KK Women's and Children's Hospital, Singapore City, Singapore.
MOH Holdings, Singapore City, Singapore.
Helicobacter. 2018 Feb;23(1). doi: 10.1111/hel.12455. Epub 2017 Nov 26.
Hyperemesis gravidarum remains a common, distressing, and significant yet poorly understood disorder during pregnancy. The association between maternal Helicobacter pylori (H. pylori) infection and hyperemesis gravidarum has been increasingly recognized and investigated. This study thus aimed to provide an updated review and meta-analysis of the topic.
Using the search terms (H. pyloriOR Helicobacter ORHelicobacter pyloriOR infection) AND (pregnancy OR emesis OR hyperemesis gravidarum OR nausea OR vomiting), a preliminary search on the PubMed, Ovid, Web of Science, Google Scholar, and WanFang database yielded 372 papers published in English between January 1st, 1960 and June 1st, 2017.
A total of 38 cross-sectional and case-control studies, with a total of 10 289 patients were eligible for review. Meta-analysis revealed a significant association between H. pylori infection and hyperemesis gravidarum during pregnancy, with a pooled odds ratio of 1.348 (95% CI: 1.156-1.539, P < .001). Subgroup analysis found that serologic and stool antigen tests were comparable methods of detecting H. pylori as they yielded similar odds ratios.
Although the studies did not have high heterogeneity (I = 28%), publication bias was observed, and interstudy discrepancies in the diagnostic criteria adopted for hyperemesis gravidarum limit the reliability of findings. Also, 15 of the included studies were from the same country (Turkey), which could limit the generalizability of current findings. The prevalence of H. pylori infection varies throughout the world, and there may also be pathogenic differences as most strains of H. pylori in East Asia carry the cytotoxin-associated gene A gene.
H. pylori infection was associated with an increased likelihood of hyperemesis gravidarum during pregnancy. Given the high prevalence of H. pylori infections worldwide, detecting H. pylori infection and the eradication of maternal H. pylori infection could be part of maternal hyperemesis gravidarum management. Further confirmation with robust longitudinal studies and mechanistic investigations are needed.
妊娠剧吐仍然是一种常见的、令人痛苦的、严重但尚未被充分了解的孕期疾病。母体幽门螺杆菌（H. pylori）感染与妊娠剧吐之间的关联已逐渐得到认识和研究。因此，本研究旨在对这一主题进行综述和荟萃分析。
使用检索词（H. pylori 或 Helicobacter 或 Helicobacter pylori 或感染）和（妊娠或呕吐或妊娠剧吐或恶心或呕吐），在 PubMed、Ovid、Web of Science、Google Scholar 和万方数据库上进行初步检索，共检索到 1960 年 1 月 1 日至 2017 年 6 月 1 日期间发表的 372 篇英文文献。
共有 38 项横断面和病例对照研究，共 10289 例患者符合纳入标准。荟萃分析显示，H. pylori 感染与妊娠剧吐显著相关，合并优势比为 1.348（95%置信区间：1.156-1.539，P < 0.001）。亚组分析发现，血清学和粪便抗原检测是检测 H. pylori 的等效方法，因为它们产生的优势比相似。
尽管研究的异质性不高（I²=28%），但存在发表偏倚，且纳入研究采用的妊娠剧吐诊断标准存在差异，限制了研究结果的可靠性。此外，纳入的 15 项研究均来自同一国家（土耳其），这可能限制了当前研究结果的普遍性。H. pylori 感染的流行率在全球范围内有所不同，东亚地区的大多数 H. pylori 菌株携带细胞毒素相关基因 A 基因，可能存在致病性差异。
H. pylori 感染与妊娠剧吐的发生密切相关。鉴于全球 H. pylori 感染的高流行率，检测 H. pylori 感染并根除母体 H. pylori 感染可能是妊娠剧吐管理的一部分。需要进一步通过强有力的纵向研究和机制研究来证实。
