Hyperemesis gravidarum does not usually recur in each pregnancy

Women who have suffered from Hyperemesis gravidarum can now be reassured that severe morning sickness does not necessarily recur in each pregnancy according to the results of the study published August 16 in the American Journal of Obstetrics & Gynecology.

The Finnish study provides evidence that 3 out of 4 women who suffered from hyperemesis gravidarum will not experience it in the subsequent pregnancy. The incidence of hyperemesis is 0.5-2.0% and is the most common cause of first-trimester hospital admissions.

The exact etiology of hyperemesis is still unknown, and both maternal and paternal genetics, family history and environmental causes have all been implicated in its causation. Hyperemesis recently hit the headlines when Kate Middleton, the Duchess of Cambridge and wife of Britain's Prince William, was hospitalized with hyperemesis gravidarum during her first pregnancy.

Finnish researchers identified 1836 women over a period of 7 years who were diagnosed with hyperemesis during their first pregnancy and who had at least one more subsequent delivery. The first pregnancy with hyperemesis was considered as an index pregnancy, and the recurrence rate was calculated based on the incidence of hyperemesis and the total number of subsequent pregnancies. 

There were 2,267 later pregnancies, of whom hyperemesis occurred in 544 or 24% of pregnancies, while in 1723 pregnancies no morning sickness was noted. In case of more than 1 subsequent pregnancy, 333 (11%) of women suffered from hyperemesis in all of their pregnancies.

Women who were second para during the index pregnancy were 33% more likely to suffer from hyperemesis as compared to those who were para one (adjusted odds ratio, 1.33, P = .046).

Being overweight and smokers were at decreased odds of recurrence of hyperemesis in subsequent pregnancy. Women with female fetuses were also at 29% increased odds of recurring hyperemesis (adjusted odds ratio, 1.29, P = .012).

Miina Nurmi, lead author of the study, told Reuters Health by email, “It is good to know that hyperemesis gravidarum (HG) is not a ‘lifelong sentence’ to everyone - sometimes HG patients have been told that HG would be with them in every pregnancy.”

 “It is reassuring to know that hyperemesis does not appear to become more likely with each pregnancy and that after 1 pregnancy with hyperemesis, the following pregnancy may be different,” the authors concluded, admitting that comparison of recurrence is difficult given the lack of universal definition of hyperemesis gravidarum.

The authors further suggested that "Large prospective studies concentrating on HG patients' future pregnancies, studied with both symptom diaries and medical records, would be an ideal way, though slow and somewhat expensive, to come as close to the actual recurrence rate as possible."

Abstract

Ob/Gyn Updated Facebook page

Finally, a drug free treatment for morning sickness by just wearing a wrist band.

Reliefband Neurowave

Reliefband Technologies, revealed their new product Reliefband Neurowave during the 2017Consumer Electronics Show (CES) in Las Vegas yesterday. The Reliefband Neurowave is a FDA approved wearable device to treat morning sickness, motion sickness, chemotherapy-induced and post-surgery nausea and.[i]

The Reliefband is worn on the wrist like a watch. The device generates, programmed transdermal pulses with a highly-specific waveform, frequency, and amplitude to stimulate the median nerve on the underside of the wrist. Through this neuromodulation, the reliefband modulates the neural activity of the emetic center of the brain, which in turns blocks the signals arriving from stomach that leads to nausea and vomiting.

The newly designed reliefband is a rare combination of contemporary design and FDA cleared clinically proven technology. Studies have shown that reliefband technology of neuromodulation is comparable to routine antiemetic prescribed in postoperative nausea and vomiting. [2]

J-shaped band 

 It’s unique ‘J-shaped’ makes it easier to put on and off. The modern band architecture makes it a perfect fit against the median nerve to minimize errors. It is so aesthetically designed that it can be worn in any social settings. New hypoallergenic 316L Surgical Steel contacts makes more efficient transmission of current. The gadget has 10 intensity settings to choose per the intensity of individual needs and symptoms. It also comes with a fully rechargeable battery.

Nick Spring, CEO Reliefband Technologies says "For the 60 million Americans who frequently suffer with motion sickness and the nearly 80% of women who experience morning sickness during pregnancy, the Reliefband Neurowave is simply life-changing."

The Reliefband Neurowave was developed in response to customers who told us they had given up hope of controlling their nausea," he said. "We wanted to help those who are sick of feeling sick by making a drug-free device that is easy-to-use and elegant to wear over long periods. This way they can start living their lives without the worry, embarrassment, discomfort and inconvenience nausea can bring."

Reliefband Technologies LLC, the current world leaders in Wearble techonology was established in 2015 and the first reliefband was launched on January 6, 2016.

Old model of reliefband

The new updated design is expected to hit the US market in second quarter of 2017 and will cost $150.

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[1] http://www.reliefband.com/medical-professionals/

[2] https://www.ncbi.nlm.nih.gov/pubmed/12411789

Morning Sickness in early pregnancy linked to lower risk of miscarriages and still births.

Nausea and vomiting in early pregnancy affects 50-80% of pregnant women. Researchers have linked its etiology to imbalance in carbohydrate metabolism, rising hormonal levels in pregnancy, psychosomatic factors  evolutionary survival adaptation which protects pregnant mothers and their babies from food poisoning. 

 Few  observational studies in the past have documented that incidence of pregnancy loss is lower in patients who have morning sickness in first trimester.

A new study published in the in the journal JAMA Internal Medicine[1] found that women who suffer from nausea and vomiting in the first trimester have 50% less chance of miscarriage.

The study is a result of secondary data analysis of a Randomized Control Trial (RCT) examining Effects of Aspirin in Gestation and Reproduction (EAGeR) Trial.[2] The EAGeR study is a multi-site, double-blinded randomized trial designed to assess the effects of low-dose aspirin on implantation and pregnancy outcome carried out by researchers at NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and other institutions.

The secondary analysis was limited to women who had a pregnancy confirmed by positive human chorionic gonadotropin (hCG) test, had a history of at least one pregnancy loss. A total of 797 study subjects was recruited. The women kept a daily diary for nausea and vomiting from week 2 to week 8 of pregnancy, and monthly thereafter.

Out of 797 pregnancies, 188 ended in loss (23.6%), and at the end of 8 weeks about 57.3 percent of the women reported experiencing nausea and 26.6 percent reported nausea with vomiting. 

In this cohort of women, it was seen that nausea alone or nausea with vomiting during pregnancy were associated with nearly 50%-75% reduction in the risk for pregnancy loss. When the analysis was done for peri-implantation pregnancy loss, the results were similar but they were not statistically significant.

Younger women (age <25 years) suffered much more with nausea and vomiting as compared to older women.

The association persisted even after accounting for confounding factors like maternal stress, alcohol intake, caffeine intake, smoking, fetal sex, multiple-fetal gestation, and karyotype.

Stefanie Hinkle, the lead author and a researcher at the national institute said "Our study evaluates symptoms from the earliest weeks of pregnancy, immediately after conception, and confirms that there is a protective association between nausea and vomiting and a lower risk of pregnancy loss.” But, was not sure whether the study results could be applied to primigravida.

She also went to stress that women with no nausea or vomiting should not be alarmed as a result of this study. "Every pregnancy is different and just because they don't have symptoms doesn't mean they're going to have a pregnancy loss," Hinkle said.[3]

The study was also followed by an accompanying editorial by Siripanth Nippita, MD, and Laura E. Dodge, ScD, MPH, from the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center. They said "This study's contribution to the existing literature is valuable for several reasons. It builds on a prior cohort study by Sapra et al and similarly enrolled a large sample of women before conception."

They further quote “The widespread availability of sensitive urine hCG tests coupled with real-time electronic data capture using mobile phone apps or similar technology has the potential to improve data quality and eliminate recall bias. Given these methodologic advantages over previous investigations, we hope that such studies can further deepen our understanding of the underlying causes of [nausea and vomiting in pregnancy]."

The researchers also urged women with nausea and vomiting in pregnancy to seek medical consultation since it negatively affects the quality of life.

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[1] http://archinte.jamanetwork.com/article.aspx?articleid=2553283

[2] http://grantome.com/grant/NIH/ZIA-HD008795-08

[3] Stefanie N. Hinkle, Sunni L. Mumford, Katherine L. Grantz, Robert M. Silver, Emily M. Mitchell, Lindsey A. Sjaarda, Rose G. Radin, Neil J. Perkins, Noya Galai, Enrique F. Schisterman. Association of Nausea and Vomiting During Pregnancy With Pregnancy Loss. JAMA Internal Medicine, 2016; DOI: 10.1001/jamainternmed.2016.5641