Hyperemesis gravidarum

Valtaosa odottajista kokee alkuraskaudessa ainakin lievää pahoinvointia ja oksentelua (emesis gravidarum). Harvinaisempi raskauspahoinvoinnin ja oksentelun äärimuoto on hyperemesis gravidarum, jossa oksentelu on hallitsematonta ja johtaa merkittävään kuivumiseen, vajaaravitsemukseen sekä elektrolyyttihäiriöihin ja painon vähenemiseen. Tila vaatii usein sairaalahoitoa, jossa sekä suun kautta että suonensisäisesti annettavalla nesteytyksellä tuetaan ravitsemusta ja korjataan kuivuminen sekä elektrolyyttihäiriöt. Lievemmissä tapauksissa nestehoito voidaan antaa perusterveydenhuollossakin, tarvittaessa useina peräkkäisinä päivinä. Voimakkaasta raskauspahoinvoinnista ja oksentelusta kärsivät odottajat tarvitsevat myös psyykkistä tukea. Valtaosalla vaikeatkin oireet helpottavat raskauden edetessä. Raskauden ennuste on yleensä hyvä, eikä hyperemesis gravidarum aina toistu seuraavissa raskauksissa.</p

First-Night Effect on Sleep in Different Female Reproductive States

Objectives: In sleep laboratory studies, the new environment is generally considered to disturb sleep during the first night. However, older women have rarely been studied. Although menopause and hormone therapy affect sleep, their impact on the first-night effect is virtually unknown. Participants: Four groups of women with no sleep laboratory experience: young on hormonal contraceptives (n = 11, 23.1 [0.5] years), perimenopausal (n = 15, 48.0 (0.4] years), postmenopausal without hormone therapy (HT; off-HT, n = 22, 63.4 [0.8] years) and postmenopausal with HT (n = 16, 63.1 [0.9] years). Procedure: A cross-sectional study. Methods: Polysomnography was performed over two consecutive nights and the first-night effect and group differences were evaluated. Questionnaire-based insomnia and sleepiness scores were correlated to sleep variables and their between-night changes. Results: Although sleep in young women was deeper and less fragmented than in the other groups, first-night effect was similar in all study groups. Total sleep time, sleep efficiency, and S1 and S2 sleep increased, and wake after sleep onset, awakenings per hour of sleep, S2 and REM latencies, and percentage of SWS decreased from the first to the second night. Perimenopausal women had more insomnia complaints than other women. Insomnia complaints were associated with more disturbed sleep but not with the first-night effect. Conclusions: A first night in a sleep laboratory elicits a marked interference of sleep architecture in women of all ages, with a carryover effect of lighter sleep on the second study night. Menopausal state, HT use, or insomnia complaints do not modify this effect.Peer reviewe

Sleep during menopausal transition : A 10-year follow-up

Correction: Volume44, Issue12 Article Number: zsab211 DOI: 10.1093/sleep/zsab211 Published: DEC 10 2021 Publisher Copyright: © 2020 Sleep Research Society 2020. Published by Oxford University Press on behalf of the Sleep Research Society.Study Objectives: A 10-year observational follow-up study to evaluate the changes in sleep architecture during the menopausal transition. Methods: Fifty-seven premenopausal women (mean age 46 years, SD 0.9) were studied at baseline and after a 10-year follow-up. At both time points, polysomnography (PSG) was performed, and the serum follicle-stimulating hormone (S-FSH) concentration was measured. Linear regression models were used to study the effects of aging and menopause (assessed as change in S-FSH) on sleep. Results: After controlling for body mass index, vasomotor, and depressive symptoms, higher S-FSH level was associated with longer sleep latency (B 0.45, 95% confidence interval [CI]: 0.07 to 0.83). Aging of 10 years was associated with shorter sleep latency (B -46.8, 95% CI: -77.2 to -16.4), shorter latency to stage 2 sleep (B -50.6, 95% CI: -85.3 to -15.9), decreased stage 2 sleep (B -12.4, 95% CI: -21.4 to -3.4), and increased slow-wave sleep (B 12.8, 95% CI: 2.32 to 23.3) after controlling for confounding factors. Conclusions: This study suggests that PSG measured sleep of middle-aged women does not worsen over a 10-year time span due to the menopausal transition. The observed changes seem to be rather age- than menopause-dependent.Peer reviewe

Incidence and risk factors of hyperemesis gravidarum: A national register‐based study in Finland, 2005–2017

IntroductionHyperemesis gravidarum is the most common reason for hospitalization in early pregnancy in pregnancies resulting in delivery. Several associative factors indicate that the etiology is likely to be multifactorial. To assess this, we used a unique procedure to compare hyperemetic pregnancies to non‐hyperemetic pregnancies both with different women and the same women's different pregnancies.Material and methodsData about all pregnancies resulting in delivery in Finland in 2005–2017 were retrieved from health care registers. Women who had hyperemesis gravidarum diagnosis in any pregnancy in the Finnish Hospital Discharge Register were chosen as cases (n = 9315) and other women (n = 428 150) as the reference group. Incidence of hyperemesis gravidarum was calculated and associations between hyperemesis and maternal, environmental and pregnancy‐related factors were analyzed in a novel setting by comparing case women's pregnancies diagnosed with hyperemesis to 1) reference group women's pregnancies and 2) case women's non‐hyperemetic pregnancies.ResultsOut of the 437 465 women who had at least one pregnancy resulting in delivery during the study period, 9315 women had at least one hyperemetic pregnancy. Total number of pregnancies resulting in delivery was 741 387 and 9549 of those were diagnosed with hyperemesis gravidarum, thus the incidence of hyperemesis gravidarum was 1.3%. In comparison 1), case women's hyperemetic pregnancies vs reference group's pregnancies, younger maternal age, higher gravidity, underweight and overweight were associated with increased risk of hyperemesis; in contrast, in comparison 2), case women's hyperemetic pregnancies vs their non‐hyperemetic pregnancies, higher age and obesity were associated with higher risk of hyperemesis, whereas the risk was lower as gravidity and parity increased. In both comparisons, smoking was associated with lower risk, whereas higher municipality population, assisted reproductive technology, multiple gestation and female sex of the fetus were associated with increased risk of hyperemesis.Conclusions​​​​​​​Our novel study setting provided new insights about risk factors: hyperemetic pregnancies differ both from pregnancies of women who had never been diagnosed with hyperemesis and from hyperemetic women's non‐hyperemetic pregnancies. Incidence of hyperemesis gravidarum in Finland was comparable to other countries.</div

Sleep quality in women with nausea and vomiting of pregnancy: a cross-sectional study

BackgroundNausea and vomiting of pregnancy (NVP) deteriorates many aspects of daily lives of women. However, little is known about associations between NVP and sleep quality.MethodsWomen attending to routine mid-pregnancy visits in maternity health care clinics in Turku city area and surrounding municipalities, Finland, during 2011-2014, were invited to participate. A cohort of 1203 volunteers (mean age 30years, mean gestational week 16.6, mean BMI 24.4kg/m(2), nulliparous 46%) was recruited. The severity of NVP in the worst 12-h period of current pregnancy was assessed with Pregnancy Unique Quantification of Emesis Questionnaire (PUQE) and categorized accordingly into no/mild/moderate and severe NVP. Sleep disturbances during the past 3months were assessed with selected questions (difficulty falling asleep, night awakenings, too early morning awakenings and sleepiness during the day) from Basic Nordic Sleep Questionnaire (BNSQ). In addition, general sleep quality, as well as physical and mental quality of life (QoL) were rated with three visual analog scales (VAS). Associations between PUQE categories (severity of NVP) and sleep disturbances, general sleep quality, physical QoL and mental QoL were evaluated with multinomial regression analysis.ResultsAccording to PUQE, NVP was most frequently moderate (n=629, 52.3%), followed by mild (n=361, 30.0%) and severe (n=77, 6.4%). Only 11.3% had no NVP (n=136). The most frequent sleep disturbance was night awakenings (69.9%, n=837), followed by sleepiness during the day (35.7%, n=427), too early morning awakenings (12.0%, n=143) and difficulty falling asleep (7.1%, n=81). In adjusted analysis (age, parity, body mass index, smoking, employment), more severe NVP was associated with night awakenings (AOR 3.9, 95% CI 1.79-8.47, P<0.0001) and sleepiness during the day (AOR 4.7, 95% CI 2.20-9.94, P<0.0001). In VAS, women with more severe NVP rated worse general sleep quality and worse physical and mental QoL. However, in multivariable analysis, the association between the severity of NVP and physical and mental QoL was stronger than that of sleep .ConclusionsMore severe NVP is associated with sleep disturbances and in close relation to lower physical and mental QoL. Thus, in comprehensive care of women with NVP, also sleep quality should be evaluated

Readmissions due to hyperemesis gravidarum: a nation-wide Finnish register study

Purpose: To evaluate the burden of illness caused by hyperemesis gravidarum (HG) and association of readmissions due to HG with maternal, environmental and pregnancy-related factors, and different pregnancy outcomes.Methods: Data of women with HG diagnosis in Finland, 2005-2017, were retrieved from health-care registers. Associations between readmissions due to HG and age, gravidity, parity, pre-pregnancy body mass index (BMI), smoking, marital status, socioeconomic status, municipality population, assisted reproductive technology (ART), and number and sex of fetuses were analyzed in pregnancies resulting in delivery. Admissions and readmissions due to HG in deliveries, gestational trophoblastic disease, ectopic pregnancies, miscarriages and pregnancy terminations were calculated.Results: 10,381 pregnancies with HG diagnosis were identified: 9518 live births, 31 stillbirths, 8 cases of gestational trophoblastic disease, 16 ectopic pregnancies, 299 miscarriages, and 509 pregnancy terminations. Both outpatients and inpatients were included. Readmission occurred in 60% of pregnancies, inpatient readmission in 17%. Parity of ≥ 5, multiple gestation and female sex of fetus were associated with higher odds of readmission, maternal age 36-40 years, BMI ≥ 35 kg/m2, smoking and ART with lower odds of readmission. Of the 9549 pregnancies resulting in delivery, 33% involved at least one outpatient visit or inpatient episode after the first trimester, and 8% in the third trimester.Conclusion: The majority of women suffering from HG needed repeated medical care, often persisting after the first trimester. Our results provide practical information allowing clinicians to prepare for symptom duration beyond the first trimester and emphasize the importance of planning for eventual long-term treatment.</p

Recurrence patterns of hyperemesis gravidarum

BackgroundHyperemesis gravidarum, excessive vomiting in pregnancy, affects approximately 0.3–3.0% of all pregnancies, but the risk is considerably higher in pregnancies following a hyperemetic pregnancy. The reported recurrence rate of hyperemesis gravidarum is wide, ranging from 15% to 81%, depending on study settings. Factors affecting recurrence of hyperemesis gravidarum are as yet insufficiently studied.ObjectiveTo evaluate the recurrence rate of hyperemesis gravidarum in subsequent pregnancies, to elucidate chronological patterns of recurrence of the condition, and to analyze maternal, environmental and pregnancy-related factors associated with recurring hyperemesis gravidarum.Study DesignOut of all pregnancies ending in delivery in Finland between 2004 and 2011, data of women who had at least one pregnancy ending in delivery following a pregnancy diagnosed with hyperemesis gravidarum were retrieved from Hospital Discharge Register and Medical Birth Register (1836 women, 4103 pregnancies; 1836 index pregnancies and 2267 subsequent pregnancies). The first pregnancy with hyperemesis gravidarum diagnosis was chosen as the index pregnancy, and recurrence rate was calculated by comparing the number of hyperemetic pregnancies which followed the index pregnancy to the total number of pregnancies which followed the index pregnancy. Recurrence patters of hyperemesis gravidarum were illustrated by presenting the chronological order of the women’s pregnancies beginning from the index pregnancy to the end of the follow-up period. The associations between recurring hyperemesis and age, parity, pre-pregnancy body mass index, smoking, marital and socioeconomic status, domicile, month of delivery, assisted reproductive technology (ART), sex and number of fetuses were analyzed in both the index pregnancies and in pregnancies following the index pregnancy.ResultsThere were 544 pregnancies with a hyperemesis diagnosis and 1723 pregnancies without a hyperemesis diagnosis following the index pregnancies. The overall recurrence rate of hyperemesis gravidarum in pregnancies following the index pregnancy was 24%. In case of more than one subsequent pregnancy, 11% of women were diagnosed with hyperemesis in all of their pregnancies. In the index pregnancies, recurrence of hyperemesis gravidarum was more common among women with parity of two than parity of one (adjusted OR=1.33, p=0.046). Overweight women (adjusted OR=0.58, p=0.036) or women who smoked after the first trimester (adjusted OR=0.27, pConclusionsIn the majority of pregnancies following an earlier hyperemetic pregnancy, hyperemesis gravidarum does not recur, but hyperemetic pregnancies occur in the next pregnancies with little predictability. Only few factors associated with recurring hyperemesis could be identified. Although estimating the probability of recurrence of hyperemesis gravidarum in a subsequent pregnancy based on a woman’s first hyperemetic pregnancy turned out not to be feasible, it is reassuring to know that hyperemesis does not appear to become more likely with each pregnancy and that after one pregnancy with hyperemesis, the following pregnancy may be different.</div