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This review article outlines the prevalence of nausea and vomiting of pregnancy (NVP) and hyperemesis gravidarum (HG), definition of NVP and HG, aetiology, risk factors, complications of HG, recommended investigations, primary care management, hospital and ambulatory daycare, therapeutic management of HG supported by good clinical evidence, discharge planning, and importance of the multidisciplinary team to provide high quality care in patients with NVP and HG.

Juvenile-onset arthritis may negatively influence pregnancy outcomes

24 Jul 2017

The risk of both maternal and infant complications appears to be high among women with juvenile-onset arthritis (JIA) confined to childhood and among those with JIA persistent into adulthood, a Swedish population-based cohort study has shown.

Researchers looked at 1,807 births among women with JIA and 1,949,202 control births. Given that JIA is a heterogenic condition, births to women with the condition was categorized as JIA paediatric only (n=1,169) and JIA persisting into adulthood (n=638). Generalized estimating equations were used in the analysis.

JIA was found to be associated with an increased risk of preterm birth, especially that which was medically indicated. The adjusted odds ratios [aORs] were 1.74 (95 percent CI, 1.35 to 2.67) in the JIA paediatric subgroup and 4.12 (2.76 to 6.15) in the JIA persisting into adulthood subgroup.

Women with JIA persisting into adulthood were particularly at increased risk of very preterm birth (aOR, 3.14; 1.58 to 6.24), spontaneous preterm birth (aOR, 1.63; 1.11 to 2.39), small for gestational age birth (aOR, 1.84; 1.19 to 2.85), and early-onset and late-onset pre-eclampsia (aOR, 6.28; 2.68 to 13.81 and aOR, 1.96; 1.31 to 2.91, respectively).

On the other hand, women with JIA paediatric only were at higher risk of delivery by caesarean section (aOR, 1.42; 1.66 to 1.73) and induction of labour (aOR, 1.45; 1.18 to 1.77).

No association was found between JIA (regardless of persistence into adulthood) and neonatal death, stillbirth or low Apgar score.

Characterized by onset of arthritis before the age of 16 years, JIA may result in remission or persist into adulthood. In affected women, chronic inflammation such as rheumatoid arthritis and inflammatory bowel disease have been implicated in the excess risk of adverse pregnancy outcomes. Mechanisms by which JIA may affect health in adulthood include ongoing inflammatory activity and exposure to immune-modulatory therapies, systemic effects of past inflammatory activity such as impaired growth during adolescence, and local effects such as joint destruction. [Rheumatology 2013;52:1163–71; Curr Opin Rheumatol 2014;26:329–33; Clin Gastroenterol Hepatol 2012;10:1246–52; Inflamm Bowel Dis 2014;20:1091–8]

Findings of the present study highlight the importance of increased surveillance during pregnancy and delivery in the population of women with JIA, researchers said.

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Most Read Articles
07 Aug 2016
Pravastatin supplementation is associated with improved pregnancy outcomes among women with refractory obstetric antiphospholipid syndrome (APS) who developed preeclampsia (PE) or intrauterine growth restriction (IUGR) during standard antithrombotic therapy, according to a study.
Roshini Claire Anthony, 07 Sep 2016

Estrogen receptor α (ESR1) mutations Y537S and D538G are associated with reduced overall survival (OS) in patients with human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer, according to findings of a secondary analysis of the BOLERO-2* clinical trial.

Christina Leung, Robert Chin, 19 Sep 2017
This review article outlines the prevalence of nausea and vomiting of pregnancy (NVP) and hyperemesis gravidarum (HG), definition of NVP and HG, aetiology, risk factors, complications of HG, recommended investigations, primary care management, hospital and ambulatory daycare, therapeutic management of HG supported by good clinical evidence, discharge planning, and importance of the multidisciplinary team to provide high quality care in patients with NVP and HG.