The Effect of Hyperemesis Gravidarum on Gestational Diabetes and Pregnancy Outcomes

Abstract

Objective:  Nausea and vomiting in pregnancy is the most common complication that observed in %50-80 of pregnant women. Approximately %1 of pregnant women experience severe nausea and vomiting during the first trimester and are diagnosed with hyperemesis gravidarum (HG). HG is the major reason for hospitalization before 20 gestational weeks. A relationship between insulin sensitivity, HG, and gestational diabetes mellitus (GDM) has been established. In this study, we aimed to assess the impact of HG on GDM and pregnancy outcomes.

Method: This retrospective study was conducted at Konya Akşehir State Hospital between 1^st March 2015 and 30^th September 2017. A total of 100 women included in this study (n:46 hyperemesis, n:54 control). Screening for GDM was performed once during pregnancy. GDM diagnosis was obtained with a 75-g OGTT, during the second trimester, from 24–28 weeks of gestation. Main outcomes were gestational diabetes, pregnancy-induced hypertension, fetal birth weight, preterm birth and fetal sex. Statistical analysis was performed using SPSS 15.0. p < 0.05 was considered as statistically significant.

Results: At initial examination, no significant differences in maternal age and BMI were observed between the two groups. We found no statistical difference between the groups in the prevalence of
GDM, pregnancy-induced hypertension,  fetal birth weight, preterm birth and fetal sex.

Conclusion: In the literature, there are many studies that shows negative effects of HG on maternal and fetal outcomes. In our study, it was found that  HG  is not associated with adverse pregnancy outcomes. The lack of this study is the small number of patients. More extensive studies are needed to define long term effects of HG.

Keywords

• Hyperemesis gravidarum,gestational diabetes,pregnancy outcomes

Hiperemezis Gravidarumun Gestasyonel Diyabet ve Gebelik Sonuçları Üzerine Etkisi

Öz

Giriş: Bulantı ve kusma, gebe kadınların% 50-80'inde görülen en yaygın komplikasyondur. Gebe kadınların yaklaşık% 1'i ilk trimesterde şiddetli bulantı ve kusma yaşarlar ve hiperemezis gravidarum (HG) tanısı alırlar. HG 20. gebelik haftasından önce hastaneye yatışın ana nedenidir. Önceki çalışmalarda, insülin duyarlılığı, HG ve gestasyonel diabetes mellitus (GDM) arasında bir ilişki kurulmuştur. Bu çalışmada, HG’nin, GDM ve gebelik sonuçları üzerindeki etkisini değerlendirmek amaçlanmıştır.

Gereç ve yöntem: Bu retrospektif çalışma 1 Mart 2015-30 Eylül 2017 tarihleri arasında Konya Akşehir Devlet Hastanesi'nde yapıldı. Çalışmaya toplam 100 hasta dahil edildi (n: 46 HG, n: 54 kontrol). GDM için tarama gebelik sırasında bir kez gerçekleştirildi. GDM tanısı, ikinci trimesterde, 24-28 gebelik haftasından 75 g OGTT ile konuldu. Başlıca değerlendirilen parametreler; gestasyonel diyabet, gebeliğe bağlı hipertansiyon, fetal doğum ağırlığı, preterm doğum ve fetal cinsiyet idi. İstatistiksel analiz SPSS 15.0 kullanılarak yapıldı. p <0.05 istatistiksel olarak anlamlı kabul edildi.

Bulgular: İlk muayenede, iki grup arasında maternal yaş ve VKİ açısından anlamlı bir farklılık gözlenmedi. GDM prevalansı, gebeliğe bağlı hipertansiyon, fetal doğum ağırlığı, preterm doğum ve fetal cinsiyet açısından gruplar arasında istatistiksel olarak anlamlı fark bulunmadı.

Sonuç: Literatürde hiperemezis gravidarumun maternal ve fetal sonuçlar üzerine olumsuz etkilerini gösteren birçok çalışma vardır. Çalışmamızda hiperemezis gravidarumun olumsuz gebelik sonuçları ile ilişkili olmadığı bulunmuştur. Bu çalışmanın kısıtlılığı hasta sayısının az olmasıdır. Hiperemezis gravidarumun uzun dönem etkilerini tanımlamak için daha kapsamlı çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• hiperemezis gravidarum,gestasyonel diyabet,gebelik sonuçları

Kaynakça

1. KAYNAKLAR1.Jarvis S, Nelson-Piercy C. Management of nausea and vomiting in pregnancy. BMJ. 2011;342:d3606.
2. 2.Bailit JL. Hyperemesis gravidarium: Epidemiologic findings from a large cohort.Am J Obstet Gynecol. 2005 Sep;193(3 Pt 1):811-4.
3. 3.Helseth R, Ravlo M, Carlsen SM, Vanky EE. Androgens and hyperemesis gravidarum: a case–control study. Eur J Obstet Gynecol Reprod Biol. 2014;175:167–71.
4. 4.Fell DB, Dodds L, Joseph KS, Allen VM, Butler B. Risk factors for hyperemesis gravidarum requiring hospital admission during pregnancy. Obstet Gynecol. 2006;107(2 Pt 1):277–84.
5. 5.Goodwin TM, Hershman JM, Cole L. Increased concentration of the free beta-subunit of human chorionic gonadotropin in hyperemesis gravidarum. Acta Obstet Gynecol Scand. 1994;73:770–772.
6. 6. Depue RH, Bernstein L, Ross RK, Judd HL, HendersonBE. Hyperemesis gravidarum in relation to estradiol levels, pregnancy outcome, and other maternal factors: a seroepidemiologic study. Am J Obstet Gynecol. 1987;156:1137–1141.
7. 7. Tan PC, Jacob R, Quek KF, Omar SZ. The fetal sex ratio and metabolic, biochemical, haematological and clinical indicators of severity of hyperemesis gravidarum. BJOG 2006; 113:733–737.
8. 8.Vikanes A, Skjaerven R, Grjibovski AM, Gunnes N, Vangen S, Magnus P. Recurrence of hyperemesis gravidarum a cross generations: population based cohort study. BMJ. 2010;340:c2050.

9. 9.Ismail S.K.,Kenny L. Review on hyperemesis gravidarum. Best Pract Res ClinGastroenterol. 2007;21:755–69.
10. 10.Fejzo MS, MacGibbon KW, Romero R, Goodwin TM, Mullin PM. Recurrence risk of hyperemesis gravidarum. J Midwifery Women Health. 2011;56:132–6.
11. 11.Ohara R, Obata-Yasuoka M, Abe K, et al. Effect of hyperemesis gravidarum on gestational diabetes mellitus screening. Int J Gynaecol Obstet. 2016;132:156–158.
12. 12.Ayyavoo A, Derraik JG, Hofman PL, et al. Severe hyperemesis gravidarum is associated with reduced insulin sensitivity in the off spring in childhood. J Clin Endocrinol Metab. 2013;98:3263–3268.
13. 13.Koffler M, Kisch ES. Starvation diet and very-low-calorie diets may induce insulin resistance and overt diabetes mellitus. J Diabet Complicat. 1996;10(2):109–12.
14. 14.Petry CJ, Ong KK, Beardsall K, Hughes IA, Acerini CL, Dunger DB. Vomiting in pregnancy is associated with a higher risk of low birth weight: a cohort study. BMC Pregnancy Childbirth. 2018 May 4;18(1):133. doi: 10.1186/s12884-018-1786-1.
15. 15.Hastoy A, LienTran P, Lakestani O, Barau G, Gérardin P, Boukerrou M. Hyperemesis gravidarum and pregnancy outcomes. J Gynecol Obstet BiolReprod. 2015;44:154–63.
16. 16.Dodds L, Fell DB, Joseph KS, Allen VM, Butler B. Outcomes of pregnancies complicated by hyperemesis gravidarum. Obstet Gynecol. 2006 Feb;107(2 Pt 1):285-92.
17. 17.Kuru O, Sen S, Akbayır O, Goksedef BP, Ozsürmeli M, Attar E, Saygılı H. Outcomes of pregnancies complicated by hyperemesis gravidarum. Arch Gynecol Obstet. 2012 Jun;285(6):1517-21.
18. 18. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, et all. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010 Mar; 33 (3): 676-82. doi: 10.2337/dc09-1848.
19. 19. Zhou YP, Grill V. Long term exposure to fatty acids and ketones inhibits B-cell functions in human pancreatic islets of Langerhans. J Clin Endocrinol Metab 1995;80(5): 1584–90.
20. 20. Duska F, Andel M, Kubena A, Macdonald IA. Effects of acute starvation on insulin resistance in obese patients with and without type 2 diabetes mellitus. Clin Nutr 2005; 24(6):1056–64.
21. 21. Madendag Y, Sahin E, Madendag Col I, Eraslan SM, Tayyar AT, Ozdemir F, et all. The effect of hyperemesis gravidarum on the 75 g oral glucose tolerance test screening and gestational diabetes mellitus. J Matern Fetal Neonatal Med. 2018 Aug;31(15):1989-1992.
22. 22. Bennett CJ, Walker RE, Blumfield ML, Gwini SM, Ma J, Wang F, et all. Interventions designed to reduce excessive gestational weight gain can reduce the incidence of gestational diabetes mellitus: A systematic review and meta-analysis of randomised controlled trials. Diabetes Res Clin Pract. 2018 Jul;141:69-79.
23. 23. Tuomilehto J, Lindström J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001; 344: 1343-1350.
24. 24. Sørensen HT, Thulstrup AM, Mortensen JT, Larsen H, Pedersen L. Hyperemesis gravidarum and sex of child. Lancet. 2000 Jan 29;355(9201):407.
25. 25. Basso O, Olsen J. Sex ratio and twinning in women with hyperemesis or pre-eclampsia. Epidemiology. 2001 Nov;12(6):747-9.