Fejzo Marlena S, Magtira Aromalyn, Schoenberg Frederic Paik, Macgibbon Kimber, Mullin Patrick M
University of California, Los Angeles, Department of Obstetrics, Gynecology, and Medicine, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Department of Maternal-Fetal Medicine, Los Angeles, CA, USA.
University of California, Los Angeles, Department of Statistics, Los Angeles, CA, USA.
Eur J Obstet Gynecol Reprod Biol. 2015 Jun;189:79-84. doi: 10.1016/j.ejogrb.2015.03.028. Epub 2015 Apr 2.
The purpose of this study is to determine the frequency of emotional, behavioral, and learning disorders in children exposed in utero to hyperemesis gravidarum (HG) and to identify prognostic factors for these disorders.
Neurodevelopmental outcomes of 312 children from 203 mothers with HG were compared to neurodevelopmental outcomes from 169 children from 89 unaffected mothers. Then the clinical profiles of patients with HG and a normal child outcome were compared to the clinical profiles of patients with HG and a child with neurodevelopmental delay to identify prognostic factors. Binary responses were analyzed using either a Chi-square or Fisher Exact test and continuous responses were analyzed using a t-test.
Children exposed in utero to HG have a 3.28-fold increase in odds of a neurodevelopmental diagnosis including attention disorders, learning delay, sensory disorders, and speech and language delay (P<0.0005). Among characteristics of HG pregnancies, only early onset of symptoms (prior to 5 weeks gestation) was significantly linked to neurodevelopmental delay. We found no evidence for increased risk of 13 emotional, behavioral, and learning disorders, including autism, intellectual impairment, and obsessive-compulsive disorder. However, the study was not sufficiently powered to detect rare conditions. Medications, treatments, and preterm birth were not associated with an increased risk for neurodevelopmental delay.
Women with HG are at a significantly increased risk of having a child with neurodevelopmental delay. Common antiemetic treatments were not linked to neurodevelopmental delay, but early symptoms may play a role. There is an urgent need to address whether aggressive treatment that includes vitamin and nutrient supplementation in women with early symptoms of severe nausea of pregnancy decreases the risk of neurodevelopmental delay.
本研究旨在确定子宫内暴露于妊娠剧吐（HG）的儿童中情绪、行为和学习障碍的发生率，并确定这些障碍的预后因素。
将203名患有HG的母亲所生的312名儿童的神经发育结果与89名未受影响的母亲所生的169名儿童的神经发育结果进行比较。然后，将HG患儿且神经发育正常的临床特征与HG患儿且神经发育延迟的临床特征进行比较，以确定预后因素。二元反应采用卡方检验或Fisher精确检验进行分析，连续反应采用t检验进行分析。
子宫内暴露于HG的儿童被诊断为神经发育障碍（包括注意力障碍、学习延迟、感觉障碍以及言语和语言延迟）的几率增加了3.28倍（P<0.0005）。在HG妊娠的特征中，只有症状早发（妊娠5周前）与神经发育延迟显著相关。我们没有发现包括自闭症、智力障碍和强迫症在内的13种情绪、行为和学习障碍风险增加的证据。然而，该研究的样本量不足以检测罕见疾病。药物、治疗和早产与神经发育延迟风险增加无关。
患有HG的女性生育神经发育延迟儿童的风险显著增加。常用的止吐治疗与神经发育延迟无关，但早期症状可能起作用。迫切需要探讨对有妊娠早期严重恶心早期症状的女性进行积极治疗（包括补充维生素和营养物质）是否能降低神经发育延迟的风险。
