Grooten Iris J, Den Hollander Wouter J, Roseboom Tessa J, Kuipers Ernst J, Jaddoe Vincent W, Gaillard Romy, Painter Rebecca C
Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands.
Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Am J Obstet Gynecol. 2017 May;216(5):512.e1-512.e9. doi: 10.1016/j.ajog.2017.01.042. Epub 2017 Feb 7.
Nausea and occasional vomiting in early pregnancy is common. Why some women experience severe nausea and occasional vomiting in early pregnancy is unknown. Causes are multifactorial and only symptomatic treatment options are available, although adverse birth outcomes have been described. Helicobacter pylori infection has been implicated in the cause of nausea and occasional vomiting in early pregnancy.
The purpose of this study was to investigate the association of H pylori with vomiting severity in pregnancy and its effect on birth outcome.
We assembled a population-based prospective cohort of pregnant women in The Netherlands. Enrolment took place between 2002 and 2006. H pylori serology was determined in mid gestation. Women reported whether they experienced vomiting in early, mid, and late gestation. Maternal weight was measured in the same time periods. Birth outcomes were obtained from medical records. Main outcome measures were vomiting frequency (no, occasional, daily) and duration (early, mid, late gestation), maternal weight gain, birthweight, small for gestational age, and prematurity. Data were analyzed with the use of multivariate regression.
We included 5549 Women, of whom 1932 (34.8%) reported occasional vomiting and 601 (10.8%) reported daily vomiting. Women who were H pylori-positive (n=2363) were more likely to report daily vomiting (adjusted odds ratio, 1.44; 95% confidence interval, 1.16-1.78). H pylori-positivity was associated with a reduction of total weight gain in women with daily vomiting (adjusted difference, -2.1 kg; 95% confidence interval, -2.7 to -1.5); infants born to women with H pylori and daily vomiting had slightly reduced birthweight (addjusted difference -60g; 95% confidence interval, -109 - -12) and an increased risk of being small for gestational age (adjusted odds ratio, 1.49; 95% confidence interval, 1.04-2.14). H pylori and daily vomiting did not significantly affect prematurity rate.
This study suggests that H pylori is an independent risk factor for vomiting in pregnancy. In women with daily vomiting, H pylori is also associated with low maternal weight gain, reduced birth weight, and small for gestational age. Because effective treatments for severe nausea and occasional vomiting in early pregnancy are currently lacking, the effect of H pylori eradication therapy on nausea and occasional vomiting in early pregnancy symptom severity should be the target of future studies.
妊娠早期恶心和偶尔呕吐很常见。为何有些女性在妊娠早期会出现严重恶心和偶尔呕吐尚不清楚。病因是多因素的，尽管已有不良分娩结局的描述，但目前只有对症治疗方法。幽门螺杆菌感染被认为与妊娠早期恶心和偶尔呕吐的病因有关。
本研究旨在调查幽门螺杆菌与妊娠呕吐严重程度的关联及其对分娩结局的影响。
我们在荷兰组建了一个基于人群的孕妇前瞻性队列。招募时间为2002年至2006年。在妊娠中期测定幽门螺杆菌血清学。女性报告她们在妊娠早期、中期和晚期是否经历过呕吐。在同一时期测量孕妇体重。从医疗记录中获取分娩结局。主要结局指标为呕吐频率（无、偶尔、每日）和持续时间（妊娠早期、中期、晚期）、孕妇体重增加、出生体重、小于胎龄儿和早产。使用多变量回归分析数据。
我们纳入了5549名女性，其中1932名（34.8%）报告偶尔呕吐，601名（10.8%）报告每日呕吐。幽门螺杆菌阳性的女性（n = 2363）更有可能报告每日呕吐（校正优势比，1.44；95%置信区间，1.16 - 1.78）。幽门螺杆菌阳性与每日呕吐女性的总体重增加减少有关（校正差异，-2.1 kg；95%置信区间，-2.7至-1.5）；幽门螺杆菌阳性且每日呕吐的女性所生婴儿出生体重略有降低（校正差异-60g；95%置信区间，-109至-12），小于胎龄儿风险增加（校正优势比，1.49；95%置信区间，1.04 - 2.14）。幽门螺杆菌和每日呕吐对早产率无显著影响。
本研究表明幽门螺杆菌是妊娠呕吐的独立危险因素。在每日呕吐的女性中，幽门螺杆菌还与孕妇体重增加少、出生体重降低和小于胎龄儿有关。由于目前缺乏针对妊娠早期严重恶心和偶尔呕吐的有效治疗方法，根除幽门螺杆菌治疗对妊娠早期恶心和偶尔呕吐症状严重程度的影响应成为未来研究的目标。
