Interventionist versus expectant care for severe pre-eclampsia between 24 and 34 weeks' gestation.

Background: Severe pre-eclampsia can cause significant mortality and morbidity for both mother and child, particularly when it occurs remote from term, between 24 and 34 weeks' gestation. The only known cure for this disease is delivery. Some obstetricians advocate early delivery to ensure that the development of serious maternal complications, such as eclampsia (fits) and kidney failure are prevented. Others prefer a more expectant approach delaying delivery in an attempt to reduce the mortality and morbidity for the child associated with being born too early. Objectives: The objective of the review was to compare the effects of a policy of interventionist care and early delivery with a policy of expectant care and delayed delivery for women with early onset severe pre-eclampsia. Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 February 2013). Selection criteria: Randomised trials comparing the two intervention strategies for women with early onset severe pre-eclampsia. Data collection and analysis: Two review authors independently assessed trials for inclusion, extracted data and assessed risk of bias. Data were checked for accuracy. Main results: Four trials, with a total of 425 women are included in this review. Trials were at low risk of bias for methods of randomisation and allocation concealment; high risk for blinding; unclear risk for incomplete outcome data and other bias; and low risk for selective reporting. There are insufficient data for reliable conclusions about the comparative effects on most outcomes for the mother. For the baby, there is insufficient evidence for reliable conclusions about the effects on stillbirth or death after delivery (risk ratio (RR) 1.08, 95% confidence interval (CI) 0.69 to 1.71; four studies; 425 women). Babies whose mothers had been allocated to the interventionist group had more intraventricular haemorrhage (RR 1.82, 95% CI 1.06 to 3.14; one study; 262 women), more hyaline membrane disease (RR 2.30, 95% CI 1.39 to 3.81; two studies; 133 women), require more ventilation (RR 1.50, 95% CI 1.11 to 2.02; two studies; 300 women) and were more likely to have a lower gestation at birth in days (average mean difference (MD) -9.91, 95% CI -16.37 to -3.45; four studies; 425 women), more likely to be admitted to neonatal intensive care (RR 1.35, 95% CI 1.16 to 1.58) and have a longer stay in the neonatal intensive care unit (average MD 11.14 days, 95% CI 1.57 to 20.72 days; two studies; 125 women) than those allocated an expectant policy. Nevertheless, babies allocated to the interventionist policy were less likely to be small-for-gestational age (RR 0.30, 95% CI 0.14 to 0.65; two studies; 125 women). Women who had been allocated to the interventionist group were more likely to have a caesarean section (RR 1.09, 95% CI 1.01 to 1.18; four studies; 425 women) than those allocated an expectant policy. There were no statistically significant differences between the two strategies for any other outcomes. Authors' conclusions: This review suggests that an expectant approach to the management of women with severe early onset pre-eclampsia may be associated with decreased morbidity for the baby. However, this evidence is based on data from only four trials. Further large trials are needed to confirm or refute these findings and establish if this approach is safe for the mother

Correction: Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia between 34 and 37 weeks' gestation (HYPITAT-II): a multicentre, open-label randomised controlled trial

Kim Broekhuijsen, Josje Langenveld, Gert-Jan van Baaren, Mariëlle G van Pampus, Anton H van Kaam, Henk Groen, Martina Porath, Maureen TM Franssen, Ben W Mol, and HYPITAT-II study grou

Hyperemesis gravidarum severity, enteral tube feeding and cardiometabolic markers in offspring cord blood

Publisher Copyright: © The Authors 2022.Peer reviewedPublisher PD

Thyroid-stimulating hormone and free thyroxine fail to predict the severity and clinical course of hyperemesis gravidarum : A prospective cohort study

Funding information: This prospective cohort study was supported by a research grant from North West Hospital Group, Alkmaar, the Netherlands (Grant number: 2013T085) and by a research grant from the Amsterdam Reproduction and Development (AR&D) Research Institute, Amsterdam UMC, the Netherlands (Project number: 23346). ACKNOWLEDGMENTS We thank Dr. J.P. Bestwick (employed at Queen Mary University of London, London, UK) and Professor Dr. J.H. Lazarus (employed at Cardiff School of Medicine, Cardiff, UK) for providing TSH medians from their study in the UK. Dr. J.P. Bestwick and Professor Dr. Lazarus have nothing to disclose.Peer reviewedPublisher PD

The nutritional status of people hospitalized for hyperemesis gravidarum

Background and aims: Hyperemesis gravidarum (HG) is defined as severe nausea and vomiting in pregnancy. Persistent nausea and vomiting can lead to weight loss and depletion of maternal nutrients. The severity and persistence of maternal undernutrition secondary to HG, as expressed by energy, macro- and micronutrient intake, has not been extensively studied. The aim of our study was to prospectively investigate the nutritional intake of people with HG during the first twenty weeks of their pregnancy. Methods: For this study, we included people admitted for HG, who participated in the Maternal and Offspring outcomes after Treatment of HyperEmesis by Refeeding randomized controlled trial (MOTHER RCT, NTR 4197). Individuals who refused randomization were studied in an observational cohort study. We included pregnant people between 5 and 20 weeks of gestation who had completed at least one dietary questionnaire from 19 hospitals in the Netherlands. This questionnaire was collected weekly, until 20 weeks of gestation or until symptoms abated, and registered symptom severity, maternal weight and dietary intake. We excluded participants who only had data available while on tube feeding, or within 2 days of tube cessation. A 24-hour intake was calculated for intake of energy, protein, carbohydrates, fat, saturated fat, iodine, iron, folate, omega3 fatty acids and thiamine. Results: Between 2013–2016, we collected 601 dietary questionnaires from 160 participants (varying between 1 to 12 per person). The daily intake of energy, protein, carbohydrates and fat was sufficient (more than 75% of recommended amount) in respectively 27%, 38%, 73% and 27% of dietary questionnaires. The daily intake of energy, protein, carbohydrates and fat was less than 50% of the recommended amount in respectively 44%, 39%, 17% and 43% of dietary questionnaires. 23% of dietary questionnaires exceeded the maximum recommended amount of saturated fat a day. For iodine and iron daily intake was sufficient in respectively 11% and 14% of dietary questionnaires. The daily intake of iodine and iron did not reach 50% of recommended amount in respectively 67% and 64%. Only three dietary questionnaires showed a sufficient intake of folate, 93% of dietary questionnaires did not reach 50% of recommended amount of folate. For omega3 fatty acids and thiamine the daily intake was sufficient in respectively 78% and 25%. The daily intake of omega 3 fatty acids and thiamine was less than 50% of the recommended amount in respectively 17% and 53%. Conclusion: Our findings demonstrate that intake of macro-and micronutrients as well as total energy intake is deficient in people who suffer from HG. This is a particular concern, as nutrient deficiency in pregnancy can negatively impact the health of the offspring.</p