Abstract：
OBJECTIVE: With inconsistencies regarding the possible effect of hyperemesis gravidarum on the course of pregnancy, this research aimed to study the association between hyperemesis gravidarum and pregnancy outcomes, while also addressing the trimester of diagnosis and severity.
METHODS: A retrospective cohort study was performed, including all singleton deliveries of mothers from the largest health maintenance organization in the country, in a single tertiary hospital between 1991 and 2021. The incidence of adverse pregnancy outcomes was compared between pregnancies with and without hyperemesis gravidarum diagnosis. Multivariable generalized estimation equation binary models were used to study the association between maternal hyperemesis gravidarum, trimester of diagnosis and hyperemesis gravidarum severity and the studied outcomes.
RESULTS: The study population included 232 476 pregnancies, of which 3227 (1.4%) were complicated with hyperemesis gravidarum. Women with hyperemesis gravidarum were more likely to deliver preterm (adj. OR = 1.33, 95% CI: 1.18-1.50), a newborn with low birthweight (adj. OR = 1.52, 95% CI: 1.16-1.98, only if diagnosed in the second trimester), and to have a cesarean delivery (adj. OR = 1.20, 95% CI: 1.09-1.32). They were less likely to deliver small gestational age newborn (adj. OR = 0.82, 95% CI: 0.69-0.99) and their offspring to experience perinatal mortality (adj. OR = 0.54, 95% CI: 0.31-0.93, among mild cases only). A dose-response association was observed between preterm birth and hyperemesis gravidarum (adj. OR = 1.26; 95% CI: 1.11-1.44, for mild cases and adj. OR = 2.04; 95% CI: 1.31-3.19, for severe cases).
CONCLUSIONS: Hyperemesis gravidarum is associated with an increased risk for adverse pregnancy outcomes including mainly preterm delivery in a dose-response manner and when diagnosed during the second trimester.
METHODS: A retrospective cohort study was performed, including all singleton deliveries of mothers from the largest health maintenance organization in the country, in a single tertiary hospital between 1991 and 2021. The incidence of adverse pregnancy outcomes was compared between pregnancies with and without hyperemesis gravidarum diagnosis. Multivariable generalized estimation equation binary models were used to study the association between maternal hyperemesis gravidarum, trimester of diagnosis and hyperemesis gravidarum severity and the studied outcomes.
RESULTS: The study population included 232 476 pregnancies, of which 3227 (1.4%) were complicated with hyperemesis gravidarum. Women with hyperemesis gravidarum were more likely to deliver preterm (adj. OR = 1.33, 95% CI: 1.18-1.50), a newborn with low birthweight (adj. OR = 1.52, 95% CI: 1.16-1.98, only if diagnosed in the second trimester), and to have a cesarean delivery (adj. OR = 1.20, 95% CI: 1.09-1.32). They were less likely to deliver small gestational age newborn (adj. OR = 0.82, 95% CI: 0.69-0.99) and their offspring to experience perinatal mortality (adj. OR = 0.54, 95% CI: 0.31-0.93, among mild cases only). A dose-response association was observed between preterm birth and hyperemesis gravidarum (adj. OR = 1.26; 95% CI: 1.11-1.44, for mild cases and adj. OR = 2.04; 95% CI: 1.31-3.19, for severe cases).
CONCLUSIONS: Hyperemesis gravidarum is associated with an increased risk for adverse pregnancy outcomes including mainly preterm delivery in a dose-response manner and when diagnosed during the second trimester.
摘要：
目的：妊娠剧吐对妊娠过程的可能影响不一致，这项研究旨在研究妊娠剧吐与妊娠结局之间的关系，同时还解决了三个月的诊断和严重程度。
方法：进行了一项回顾性队列研究，包括全国最大的健康维护组织的所有单身母亲分娩，1991年至2021年期间在一家三级医院。比较有和没有妊娠剧吐诊断的妊娠不良结局的发生率。多变量广义估计方程二元模型用于研究母体妊娠剧吐之间的关联，诊断和妊娠剧吐严重程度以及研究结果。
结果：研究人群包括232476例怀孕，其中3227例（1.4％）并发妊娠剧吐。妊娠剧吐的女性更有可能早产（调整。OR=1.33，95%CI：1.18-1.50），出生体重低的新生儿（adj.OR=1.52，95%CI：1.16-1.98，仅在妊娠中期诊断），并进行剖腹产（adj.OR=1.20，95%CI：1.09-1.32）。他们分娩胎龄较小的新生儿的可能性较小（调整。OR=0.82，95％CI：0.69-0.99）及其后代经历围产期死亡率（调整。OR=0.54，95％CI：0.31-0.93，仅在轻度病例中）。在早产和妊娠呕吐之间观察到剂量反应关联（调整。OR=1.26；95%CI：1.11-1.44，轻度病例和调整。OR=2.04；95%CI：1.31-3.19，重症病例）。
结论：妊娠剧吐与不良妊娠结局的风险增加相关，包括主要以剂量反应方式早产和在妊娠中期诊断时。
方法：进行了一项回顾性队列研究，包括全国最大的健康维护组织的所有单身母亲分娩，1991年至2021年期间在一家三级医院。比较有和没有妊娠剧吐诊断的妊娠不良结局的发生率。多变量广义估计方程二元模型用于研究母体妊娠剧吐之间的关联，诊断和妊娠剧吐严重程度以及研究结果。
结果：研究人群包括232476例怀孕，其中3227例（1.4％）并发妊娠剧吐。妊娠剧吐的女性更有可能早产（调整。OR=1.33，95%CI：1.18-1.50），出生体重低的新生儿（adj.OR=1.52，95%CI：1.16-1.98，仅在妊娠中期诊断），并进行剖腹产（adj.OR=1.20，95%CI：1.09-1.32）。他们分娩胎龄较小的新生儿的可能性较小（调整。OR=0.82，95％CI：0.69-0.99）及其后代经历围产期死亡率（调整。OR=0.54，95％CI：0.31-0.93，仅在轻度病例中）。在早产和妊娠呕吐之间观察到剂量反应关联（调整。OR=1.26；95%CI：1.11-1.44，轻度病例和调整。OR=2.04；95%CI：1.31-3.19，重症病例）。
结论：妊娠剧吐与不良妊娠结局的风险增加相关，包括主要以剂量反应方式早产和在妊娠中期诊断时。
