妊娠剧吐的研究进展

Research progress on hyperemesis gravidarum

摘要

妊娠剧吐(HG)是孕妇在妊娠前期最常见的疾病之一,如果不能得到有效的治疗,会导致孕妇出现营养不良、胃肠道损伤、电解质紊乱、尿酮体阳性、酮症酸中毒等症状,严重时还会导致神经系统损伤而引发Wernicke脑病,若不能获得有效的治疗,会危及孕妇的生命.HG还可能会对胎儿造成不利的影响,如发育迟缓、体重下降、早产等.HG的病因至今尚未明确,主要认为与遗传、内分泌、感染等多种因素有关.近年来学者们从现行的治疗方案、管理方法、病因,以及HG对胎儿和产妇的影响等进行了研究,本文就以上几个部分对HG的研究成果进行综述.

Abstract

Hyperemesis gravidarum (HG) is one of the most common conditions affecting pregnant women during early pregnancy. If not effectively treated, HG can lead to complications such as malnutrition, gastrointestinal damage, electrolyte imbalance, positive urine ketones, ketoacidosis, and in severe cases, neurological damage that may result in Wernicke's encephalopathy, posing a serious threat to maternal life. HG may also adversely affect fetal development, potentially causing growth restriction, low birth weight, and preterm birth. The etiology of HG remains unclear, but it is believed to be associated with multiple factors including genetics, endocrine changes, and infections. In recent years, scholars have conducted extensive research on current treatment protocols, management strategies, etiological mechanisms, and the impact of HG on both mother and fetus. This paper reviews recent research findings on these aspects of HG.

关键词

妊娠剧吐 / 妊娠恶心呕吐 / 妊娠期管理 / 病因 / 治疗 / 妊娠

Key words

hyperemesis gravidarum / nausea and vomiting of pregnancy / pregnancy management / etiology / treatment / pregnancy

参考文献

[1] Nelson-Piercy C, Dean C, Shehmar M, et al. The management of nausea and vomiting in pregnancy and hyperemesis gravidarum (Green-top Guideline No. 69)[J]. BJOG, 2024, 131(7): e1-e30.

[2] Nurmi M, Rautava P, Gissler M, et al. Incidence and risk factors of hyperemesis gravidarum: a national register-based study in Finland, 2005-2017[J]. Acta Obstet Gynecol Scand, 2020, 99(8): 1003-1013.

[3] Dean CR, Nijsten K, Spijker R, et al. Systematic evidence map of evidence addressing the top 10 priority research questions for hyperemesis gravidarum[J]. BMJ Open, 2022, 12(9): e052687.

[4] Bérard A, Sheehy O, Gorgui J, et al. New evidence for concern over the risk of birth defects from medications for nausea and vomiting of pregnancy[J]. J Clin Epidemiol, 2019, 116: 39-48.

[5] Schrager NL, Parker SE, Werler MM, et al. The association of nausea and vomiting of pregnancy, its treatments, and select birth defects: findings from the national birth defects prevention study[J]. Birth Defects Res, 2023, 115(3): 275-289.

[6] Sun L, Xi Y, Wen X, et al. Use of metoclopramide in the first trimester and risk of major congenital malformations: a systematic review and meta-analysis[J]. PLoS One, 2021, 16(9): e0257584.

[7] Zambelli-Weiner A, Via C, Yuen M, et al. First trimester ondansetron exposure and risk of structural birth defects[J]. Reprod Toxicol, 2019, 83: 14-20.

[8] Tabrizi S, Heidari S, Rafiei H, et al. Investigation role of ondansetron on long QT interval among non-cardiac patients[J]. Ann Med Surg (Lond), 2021, 71: 102971.

[9] Suarez EA, Boggess K, Engel SM, et al. Ondansetron use in early pregnancy and the risk of miscarriage[J]. Pharmacoepidemiol Drug Saf, 2021, 30(2): 103-113.

[10] Fiorentini M, Nedu B, Dapoto F, et al. When time is brain: A systematic review about Wernicke encephalopathy as a dramatic consequence of thiamin deficiency in hyperemesis gravidarum[J]. J Matern Fetal Neonatal Med, 2023, 36(2): 2223678.

[11] Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin No. 189: nausea and vomiting of pregnancy[J]. Obstet Gynecol, 2018, 131(1): e15-e30.

[12] Einion A. The management of nausea and vomiting of pregnancy and hyperemesis gravidarum[J]. Pract Midwife, 2016, 19(9): 33-35.

[13] 马丽娜, 漆海宁, 邢建红, 等. 妊娠恶心呕吐的妊娠期管理现状与展望[J]. 国际妇产科学杂志, 2024, 51(3): 306-311.

[14] Fejzo MS, MacGibbon KW, First O, et al. Whole-exome sequencing uncovers new variants in GDF15 associated with hyperemesis gravidarum[J]. BJOG, 2022, 129(11): 1845-1852.

[15] Fejzo MS, Fasching PA, Schneider MO, et al. Analysis of GDF15 and IGFBP7 in hyperemesis gravidarum support causality[J]. Geburtshilfe Frauenheilkd, 2019, 79(4): 382-388.

[16] 朱梦一, 高敬书, 王宇, 等. 生长分化因子15与不良妊娠结局的研究进展[J]. 国际生殖健康/计划生育杂志, 2023, 42(5): 419-423.

[17] Tang Y, Yang Y, Lv Z, et al. Adverse pregnancy outcomes and helicobacter pylori infection: a meta-analysis[J]. Int J Clin Pract, 2021, 75(10): e14588.

[18] Nijsten K, Minnen LVD, Wiegers HMG, et al. Hyperemesis gravidarum and vitamin K deficiency: a systematic review[J]. Br J Nutr, 2022, 128(1): 30-42.

[19] Munk-Olsen T, Liu X, Madsen KB, et al. Postpartum depression: a developed and validated model predicting individual risk in new mothers[J]. Transl Psychiatry, 2022, 12(1): 419.

[20] Nijsten K, Jansen LAW, Limpens J, et al. Long-term health outcomes of children born to mothers with hyperemesis gravidarum: a systematic review and meta-analysis[J]. Am J Obstet Gynecol, 2022, 227(3): 414-429.e17.

[21] Sasso EB, Bolshakova M, Bogumil D, et al. Marijuana use and perinatal outcomes in obstetric patients at a safety net hospital[J]. Eur J Obstet Gynecol Reprod Biol, 2021, 266: 36-41.

[22] Meinich T, Trovik J. Early maternal weight gain as a risk factor for SGA in pregnancies with hyperemesis gravidarum: a 15-year hospital cohort study[J]. BMC Pregnancy Childbirth, 2020, 20(1): 255.