Maslin Kate, Shaw Victoria, Brown Anne, Dean Caitlin, Shawe Jill
School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Devon, UK.
School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Devon, UK.
Eur J Obstet Gynecol Reprod Biol. 2021 Feb;257:76-83. doi: 10.1016/j.ejogrb.2020.12.003. Epub 2020 Dec 10.
Hyperemesis gravidarum (HG) is characterised by extreme nausea and vomiting of pregnancy, which can lead to dehydration, weight loss and electrolyte disturbances. Historically research has been challenging due to a lack of diagnostic criteria and objective outcome measures. Most studies in this population group have focused on medical management of symptoms, with little known about the effect of HG on nutritional intake and how this relates to perinatal outcomes. The aim of this study was to synthesise current knowledge of the dietary intake of women with HG. A systematic search of search engines was conducted in April 2020 using the following databases: MEDLINE, Embase, CINAHL, Cochrane database, Scopus, NHS Evidence, BNI, Emcare, ClinicalTrials.gov, PROSPERO, Ethos and Open Grey. Titles and abstracts were screened independently by two reviewers against predefined inclusion and exclusion criteria. Studies were included where the authors described severe pregnancy nausea and vomiting as HG, regardless of how HG was defined. After removal of duplicates, 4402 titles were identified, of which 3992 were initially excluded based on abstract and title. Following full text review, four of 10 articles were included. Three of the studies were hospital-based case control studies, one was an observational women's cohort study. Assessment of dietary intake was heterogeneous, with both retrospective and prospective self-report methods used, over different timeframes. In three of the studies, dietary intake was reported at one time point only. In total, across all four studies, data from only 314 women were included. Overall, despite data collected from four different countries, over 30 years, with various methods, women with HG had a significantly poorer dietary intake compared to non-affected pregnant women, consuming less than 50 % of recommended intakes for most nutrients. Nutritional intake worsened with increasing severity of symptoms. As this was a scoping review, study quality was not assessed. Overall, this review has identified a paucity of data about the dietary intake of women with HG; the limited available data indicates that women with HG are at risk of malnutrition. Future research quantifying nutritional intake in women with HG at several time points during pregnancy would provide valuable reference data, enabling nutritional status and outcomes to be monitored and interventions to be evaluated.
妊娠剧吐（HG）的特征是孕期出现严重的恶心和呕吐，可导致脱水、体重减轻和电解质紊乱。从历史上看，由于缺乏诊断标准和客观的结局指标，相关研究一直具有挑战性。该人群的大多数研究都集中在症状的药物治疗上，对于HG对营养摄入的影响以及这与围产期结局的关系知之甚少。本研究的目的是综合当前关于HG女性饮食摄入的知识。2020年4月，使用以下数据库对搜索引擎进行了系统检索：MEDLINE、Embase、CINAHL、Cochrane数据库、Scopus、NHS Evidence、BNI、Emcare、ClinicalTrials.gov、PROSPERO、Ethos和Open Grey。两名审稿人根据预先定义的纳入和排除标准独立筛选标题和摘要。只要作者将严重的妊娠恶心和呕吐描述为HG，无论HG如何定义，相关研究均被纳入。去除重复项后，共识别出4402个标题，其中3992个基于摘要和标题最初被排除。经过全文审查，10篇文章中有4篇被纳入。其中3项研究是基于医院的病例对照研究，1项是观察性女性队列研究。饮食摄入评估方法各异，在不同的时间范围内使用了回顾性和前瞻性自我报告方法。在3项研究中，仅在一个时间点报告了饮食摄入情况。在所有4项研究中，总共仅纳入了314名女性的数据。总体而言，尽管数据来自4个不同国家，跨越30多年，采用了各种方法，但与未受影响的孕妇相比，HG女性的饮食摄入明显较差，大多数营养素的摄入量不到推荐摄入量的50%。营养摄入随着症状严重程度的增加而恶化。由于这是一项范围综述，未评估研究质量。总体而言，本综述发现关于HG女性饮食摄入的数据匮乏；有限的现有数据表明HG女性存在营养不良风险。未来在孕期多个时间点对HG女性的营养摄入进行量化研究，将提供有价值的参考数据，以便监测营养状况和结局，并评估干预措施。
