Association between severe nausea and vomiting in early pregnancy and the risk of neural tube defects in Northern China

Background: Around half of all pregnant women experience vomiting, and more than 80% of women experience nausea in the first 12 weeks. Women with severe nausea and vomiting during pregnancy may have hyperemesis gravidarum (HG), an entity distinct from nausea and vomiting of pregnancy (NVP), which if left untreated may lead to significant maternal and foetal morbidity. In our study, we studied, clinical and laboratory parameters in patients presenting with excessive vomiting. The study may help in evaluating what is the major clinical problem encountered during treatment and how many days of care are needed in such cases.Methods: The study design was a prospective observational study. Patients attending the ANC clinic and emergency indoor cases at Peoples college of medical sciences, Bhopal were considered as study population. 100 patients who satisfied inclusion and exclusion criteria were included in the study. Patient’s sociodemographic variables, detailed obstetric history, clinical and laboratory parameters were recorded. Results obtained were analysed and tabulated.Results: Persistence of vomiting in the first trimester leading to dehydration and hospitalization was documented in 12% of patients. The 5% of then had metabolic acidosis and 1% required correction of starvation ketoacidosis, but there was not significant weight loss observed in any of the case. Liver function test were normal in almost in all cases except 9% had raised serum alkaline phosphatase levels.Conclusions: All cases with vomiting in early pregnancy should receive attention and exclusion of all emergency clinical conditions. Patient should be screened for urine tract infection and diabetes in all cases.

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Sex differences in the prevalence of neural tube defects and preventive effects of folic acid (FA) supplementation among five counties in northern China: results from a population-based birth defect surveillance programme

BMJ Open ◽

10.1136/bmjopen-2018-022565 ◽

2018 ◽

Vol 8 (11) ◽

pp. e022565 ◽

Cited By ~ 5

Author(s):

Jufen Liu ◽

Jing Xie ◽

Zhiwen Li ◽

Nicholas D E Greene ◽

Aiguo Ren

Keyword(s):

Sex Differences ◽

Folic Acid ◽

Neural Tube ◽

Neural Tube Defects ◽

Gestational Age ◽

Birth Defect ◽

Northern China ◽

Population Based ◽

Secondary Outcome ◽

Surveillance Programme

ObjectivesSex differences in prevalence of neural tube defects (NTDs) have previously been recognised; however, the different susceptibility of men and women have not been examined in relation to the effects of folic acid (FA) supplementation. We hypothesised that FA may have a disproportionate effect that alters the sex-specific prevalence of NTDs.SettingData from two time points, before (2003–2004) and after (2011–2016) the start of the supplementation programme, were obtained from a population-based birth defect surveillance programme among five counties in northern China. All live births (28 or more complete gestational weeks), all stillbirths of at least 20 weeks’ gestational age and pregnancy terminations at any gestational age following the prenatal diagnosis of NTDs were included.ParticipantsA total of 25 249 and 83 996 births before and after the programme were included respectively.Primary and secondary outcome measuresThe prevalence of NTDs by sex and subtype, Male:female rate ratios and their 95% CI were calculated.ResultsOverall, NTDs were less prevalent among men than among women (rate ratio (RR) 0.92; 95% CI 0.90 to 0.94), so was anencephaly (RR 0.77; 95% CI 0.73 to 0.81) and encephalocele (RR 0.75; 95% CI 0.61 to 0.92), while spina bifida showed a male predominance (RR 1.10; 95% CI 1.05 to 1.15). The overall prevalence of NTDs decreased by 78/10 000 in men and 108.7/10 000 in women from 2003 to 2004 to 2011 to 2016. There was a significant sex difference in the magnitude of reduction, being greater in women than men, particularly for anencephaly.ConclusionsThe prevalence of NTDs decreased in both sexes after the implementation of a massive FA supplementation programme. While female predominance was observed in open NTDs and total NTDs, they also had a greater rate of decrease in NTDs after the supplementation programme.

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