Understanding the Stigma of Hyperemesis Gravidarum: Qualitative Findings from an Action Research Study

Abstract: Background: Severe nausea and vomiting in pregnancy (hyperemesis gravidarum) can be a distressing and debilitating condition when it is uncontrolled. For all concerned, hyperemesis gravidarum can be difficult to treat satisfactorily, and women tend to be admitted to a hospital several times during early pregnancy. Our research objectives were to describe the experience of hyperemesis gravidarum from the perspective of affected women and to explore with health care professionals the barriers and facilitators to caring for women with the condition. Methods: A qualitative research design was used. A total of 18 women were interviewed, of whom 8 had two or more interviews. Seven focus groups were conducted with health care professionals. Thematic data analysis was undertaken. Results: The main themes emerging from the women’s data were the effect and burden of the symptoms of the condition and feeling unpopular with staff. From the practitioner data, the main themes were the validity (or invalidity) of hospitalization for women, skepticism of the severity of symptoms, the psychological and social dimensions of the condition, and inadequate primary care services. Conclusions: The main findings revealed that hyperemesis gravidarum is a debilitating condition and that the unhelpful attitudes of practitioners may affect whether women access timely and appropriate care. Many women appear to be unsupported by primary care services and are distressed when perceived either as “time wasters” or someone else’s responsibility. We propose that a tailored assessment and care plan for each woman is needed to help them control their symptoms, which ideally should be delivered in the community. (BIRTH 37:3 September 2010)     

The effect of hyperemesis gravidarum on the 75 g oral glucose tolerance test screening and gestational diabetes mellitus

Objective: To clarify the effect of hyperemesis gravidarum (HG) on the 75?g oral glucose tolerance test (OGTT) and gestational diabetes mellitus.

Methods: This retrospective cohort study was conducted via an evaluation of the hospital database medical records of 700 pregnant women. Of these, 60 were included in the study group as a result of hospitalization due to HG, 41 were excluded, and the remaining 599 formed a control group. The body mass index (BMI), urine ketone levels, and ages of all participants were separately recorded, both in the initial examination and during the 75?g OGTT.

Results: At initial examination, no significant differences in maternal age and BMI were observed between the two groups. There was a significant decrease in BMI after 75?g OGTT in the study group. No significant difference in fasting serum glucose levels was found between the two groups, but significant differences in first and second hour serum glucose levels were observed.

Conclusions: HG may improve in many women in the late second trimester, and loss of fatty tissue may affect the 75?g OGTT screening results. The appropriate cutoff value of 75?g OGTT for HG should be reevaluated following future, larger, studies.     

治疗妊娠剧吐中西医结合方案临床观察

目的:探讨中西医结合方案治疗妊娠剧吐的临床疗效进行观察分析。方法:对我院2012年1月-2013年1月住院就诊妊娠剧吐患者52例,随机分2组:对照组26例使用静脉支持补液西医治疗和治疗组26例中西医结合治疗进行临床观察和比较。结果:治疗组与对照组比较,治疗组总有效率为84.62%,对照组总有效率为69.23%,治疗组有效率明显升高,症状改善更为明显,P<0.05,差异有统计学意义。结论:中西医结合治疗妊娠剧吐患者临床观察疗效明显,值得临床推广。     

血清β-羟丁酸在糖尿病酮症酸中毒和妊娠剧吐中的诊断价值

目的 探讨血清β-羟丁酸测定在糖尿病酮症酸中毒(DKA)和妊娠剧吐中的诊断价值.方法 采用酶速率法测定血清β-羟丁酸浓度,对糖尿病酮症酸中毒、糖尿病无酮症(NDK)、健康对照、妊娠剧吐孕妇、正常孕妇组进行β-羟丁酸检测,同时对其进行尿酮体和血糖检验.结果 DKA的β-羟丁酸浓度和阳性率显著高于NDK组(P＜0.01)和对照组(P＜0.01);NDK组的β-羟丁酸浓度与对照组比较差异有统计学意义(P＜0.05);DKA尿酮体阳性率显著高于NDK组(P＜0.01)和对照组(P＜0.01).妊娠剧吐组的β-羟丁酸浓度和阳性率显著高于正常孕妇组(P＜0.01);妊娠剧吐组的尿酮体阳性率显著高于正常孕妇组(P＜0.01).结论 β-羟丁酸对DKA和妊娠剧吐的早期诊断具有重要的诊断价值,对鉴别诊断和治疗的疗效观察具有重要意义,联合血糖、尿酮体等同时检测更能全面诊断和分析疾病.     

Hyperemesis gravidarum during Ramadan

During Ramadan, adult Muslims fast from dawn to dusk. We frequently encounter young pregnant Muslim women with hyperemesis gravidarum who fast during this holy month. We have investigated whether there is an association between the prolonged fasting during Ramadan and excessive vomiting during pregnancy. Possible psychologic and physiologic explanations are presented and discussed.     

The Hyperemesis Beliefs Scale (HBS): a new instrument for assessing beliefs about severe nausea and vomiting in pregnancy

Objective. The purpose of this research was to validate the Hyperemesis Beliefs Scale (HBS), a new instrument for assessing patient perception factors of hyperemesis gravidarum (HG) that influence reported patient satisfaction with medical care.

Methods. Patients' beliefs and their perception of their physicians' beliefs about the causal explanations of HG, seriousness of the illness, and the impact of the illness upon patients' daily lives were determined using a newly developed hyperemesis beliefs scale (HBS) in a sample of 96 women. Exploratory factor analyses of the patient and physician versions of the HBS were performed separately using principal factor analysis extraction and oblique rotation in SPSS.

Results. Exploratory factor analyses of patient and physician versions of the HBS demonstrated broad support for the hypothesized factor structure. However, two key differences appeared in the two versions of the HBS. First, the patient items exhibited two causal factors (general and personal), whereas the physician items showed only a single causal factor. Second, in the patient version, items assessing the impact of HG on the babies' health loaded separately from the rest of the items in the HBS, whereas the analyses of the corresponding physician items indicated that the baby items loaded well on the degree of seriousness factor.

Conclusion. This scale may be of value in facilitating further research on HG illness representations, patient–physician relationship and patient satisfaction. Specifically, the HBS design provides data to show whether patient–physician agreement on particular measures is associated with better patient satisfaction outcomes.     

Use of diazepam for hyperemesis gravidarum

Objective. To evaluate the efficacy and safety of intravenous (IV) fluid and diazepam therapy compared with the IV-fluid only therapy for the resistant hyperemesis gravidarum (HG) cases.

Methods. Medical records of 74 HG cases who were refractory to standard management were reviewed. All patients hospitalised were administered IV fluid and multivitamin combination as the first-step therapy. Patients who were refractory to first-step therapy were given IV fluid (Group 1, n = 43) or IV fluid and diazepam (Group 2, n = 31) depending on the patients' desire. Groups were matched for demographic characteristics, rehospitalisation requirement, patient satisfaction and neonatal outcomes.

Results. Thirteen of the 74 patients were excluded from the study because of unknown maternal and fetal outcome. The mean gestational age was 10.4 ± 2.4 year. Age, parity, body mass index and educational level were similar between the two groups. Mean diazepam dose was 62.8 ± 24.5 mg (range 40–160) in Group 2 (n = 31). The number of hospitalisation was significantly lower, and patient satisfaction was significantly higher in Group 2. There were no differences for the obstetrics outcomes between the groups.

Conclusions. The addition of diazepam to IV fluids was associated with less hospitalisation in women with hyperemesis gravidarum. Safety of diazepam therapy in early pregnancy deserves further study.     

Ghrelin,acylated ghrelin,leptin and PYY-3 levels in hyperemesis gravidarum

Abstract

Objective: To assess the serum levels of gut and adipocyte-derived metabolic hormones that control appetite, adipocity, weight gain and energy hemostasis, namely total ghrelin (TG), acylated ghrelin (AG), leptin and PYY-3 in hyperemesis gravidarum (HG).

Methods: Plasma samples of 86 women in their first trimester pregnancies with HG (n?=?30), morning sickness of pregnancy (MSP) (n?=?34) and control (n?=?22) groups were obtained. Serum levels of TG, AG, leptin and PYY-3 were compared between the groups, and the correlations with severity of symptoms using modified PUQE (Pregnancy Unique Quantification of Emesis) scoring, BMI, E₂, hCG and TSH were calculated.

Results: Levels of TG, AG, PYY-3 and the TG/leptin ratio were significantly higher in HG group compared to MSP and the control groups (p?≤?0.017). AG/TG ratio was significantly lower in the HG group compared to both MSP and control groups (p?≤?0.017). There were either weak or no significant statistical correlations between the gut and adipose-related hormones and the modified PUQE scores, BMI, E₂, hCG and TSH.

Conclusion: Gut-derived metabolic hormones ghrelin, AG and PYY-3 may be involved in the HG pathophysiology.