Hypokalemia Due to Persistent Vomiting During Pregnancy

Lans, Hyman S.; Gollin, Harvey A.; Daro, August F.; Nora, E Dalla

doi:10.1001/jama.1953.02940280020006

Cited by 12 publications

(4 citation statements)

References 9 publications

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“…Hypokalemia is a feature of metabolic disturbance in hyperemesis gravidarum [ 27 ]. A possible explanation for the observed association with HP could be more severe HG-related symptoms, i.e., increased vomiting and metabolic alkalosis.…”

Section: Discussionmentioning

confidence: 99%

Helicobacter pylori Exposure in Nausea and Vomiting of Pregnancy Increases Risk of Preterm Delivery

Masaadeh,

Mathias,

Ford

et al. 2023

Infectious Diseases in Obstetrics and Gynecology

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Background. Hyperemesis gravidarum (HG), a severe form of nausea and vomiting in pregnancy (NVP), is a leading indication for hospitalization in the first trimester. NVP and HG are associated with Helicobacter pylori (HP) infection in non-United States cohorts. How HP exposure and NVP interact to affect metabolic disturbance and pregnancy outcomes is not known. Materials and Methods. We designed a retrospective cohort study relating HP and NVP to serum electrolyte laboratory results, preterm delivery, and infant birth weight. Single academic institution discovery and independent multi-institutional validation cohorts included pregnant subjects with an HP test result. Associations of HP, NVP, and pregnancy outcomes were assessed with odds ratio calculations, Student’s t -tests, and multivariate logistic regression. Results. Among subjects with positive HP test results, the prevalence of hyperemesis gravidarum (HG) was 0.025 (66 of 2671) and NVP was 0.27 (710 of 2671). Subjects with negative HP had prevalence of HG 0.015 (165 of 10,960) and NVP 0.22 (2392 of 10,960). History of HP exposure increased risk of NVP, including HG (odds ratio 1.3, 95% CI 1.1-1.4). Patients with HP exposure had lower serum potassium (mean difference 0.1 mEq/L) and bicarbonate (mean difference 0.3 mEq/L) during pregnancy than HP-negative patients ( p < 0.01 ). Serum potassium was lowest in subjects with both NVP and HP exposure (mean 3.5 mEq/L [3.4-3.6], p < 0.0001 ). HP exposure alone carried increased risk for preterm delivery (OR 1.3 [1.1-1.4]). NVP alone increased risk of preterm delivery (OR 2.8 [2.5-3.1]) including second trimester delivery (OR 2.2 [1.7-2.8]). In multivariate analysis, HP exposure in the setting of NVP further increased risk of preterm delivery (adjusted OR 1.4 [1.0-1.9], p = 0.03 ). Conclusions. H. pylori exposure and diagnosis of NVP are individually associated with metabolic disturbances and adverse pregnancy outcomes such as preterm labor and delivery, and their combination further increases risk in US populations.

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Section: Discussionmentioning

confidence: 99%

Helicobacter pylori Exposure in Nausea and Vomiting of Pregnancy Increases Risk of Preterm Delivery

Masaadeh,

Mathias,

Ford

et al. 2023

Infectious Diseases in Obstetrics and Gynecology

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“…Potassium deficiency was first reported in 1953 in association with 8 cases of severe HG all accompanied by lethargy, listlessness, apathy, mental depression, and muscle weakness [7]. In 1953 it was noted that therapy with intravenous potassium chloride resulted in notable improvement in mental attitude and muscular strength and appeared to be "a lifesaving procedure".…”

Section: Electrolyte Monitoring and Treatmentmentioning

confidence: 99%

Why are Women Still Dying from Nausea and Vomiting of Pregnancy?

Fejzo

MacGibbon²,

Mullin³

2016

Gynecol Obstet Case Rep

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“…These surely cannot be 'the drugs of choice in pregnancy'? [1] Indeed, vomiting is common and hypokalaemia, a major risk factor for QT prolongation, is observed in hyperemesis [6]. Why is duloxetine ever prescribed [1] when its specific life-threatening serious effects include liver injury and skin reactions including Stevens-Johnson syndrome?…”

mentioning

confidence: 99%

“…Could the authors direct us to any recommendation justifying paroxetine or fluoxetine use and what kind of information women in this series would have received about malformations? [1] It appears no lessons have been learnt from the valproate scandal [6]. The first report of congenital malformation due to valproate was made by a French team in 1982.…”

mentioning

confidence: 99%

The easy misuse of antidepressants during pregnancy is depressing

Braillon

Bewley

2018

Brit J Clinical Pharma

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Bénard-Laribière et al. must be commended for their detailed monitoring of antidepressant prescriptions during pregnancy [1], in a Journal that has previous creditable pieces including warnings about malformations with paroxetine and fluoxetine [2]. However, we disagree with their views on potential undertreatment and the over-reassuring conclusion that treatment has been especially adapted in accordance with existing recommendations in a 'large proportion' of pregnant women.Firstly, all prescribers should always prioritize pregnancy and drug safety. However, data to ascertain the benefit:harm ratio or guide dosing are scarce. Even when available, such data are often overlooked by prescribers [3]. Very few drug registries exist to report postmarketing harms. The European Registry of Antiepileptic Drugs and Pregnancy (EURAP) is among notable exceptions.Secondly, in contrast to the authors' beliefs [1], first-line treatment should always be cognitive behavioural therapy (CBT)even for severe depression [4]. The most serious adverse effects of antidepressants, such as malformations [2] and postpartum haemorrhage [5], cannot be overlooked. Almost all antidepressant prescriptions in this particular observational series may be first-line treatments as psychotherapies are not reimbursed by the mandatory and affluent French health care system. France has overlooked evidence underpinning the Improving Access to Psychological Therapies programme launched in 2008 in England. This beacon, offering largely CBT approaches to people with anxiety or depressive diagnoses, has also been implemented in Quebec and Belgium. Limiting prescriptions to medicines only ties doctors' hands to the patients' detriment.

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Hypokalemia Due to Persistent Vomiting During Pregnancy

Cited by 12 publications

References 9 publications

Helicobacter pylori Exposure in Nausea and Vomiting of Pregnancy Increases Risk of Preterm Delivery

Helicobacter pylori Exposure in Nausea and Vomiting of Pregnancy Increases Risk of Preterm Delivery

Why are Women Still Dying from Nausea and Vomiting of Pregnancy?

The easy misuse of antidepressants during pregnancy is depressing

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