maternal and fetal wellbeing. Pregnancy-specific manifestations mimic the initial symptoms of leukemia and may lead to a delay in diagnosis, especially during the first trimester of pregnancy. Decision-making strategies involve the patient and couples counseling with a multidisciplinary team of hematologists, obstetricians, neonatologists and psychologists. Maternal outcome depends on the disease subtype, progression and response to medication. Fetal outcome depends on other potential pregnancy complications, possible teratogenicity, gestational age at delivery and sometimes iatrogenic prematurity. Case Presentation: We present the case of a 38-year-old multiparous patient with a late first trimester, with an AML diagnosis presenting with hyperemesis gravidarum-like symptoms. Genetic testing revealed the presence of an Fms-like tyrosine kinase 3-internal tandem duplication mutation (FLT3-ITD). Following that, a repeatedly refused termination of pregnancy and rapid disease progression with azacitidine therapy was initiated. Elective cesarean delivery was performed at 34 weeks of gestation due to progressive leukocytosis, which persisted postpartum, requiring the use of first-, second-, and eventually third-line chemotherapy. Fetal outcome was favorable at 3 months postpartum. Conclusions: Cases of AML in pregnancy require a tailored approach according to guidelines, but also patient/couple preferences, while the choice of chemotherapy is limited considering its potential teratogenic effects. This is a case with a misleading first presentation and a challenging therapeutic choice due to its genetic subtype and maternal treatment postponement. Full article

Purpose: In 2020, a lockdown due to COVID-19 was ordered by the German government, resulting in population-wide restrictions. In this retrospective study, we question the extent to which health policy restrictions have influenced medical diagnoses. Methods: The incidence rates of relevant pregnancy complications during all trimesters of pregnancy were evaluated for a 6-month pre-pandemic period (April–September 2019), in comparison to the same period during the lockdown in 2020. Mothers and newborns who presented at the University Hospital St. Hedwig, Regensburg, Germany, were included in the study. The incidence rates of preeclampsia and suspected FGR (fetal growth retardation), as relevant obstetric diseases, were further compared with those in a post-pandemic period (April–September 2023). Results: A total of 5137 newborns were included, with 1709 born during the 6-month pre-pandemic period, 1806 during the 6-month lockdown period and 1687 during the 6-month post-pandemic period. During the pandemic period, significantly fewer patients were hospitalized due to hyperemesis gravidarum (1.8% vs. 0.9%, p = 0.04). No differences were observed concerning the incidence of miscarriages before and after 14 weeks of gestation (WG), preterm deliveries (<37 WG), gestational age at preterm birth and birth weight. Likewise, within the group of preterm-born babies, no difference was observed in preeclampsia among the two periods. However, in the pandemic period, the frequency of preterm-born babies with suspected FGR was significantly lower than in the pre-pandemic period (1.5% and 0.6%, p = 0.01). Regarding this point, we analyzed data of all newborns in a comparative post-pandemic period in 2023 (n = 1687). This group presented a significantly increased FGR incidence compared to that during the pandemic, therefore returning to the pre-pandemic level (1.5% and 1.4%, p = 0.145). Conclusions: During the COVID-19 pandemic, there were significantly fewer deliveries with suspected FGR. After all specific restrictions on elective and outpatient services were lifted, the incidence of suspected FGR returned to its initial level, suggesting that the diagnosis—as a solely machine-dependent and not symptom-based diagnosis—was partly exaggerated in both the pre-and post-pandemic periods. Full article

Background: Hyperemesis gravidarum (HG) is the leading cause of hospitalization during early pregnancy, affecting approximately 0.3–3% of pregnancies. It represents the most severe end of the nausea and vomiting in pregnancy (NVP) spectrum and is associated with substantial maternal morbidity and potential adverse fetal outcomes. Despite extensive research, the exact pathophysiology remains poorly understood, and optimal management strategies continue to be debated. Methods: This narrative review synthesizes current evidence on the complications and treatment approaches for HG. A literature search was conducted in PubMed, Scopus, and Medline up to October 2024 using predefined keywords. Eligible sources included observational studies, cohort studies, descriptive studies, and case reports. Systematic reviews, meta-analyses, and non-English articles were excluded. Results: HG is associated with a broad spectrum of complications, including dehydration, electrolyte imbalances, Wernicke’s encephalopathy, cardiac arrhythmias, thromboembolism, and adverse pregnancy outcomes such as fetal growth restriction and preterm birth. Pharmacological treatments—most notably doxylamine-pyridoxine (the only FDA-approved therapy), ondansetron, metoclopramide, and corticosteroids—have demonstrated varying efficacy and safety profiles. Non-pharmacological interventions such as acupressure, dietary adjustments, psychotherapy, and hypnosis have also been studied, although evidence remains limited. Conclusions: HG requires a comprehensive and individualized management approach. While doxylamine-pyridoxine remains the cornerstone of therapy, other pharmacologic and supportive measures may offer additional benefit. Continued research is essential to clarify the underlying mechanisms, improve therapeutic efficacy, and develop evidence-based guidelines that integrate both medical and psychosocial care for affected women. Full article

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