Adverse Neonatal Outcomes in Pregnant Women with Severe Vomiting: A Meta-Analysis
Abstract
Background: We aimed to systematically evaluate the risk of negative effect for newborns born to expectant mothers with severe vomiting in terms of birth weight, premature delivery, low Apgar score, and NICU hospitalization.
Methods: We conducted a systematically search for relevant studies on PubMed, Embase, Cochrane Library, and CNKI databases, using Newcastle-Ottawa Scale to evaluate research quality, and RevMan 5.3 software for meta-analysis from 2009 to 2022. The main outcome measures were: Low-birth weight, preterm delivery, low Apgar score and growth restriction.
Results: In 9 studies, the risk of Low birth weight in hyperemesis pregnant women was increased, and the random effect model was OR 2.38 (95% CI 0.43 to 13.13). The heterogeneity of the study was high (I2=100%). Four studies showed an increased risk of low Apgar scores, with an OR of 2.69 (95% CI 0.30 to 24.48), and high heterogeneity (I2=95%). The risk of premature birth in 5 papers is equivalent, with an OR of 0.93 (95% CI 0.71 to 1.22) and low heterogeneity (I2=6%). The risk of growth restriction was higher in 7 papers, with an OR of 1.31 (95% CI 0.93 to 1.85) and lower heterogeneity (I2=29%). Subgroup analysis showed that heterogeneity mainly stemmed from differences in the definition of hyperemesis.
Conclusion: Pregnant women with severe vomiting have a higher risk of giving birth to babies with low birth weight and low Apgar scores, and a higher risk of giving birth to babies with growth restriction, but the risk of premature birth is comparable.
2. Nijsten K, Jansen L, Painter RC (2022). De-scription of the ascertainment of the quality of studies by Fejzo et al in "Long-term health outcomes of children born to mothers with hyperemesis grav-idarum: A systematic review and meta-analysis". Am J Obstet Gynecol, 227 (5): 793-794.
3. Nijsten K, Jansen L, Limpens J, et al (2022). Long-term health outcomes of children born to mothers with hyperemesis grav-idarum: A systematic review and meta-analysis. Am J Obstet Gynecol, 227 (3): 414-429.e17.
4. Adane KD, Zerga AA, Gebeyehu FB, Ayele FY (2023). Proportion of hyperemesis gravidarum and associated factors among pregnant women admitted into the obstetrics ward at Akesta general hospital, North East Ethiopia. PLoS One, 18 (2): e0281433.
5. Moberg T, Van der Veeken L, Persad E, Hansson SR, Bruschettini M (2023). Pla-centa-associated adverse pregnancy out-comes in women experiencing mild or severe hyperemesis gravidarum - a sys-tematic review and meta-analysis. BMC Pregnancy Childbirth, 23 (1): 375.
6. Veenendaal MV, van Abeelen AF, Painter RC, et al (2011). Consequences of hy-peremesis gravidarum for offspring: A systematic review and meta-analysis. BJOG, 118 (11): 1302-1313.
7. Biotti D, Osseby GV, Durand C, et al (2011). Wernicke's encephalopathy due to hyperemesis gravidarum and fetal stroke: What relationship. Clin Neurol Neurosurg, 113 (6): 490-492.
8. Stokke G, Gjelsvik BL, Flaatten KT, et al (2015). Hyperemesis gravidarum, nutri-tional treatment by nasogastric tube feeding: A 10-year retrospective cohort study. Acta Obstet Gynecol Scand, 94 (4): 359-367.
9. Akum LA, Offei EA, Kpordoxah MR, et al (2023). Compliance with the World Health Organization's 2016 prenatal care contact recommendation reduces the incidence rate of adverse birth out-comes among pregnant women in northern Ghana. PLoS One, 18 (6): e0285621.
10. Gunay T, Turgut A, Bilir RA, et al (2020). Comparative analysis of matemal and fetal outcomes of pregnancies compli-cated and not complicated with hy-peremesis gravidarum necessitating hospitalization. Medeni Med J, 35 (1): 8-14.
11. Grooten IJ, Den Hollander WJ, Roseboom TJ, et al (2017). Helicobacter pylori in-fection: A predictor of vomiting severity in pregnancy and adverse birth out-come. Am J Obstet Gynecol, 216 (5): 512.e1-512.e9.
12. Buyukkayaci Duman N, Ozcan O, Bostanci MÖ (2015). Hyperemesis gravidarum af-fects maternal sanity, thyroid hormones and fetal health: A prospective case con-trol study. Arch Gynecol Obstet, 292 (2): 307-312.
13. Koudijs HM, Savitri AI, Browne JL, et al (2016). Hyperemesis gravidarum and placental dysfunction disorders. BMC Pregnancy Childbirth, 16 (1): 374.
14. Vikanes ÅV, Støer NC, Magnus P, Grjibov-ski AM (2013). Hyperemesis gravidarum and pregnancy outcomes in the Norwe-gian Mother and Child Cohort - a co-hort study. BMC Pregnancy Childbirth, 13: 169.
15. Ong J, Sadananthan SA, Soh SE, et al (2021). Increasing nausea and vomiting of pregnancy is associated with sex-dependent differences in early child-hood growth: The GUSTO mother-offspring cohort study. BMC Pregnancy Childbirth, 21 (1): 578.
16. Morisaki N, Nagata C, Morokuma S, et al (2022). Lack of catch-up in weight gain may intermediate between pregnancies with hyperemesis gravidarum and re-duced fetal growth: The Japan Envi-ronment and Children's Study. BMC Pregnancy Childbirth, 22 (1): 199.
17. Coetzee RL, Cormack B, Sadler L, Bloom-field FH (2011). Pregnancy and neonatal outcomes following hyperemesis gravi-darum. J Dev Orig Health Dis, 2 (2): 81-88.
18. Mullin PM, Ching C, Schoenberg F, et al (2012). Risk factors, treatments, and out-comes associated with prolonged hy-peremesis gravidarum. J Matern Fetal Ne-onatal Med, 25 (6): 632-636.
19. Song J, Huang YJ (2009). A case-control study on hyperemesis grayidarum and perinatal outcomes. Matern Child Health Care China, 24 (12): 1613-1615.
20. Petry CJ, Ong KK, Beardsall K, et al (2018). Vomiting in pregnancy is associated with a higher risk of low birth weight: A cohort study. BMC Pregnancy Childbirth, 18 (1): 133.
21. Bánhidy F, Acs N, Puhó EH, Czeizel AE (2011). Hypotension in pregnant women: A population-based case-control study of pregnancy complications and birth outcomes. Hypertens Res, 34 (1): 55-61.
22. Herren H, Marcolin AC, Barbieri MA, et al (2023). Cytokine quantification and asso-ciation with cervical length in a pro-spective cohort of pregnant women. BMC Pregnancy Childbirth, 23 (1): 458.
23. Jansen LAW, Nijsten K, Limpens J, et al (2023). Perinatal outcomes of infants born to mothers with hyperemesis grav-idarum: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol, 284: 30-51.
24. Cao X, Sun M, Yang Q, et al (2022). Risk of abnormal pregnancy outcomes after us-ing ondansetron during pregnancy: A systematic review and meta-analysis. Front Pharmacol, 13: 951072.
Files | ||
Issue | Vol 54 No 5 (2025) | |
Section | Review Article(s) | |
DOI | https://doi.org/10.18502/ijph.v54i5.18626 | |
Keywords | ||
Dramatic vomiting Pregnant and parturient women Newborns Adverse outcomes |
Rights and permissions | |
![]() |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |