scholarly journals Associations of vomiting and antiemetic use in pregnancy with levels of circulating GDF15 early in the second trimester: A nested case-control study

2018 ◽  
Vol 3 ◽  
pp. 123 ◽  
Author(s):  
Clive J. Petry ◽  
Ken K. Ong ◽  
Keith A. Burling ◽  
Peter Barker ◽  
Sandra F. Goodburn ◽  
...  
Keyword(s):  
Hyperemesis Gravidarum ◽  
Nausea And Vomiting ◽  
Second Trimester ◽  
Genetic Associations ◽  
Chemoreceptor Trigger Zone ◽  
Trigger Zone ◽  
Body Mass Indexes ◽  
Study Participants ◽  
Nested Case Control ◽  
In Pregnancy

Background: Although nausea and vomiting are very common in pregnancy, their pathogenesis is poorly understood. We tested the hypothesis that circulating growth and differentiation factor 15 (GDF15) concentrations in early pregnancy, whose gene is implicated in hyperemesis gravidarum, are associated with nausea and vomiting. Methods: Blood samples for the measurement of GDF15 and human chorionic gonadotrophin (hCG) concentrations were obtained early in the second trimester (median 15.1 (interquartile range 14.4-15.7) weeks) of pregnancy from 791 women from the Cambridge Baby Growth Study, a prospective pregnancy and birth cohort. During each trimester participants completed a questionnaire which included questions about nausea, vomiting and antiemetic use. Associations with pre-pregnancy body mass indexes (BMI) were validated in 231 pregnant NIPTeR Study participants. Results: Circulating GDF15 concentrations were higher in women reporting vomiting in the second trimester than in women reporting no pregnancy nausea or vomiting: 11,581 (10,977-12,219) (n=175) vs. 10,593 (10,066-11,147) (n=193) pg/mL, p=0.02). In women who took antiemetic drugs during pregnancy (n=11) the GDF15 levels were also raised 13,157 (10,558-16,394) pg/mL (p =0.04). Serum GFD15 concentrations were strongly positively correlated with hCG levels but were inversely correlated with maternal BMIs, a finding replicated in the NIPTeR Study. Conclusions: Week 15 serum GDF15 concentrations are positively associated with second trimester vomiting and maternal antiemetic use in pregnancy. Given GDF15’s site of action in the chemoreceptor trigger zone of the brainstem and its genetic associations with hyperemesis gravidarum, these data support the concept that GDF15 may be playing a pathogenic role in pregnancy-associated vomiting.

Nausea and Vomiting of Pregnancy

2018 ◽  
Author(s):  
Elizabeth Roberts ◽  
Brett C Young
Keyword(s):  
Hyperemesis Gravidarum ◽  
Clinical History ◽  
Nausea And Vomiting ◽  
Maternal Outcomes ◽  
Pharmacologic Treatment ◽  
Second Trimester ◽  
First Line ◽  
Medical Treatments ◽  
Persistent Vomiting ◽  
Key Words Enteral Feeding

In pregnancy, the majority of women experience at least some nausea and vomiting. For many women, these symptoms are mild and self-limiting and resolve by the second trimester. A minority of women experience severe symptoms of hyperemesis gravidarum with persistent vomiting, weight loss, and electrolyte derangements. The diagnosis of hyperemesis gravidarum is based on clinical history and exclusion of other etiologies of nausea and vomiting. First-line pharmacologic treatment is with pyridoxine and doxylamine. Other medical treatments include metoclopramide, phenothiazines, antacids, and ondansetron. In refractory cases, corticosteroids and enteral or parenteral nutrition may be considered. This review contains 3 figures, 2 tables and 83 references Key words: enteral feeding, hyperemesis gravidarum, maternal outcomes, nausea and vomiting of pregnancy, neonatal outcomes, nonpharmacologic antiemetics, pharmacologic antiemetics

scholarly journals Hyperthyroidism During Pregnancy: Etiology, Diagnosis and Management

2005 ◽  
Vol 1 (1) ◽  
pp. 97-104
Author(s):  
John H Lazarus
Keyword(s):  
Radioiodine Therapy ◽  
Hyperemesis Gravidarum ◽  
Thyroid Stimulating Hormone ◽  
Postpartum Women ◽  
Reference Ranges ◽  
Second Trimester ◽  
Autoimmune Thyroid ◽  
Mother And Child ◽  
Neonatal Hyperthyroidism ◽  
In Pregnancy

Pregnancy has marked effects on thyroid physiology and autoimmune thyroid disease tends to ameliorate through gestation due to the general immunosuppression seen in pregnancy. There is a need for trimester-specific thyroid hormone reference ranges. Hyperthyroidism in pregnancy – usually due to Graves' disease – is not common but, if the patient is compliant, a good outcome can be expected for both mother and child if treatment with anti-thyroid drugs (propylthiouracil is preferred) is instituted. Thyroid-stimulating hormone receptor antibody should be measured at 36 weeks in such patients in order to predict the possibility of neonatal hyperthyroidism. Transient gestational hyperthyroidism is often associated with hyperemesis gravidarum and thyroid function should be checked in patients severely affected by this condition. Radioiodine therapy is contraindicated in pregnancy but thyroid surgery may be performed safely in the second trimester. Autoimmune thyroiditis and Graves’ hyperthyroidism occur quite commonly in postpartum women.

scholarly journals THE RELATIONSHIP OF SOCIAL SUPPORT WITH THE DEGREE OF NAUSEA AND VOMITING IN PREGNANCY

2021 ◽  
Vol 4 (1) ◽  
pp. 26
Author(s):  
Cempaka Yudithia Junandar ◽  
Ivon Diah Wittiarika ◽  
Budi Utomo ◽  
Ernawati Ernawati
Keyword(s):  
Social Support ◽  
Pregnant Women ◽  
Nausea And Vomiting ◽  
Primary Data ◽  
Moderate Degree ◽  
Second Trimester ◽  
Cross Sectional ◽  
Spearman Test ◽  
The Relationship ◽  
In Pregnancy

Abstract Background : At the beginning of a pregnancy the mother experiences various processes of transition or adaptation regarding changes in herself, so that she really needs support from her environment. Lack of social support can worsen the physiological complaints of pregnant women including Nausea and Vomiting in Pregnancy (NVP). Complaints of nausea and vomiting can affect the mother in carrying out daily activities, affect the mother's social situation with the environment and cause stress. Therefore, it is important to research the relationship between social support and the degree of nausea and vomiting in first and second-trimester pregnant women. Method : This research method is observational analytic with cross sectional research design. Sampling used the total sampling method with the criteria of pregnant women who had complaints of nausea and vomiting. Collecting data using primary data using a 24-hour PUQE questionnaire that measures the duration and frequency of nausea and vomiting and the MSPSS questionnaire measuring social support. The data collected were analyzed using the Spearman test (p<0.15). Results : Out of 47 respondents, 34 pregnant women (72.3%) received high social support. Besides that, 24 out of 47 respondents (51.1%) experienced moderate degree of NVP. In this study, there were no respondents who experienced severe degree of NVP. Spearman test analysis results obtained p= 0.833 or p>0.15. Conclusion : There is no relationship between social support with NVP in first and second trimester of pregnancy. 

scholarly journals Gestational Thyrotoxicosis in a Patient With Hyperemesis Gravidarum

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A929-A929
Author(s):  
Hind Alameddine ◽  
Gurunanthan Palani ◽  
Kidmealem Zekarias
Keyword(s):  
Hyperemesis Gravidarum ◽  
Clinical Signs ◽  
Supportive Therapy ◽  
First Trimester ◽  
Nausea And Vomiting ◽  
Antithyroid Drugs ◽  
Significant Elevation ◽  
Free T4 ◽  
Overt Hyperthyroidism ◽  
In Pregnancy

Abstract Untreated or inadequately treated overt hyperthyroidism in pregnancy can have devastating consequences for both mother and fetus. At the same time antithyroid drugs (ATDs) are known for their teratogenic effect and should be avoid when possible; once the diagnosis of hyperthyroidism is made in a pregnant woman, attention should be focused on determining the etiology of the disorder and whether it warrants treatment. Here, we report a case of hyperemesis gravidarum patient presenting with significant elevation of thyroid hormones and a review on diagnosis and management of gestational transient thyrotoxicosis. A 33-year-old female, G4P3 at 8 weeks pregnant admitted for nausea and vomiting. Thyroid labs showed TSH &lt; 0.01 (Reference: 0.4-4.0mU/L) and free T4 is 3.53 (Reference: 0.76-1.46ng/dl). Patient was discharged on antiemetics with a diagnosis of hyperemesis gravidarum. She was re-admitted at 9 weeks pregnant with ongoing nausea and vomiting. She had palpitations, fatigue and reported 15 pound weight loss in 2 weeks. Past medical history included thyroid hormone abnormality noted during pregnancies of 2011 and 2017. Physical exam was significant for tachycardia and diffusely enlarged thyroid gland. Repeat labs showed TSH &lt;0.01, free T4 5.81, total T3 of 317 (Reference: 60-181ng/dl). Thyroid ultrasound showed multiple nodules. Considering significant elevation in free T4 and total T3; empiric therapy with propylthiouracil was recommended. Patient declined anti-thyroid therapy. TSI and TRH antibodies came back later as negative. Patient was treated with enteral feeding for hyperemesis gravidarum. Thyroid labs 3 weeks later improved; FT4 down to 1.63 and TT3 down to 250. Patient delivered healthy baby at 40 weeks of gestation. Although the differential diagnosis of thyrotoxicosis in pregnancy includes any cause that can be seen in a nonpregnant patient, the most likely causes for hyperthyroidism in pregnancy are gestational thyrotoxicosis (GTT) with or without hyperemesis gravidarum or Graves’ disease. GTT is described as an hCG-mediated hyperthyroidism that occurs in the first trimester of pregnancy; it is generally asymptomatic with mild biochemical hyperthyroidism. Distinguishing true overt hyperthyroidism from GTT in a setting of hyperemesis gravidarum is challenging. The absence of clinical signs of hyperthyroidism and negative thyroid antibodies supports the diagnosis of GTT. T3 tends to be disproportionately elevated more than T4 in patients with overt hyperthyroidism. HCG level has not been found to be useful in distinguishing between GTT and GD. Overt hyperthyroidism is treated using anti-thyroid drugs (ATD) whereas supportive therapy without ATD is the accepted standard of treatment of patients with hyperemesis gravidarum and GTT. More studies addressing the best management of these group of patients is needed.

SOMANZ position paper on the management of nausea and vomiting in pregnancy and hyperemesis gravidarum

2019 ◽  
Vol 60 (1) ◽  
pp. 34-43
Author(s):  
Sandra A. Lowe ◽  
Georgina Armstrong ◽  
Amanda Beech ◽  
Lucy Bowyer ◽  
Luke Grzeskowiak ◽  
...  
Keyword(s):  
Hyperemesis Gravidarum ◽  
Position Paper ◽  
Nausea And Vomiting ◽  
In Pregnancy

scholarly journals Approach to hyperemesis gravidarum

2021 ◽  
Vol 9 (01) ◽  
Author(s):  
Raksha Dubey
Keyword(s):  
Hyperemesis Gravidarum ◽  
Meat Products ◽  
Severe Form ◽  
Nausea And Vomiting ◽  
Nutritional Deficiencies ◽  
Protective Mechanism ◽  
Pathogenic Microorganisms ◽  
Acid Base ◽  
Volume Depletion ◽  
In Pregnancy

Nausea and vomiting commonly known as morning sickness in pregnancy is extremely common. During pregnancy normal nausea and vomiting may be evolutionary protective mechanism as it may protect the pregnant woman and her embryo from harmful substances in food such as pathogenic microorganisms in meat products and toxins in plants, these effects are maximal during embryogenesis the most vulnerable period of pregnancy. Studies suggest that women who had nausea and vomiting were less likely to have miscarriages and stillbirth. Hyperemesis gravidarum is rare but the most severe form of nausea and vomiting in pregnancy that may necessitate hospitalization. It is characterized by persistent nausea and vomiting associated with ketosis and weight loss (>5%) which may lead to volume depletion, electrolyte and acid base imbalances, nutritional deficiencies and even death.

Nausea and Vomiting of Pregnancy

2018 ◽  
Author(s):  
Elizabeth Roberts ◽  
Brett C Young
Keyword(s):  
Hyperemesis Gravidarum ◽  
Clinical History ◽  
Nausea And Vomiting ◽  
Maternal Outcomes ◽  
Pharmacologic Treatment ◽  
Second Trimester ◽  
First Line ◽  
Medical Treatments ◽  
Persistent Vomiting ◽  
Key Words Enteral Feeding

In pregnancy, the majority of women experience at least some nausea and vomiting. For many women, these symptoms are mild and self-limiting and resolve by the second trimester. A minority of women experience severe symptoms of hyperemesis gravidarum with persistent vomiting, weight loss, and electrolyte derangements. The diagnosis of hyperemesis gravidarum is based on clinical history and exclusion of other etiologies of nausea and vomiting. First-line pharmacologic treatment is with pyridoxine and doxylamine. Other medical treatments include metoclopramide, phenothiazines, antacids, and ondansetron. In refractory cases, corticosteroids and enteral or parenteral nutrition may be considered. This review contains 3 figures, 2 tables and 83 references Key words: enteral feeding, hyperemesis gravidarum, maternal outcomes, nausea and vomiting of pregnancy, neonatal outcomes, nonpharmacologic antiemetics, pharmacologic antiemetics

Gastroenterology

2019 ◽  
Author(s):  
Stevan R. Emmett ◽  
Nicola Hill ◽  
Federico Dajas-Bailador
Keyword(s):  
Vestibular Nucleus ◽  
Female Gender ◽  
Well Being ◽  
Nausea And Vomiting ◽  
Autonomic Changes ◽  
Chemoreceptor Trigger Zone ◽  
Trigger Zone ◽  
Afferent Inputs ◽  
Pyloric Stomach ◽  
Neurokinin 1

Nausea and vomiting can be defined, respectively, as the urge to or the actual act of expelling undigested food from the stomach. It is thought to be an evolutionary defence mechanism to protect against toxic insult (drugs or mi­crobes) and over- eating, while it can also be triggered during pregnancy, or by unpleasant sights or smells. In some instances, it may be the symptom of a more severe underlying pathology. Severity of nausea and vomiting varies considerably between individuals exposed to the same stimulus and symptoms can be highly detrimental to patient quality of life affecting not only their nutritional intake, but also mood and well- being. Although nausea itself is a subjective term, vomiting is a pathophysiological reflex triggered by the vomiting centre located in the medulla. The vomiting centre re­ceives signals from a number of afferent inputs, i.e. the chemoreceptor trigger zone (CTZ), vestibular nucleus, ab­dominal and cardiac vagal afferents, and cerebral cortex (Table 6.1). It may also be activated by hormonal triggers, which accounts for hyperemesis in pregnancy, and the increased incidence of nausea and vomiting associated with the female gender. As the vomiting centre is located close to centres responsible for salivation and breathing, vomiting is often associated with hypersalivation and hyperventilation. The CTZ is highly vascularized and lo­cated at the floor of the fourth ventricle, just outside the blood– brain barrier and, therefore, is itself directly sensi­tive to chemical stimuli. Afferent inputs activate the vomiting centre through several known neurotransmitter pathways; dopamine (D<sub>2</sub>), serotonin (5- HT<sub>3</sub>, 5- HT<sub>4</sub>), acetylcholine (ACh), and substance P (neurokinin 1; NK<sub>1</sub>). Each of which provides a potential pharmacological target in the management of nausea and vomiting, once the cause has been established. Efferent pathways from the vomiting centre induce autonomic changes, including vasoconstriction, pallor, tachycardia, salivation, sweating, and relaxation of the lower oesophagus and fundus of the stomach. In vomiting, oesophageal relaxation leads to contraction of the pyloric sphincter, thereby emptying the contents of the jejunum, duodenum, and pyloric stomach into the relaxed fundus. Coordination of muscle contraction occurs within the dia­phragm and abdomen, and retrograde contractions from the intestine then expel the contents of the fundus.

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