Hsieh Ya-Ling, Chiang Chia-Jung, Yu Tsung
Nursing Department, Chi Mei Medical Center, Tainan, Taiwan.
Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Arch Gynecol Obstet. 2025 Sep 3. doi: 10.1007/s00404-025-08176-3.
Nausea and vomiting of pregnancy (NVP), including its severe form hyperemesis gravidarum (HG), have been linked to various perinatal outcomes, though findings remain inconsistent. This study aimed to examine the association between NVP severity and adverse pregnancy outcomes and to evaluate whether gestational weight gain (GWG) mediates these relationships.
We analyzed data from 8396 nulliparous women enrolled in the U.S. nuMoM2b cohort. NVP severity was measured using the Pregnancy-Unique Quantification of Emesis (PUQE) score across three prenatal visits and categorized as none, one, and ≥2 visits of medium-to-severe NVP. Perinatal outcomes included birth weight, gestational age, preterm delivery, small for gestational age (SGA), and low birth weight (LBW). GWG adequacy was assessed per Institute of Medicine guidelines. Multivariable regression models were used, adjusting for sociodemographic and clinical covariates.
Overall, 81.6% of women reported no visit with medium-to-severe NVP, 16.2% with one such visit, and 2.3% with two or three such visits. One visit with medium-to-severe NVP was associated with a modest reduction in birth weight (-41.4 g; 95% CI: -72.6, -10.2). Inadequate GWG-regardless of NVP status-was consistently associated with shorter gestation (-0.53 weeks), lower birth weight (-261.3 g), and increased risks of preterm birth, LBW, and SGA (ORs 1.66-2.75).
NVP severity alone showed limited impact on short-term pregnancy outcomes. However, inadequate GWG emerged as a key modifiable risk factor. These findings underscore the importance of nutritional support and symptom management during pregnancy, particularly for women with moderate-to-severe NVP. Long-term outcomes warrant further investigation.
妊娠恶心和呕吐（NVP），包括其严重形式妊娠剧吐（HG），已与各种围产期结局相关联，尽管研究结果仍不一致。本研究旨在探讨NVP严重程度与不良妊娠结局之间的关联，并评估孕期体重增加（GWG）是否介导了这些关系。
我们分析了参与美国nuMoM2b队列研究的8396名未生育女性的数据。通过在三次产前检查中使用妊娠呕吐独特量化（PUQE）评分来衡量NVP严重程度，并将其分为无、一次以及≥2次中重度NVP检查。围产期结局包括出生体重、孕周、早产、小于胎龄儿（SGA）和低出生体重（LBW）。根据医学研究所指南评估GWG是否充足。使用多变量回归模型，并对社会人口统计学和临床协变量进行调整。
总体而言，81.6%的女性报告没有中重度NVP检查，16.2%的女性有一次此类检查，2.3%的女性有两次或三次此类检查。一次中重度NVP检查与出生体重适度降低有关（-41.4克；95%置信区间：-72.6，-10.2）。无论NVP状态如何，GWG不足始终与孕周缩短（-0.53周）、出生体重降低（-261.3克）以及早产、LBW和SGA风险增加相关（比值比1.66 - 2.75）。
仅NVP严重程度对短期妊娠结局的影响有限。然而，GWG不足是一个关键的可改变风险因素。这些发现强调了孕期营养支持和症状管理的重要性，特别是对于中重度NVP的女性。长期结局值得进一步研究。
