Antihistamines and other prognostic factors for adverse outcome in hyperemesis gravidarum

Abstract

Objective The purpose of this study is to determine the frequency of adverse perinatal outcome in women with hyperemesis gravidarum and identify prognostic factors. Study design This is a case-control study in which outcomes of first pregnancies were compared between 254 women with hyperemesis gravidarum treated with intravenous fluids and 308 controls. Prognostic factors were identified by comparing the clinical profile of patients with hyperemesis gravidarum with a normal and an adverse pregnancy outcome. Binary responses were analyzed using either a Chi-square or Fisher exact test and continuous responses were analyzed using a t-test. Results Women with hyperemesis gravidarum have over a 4-fold increased risk of poor outcome including preterm birth and lower birth weight (p < 0.0001). Among maternal characteristics, only gestational hypertension had an influence on outcome (p < 0.0001). Treatment as an outpatient and/or by alternative medicine (acupuncture/acupressure/Bowen massage) was associated with a positive outcome (p < 0.0089). Poor outcomes were associated with early start of symptoms (p < 0.019), and treatment with methylprednisolone (p < 0.0217), promethazine (p < 0.0386), and other antihistamines [diphenhy- dramine (Benadryl), dimenhydrinate (Gravol), doxylamine (Unisom), hydroxyzine (Vistaril/Atarax), doxylamine and pyridoxine (Diclectin/Bendectin)] (p < 0.0151) independent of effectiveness. Among these medications, only the other antihistamines were prescribed independent of severity: they were effective in less than 20% of cases and were taken by almost 50% of patients with an adverse outcome. Conclusion Poor outcomes are significantly greater in women with HG and are associated with gestational hypertension, early symptoms, and antihistamine use. Given these results, there is an urgent need to address the safety and effectiveness of medications containing antihistamines in women with severe nausea of pregnancy.

Weight loss in pregnancy and cardiometabolic profile in childhood: findings from a longitudinal birth cohort

“…Our data suggest that overweight and obese women are more likely to experience SWL. HG has repeatedly been associated with a modest decrease in birthweight . In our study, birthweight was not clearly reduced among children born to women with SWL.…”

Adverse Maternal and Birth Outcomes in Women Admitted to Hospital for Hyperemesis Gravidarum: a Population‐Based Cohort Study

“…There is conflicting evidence on how HG may directly affect the health of the unborn child in terms of birthweight or being small‐for‐gestational‐age. Although some studies suggest that HG is not associated with adverse pregnancy outcomes, others have found associations with preterm birth and lower birthweight . Moreover, little evidence has been reported on the occurrence of stillbirth and need for neonatal care for babies born to women affected by HG.…”

Neurodevelopmental delay in children exposed in utero to hyperemesis gravidarum

“…Interestingly, the only factor significantly linked to neurode-274 velopmental delay is early onset of symptoms, which was also 275 found in a previous study to be linked to adverse fetal outcome 276 [40]. It can be of some comfort for women to know that while 277 antihistamines, which are commonly used to treat HG, were linked 278 to preterm birth in HG pregnancies, there was no evidence of 279 antihistamine exposure being linked to neurodevelopmental delay 280 in children [40]. Consistent with our findings, in a recent study, 281…”

“…This 229 theory is supported by rodent studies that show maternal care in 230 the first week after birth results in epigenetic modification of genes 231 expressed in the brain that shape neuroendocrine and behavioral 232 stress responsivity throughout life [28]. Interestingly, the only factor significantly linked to neurode-274 velopmental delay is early onset of symptoms, which was also 275 found in a previous study to be linked to adverse fetal outcome 276 [40]. It can be of some comfort for women to know that while 277 antihistamines, which are commonly used to treat HG, were linked 278 to preterm birth in HG pregnancies, there was no evidence of 279 antihistamine exposure being linked to neurodevelopmental delay 280 in children [40].…”

“…cantly associated with neurodevelopmental delay in children 40 exposed to HG in utero were also identified. 92 characteristics between all of the children who were exposed to HG 93 in utero to those children who were not.…”