Dr Melanie Nana1, Miss Hannah Ebdon1, Dr Argyro Syngelaki1, Dr Xi Yang1, Professor Kypros Nicolaides1, Professor Catherine Williamson2
1King's College London, London, England, 2Imperial College London, London, England
Biography:
Melanie is an Obstetric Medicine Registrar and NIHR Research Training Fellow currently studying the mechanisms underpinning the neurocognitive and metabolic consequences of children born to women with severe Hyperemesis Gravidarum at King’s College London
Abstract:
Background: Hyperemesis Gravidarum (HG) is associated with adverse maternal/perinatal outcomes which are understudies in diverse populations. Mechanisms for these outcomes have not been explored; we hypothesise they relate to maternal nutritional deficiency.
Objectives: 1) To characterise the maternal/perinatal outcomes in HG-pregnancies in different populations. 2) To compare nutrient status in HG-women to healthy controls, correlating with outcomes.
Methods: CogStack, a Natural Language Processing system, identified severe HG-pregnancies (requiring admission to hospital) between 2011-2023. HG-patients were compared to controls using data and stored samples from a non-intervention screening study. First trimester nutrient assays were performed at the Cambridge Nutritional Biomarker Laboratory and correlated with adverse outcomes.
Results: Cogstack identified 2741 individual patients with the term ‘hyperemesis’ on their hospital electronic record system. 881 were confirmed to have severe HG after hospital records review and were compared to 54,045 women from the background South-East London population.
HG-women were more likely to be of black ethnicity compared to white (39.2% vs 17.0%, p<0.00001); no differences in age, body mass index, parity or past medical history were determined. HG-pregnancies were associated with preterm birth (7.5% vs 5.1%, p=0.001), fetal growth restriction (FGR) (18.0% vs 12.1%, p=<0.00001) and stillbirth (0.8% vs 0.3%, p=0.005) in all ethnicities. Differences in pre-eclampsia and gestational diabetes rates were not found.
HG-patients had lower vitamin B6 (38.2 vs 16.6nmol/L, p<0.001), 25(OH)D3 (58.8 vs 42.9nmol/L (<0.001), and fat-soluble vitamin concentrations ((lutein and zeaxanthin (0.58 vs 0.45, p <0.001) and beta-carotene (0.93 vs 0.72, p=0.005)). Linear regression revealed that low iron (p<0.01), vitamin B6 (p=0.02), vitamin D (p<0.0001) and fat-soluble vitamin concentrations (both p=0.02) correlated with FGR.
Conclusion: This is the first study to correlate nutrient status in HG-women with adverse outcomes. Future work will focus on nutrient status and outcomes in different ethnic populations with potential to inform future interventions.
Keywords
Hyperemesis Gravidarum; nutritional status; maternal and fetal outcomes
References
Jansen LAW, Nijsten K, Limpens J, et al. Perinatal outcomes of infants born to mothers with hyperemesis gravidarum: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2023;284:30-51. doi: 10.1016/j.ejogrb.2023.03.004 [published Online First: 20230311]