懷孕時嚴重的嘔吐對母子都有很高的危害


  Feb. 18, 2005(華盛頓) - 西雅圖Madigan陸軍醫院的Michele A. Soltis醫師,在美國預防醫學學院2005年度會議上作出發表指出,因為妊娠劇吐而必須住院的孕婦,其所面臨的風險,包含早產、新生兒體重不足、出生前及出生後的併發症等,皆遠高於因為其他因素住院的孕婦。
  
  有兩位研究人員在會議中,以海報簡報的方式說明,孕婦在孕期有劇吐或嚴重嘔吐的現象時,大部分都需要住院治療;這些孕婦們會有體液流失、新陳代謝不良、體重減輕等現象;據悉,患有這類症狀的孕婦佔了0.1%到2.0%,症狀的導因可能是荷爾蒙失調、自主神經異常或其他功能不良。
  
  Soltis醫師及Brunson小姐假設,由於孕期劇吐會造成養分大量流失,所以可能會導致胎兒病變、早產、新生兒體重過低及畸型兒等異常現象;研究人員以普遍人口為依據,以產下活胎的案例資料作回顧性研究;評估孕期劇吐所造成的影響項目,包含孕期病症、難產及對嬰兒所造成的不良後果等。
  
  1987年到2002年間,研究人員蒐集並分析了華盛頓州的出生證明及住院資料,其中有4808位懷孕婦女曾經因為孕期劇吐而住進不屬聯邦政府的醫院;另外,以隨機的方式,選擇了9616位非因孕期劇吐而住院的孕婦作為對照組;以生產的年度為基礎,對兩組孕婦作比較;死胎、多胞胎或在聯邦醫院出生者,皆排除在本試驗之外;研究人員使用相對危險度預估法來進行多層次分析,以孕期劇吐為變因、懷孕狀況、生產情形及嬰兒的情況皆為結果。
  
  分析結果顯示,因孕期劇吐住院的婦女,子前症的罹患風險高於因其他因素住院的婦女;孕期劇吐住院的婦女中,有5.7%患有子前症,對照組則為4.3%(相對風險1.3)。
  
  另外,不論是自然生產或剖腹生產,孕期劇吐的婦女在生產後,住院期間都比較長;自然生產部分,孕期劇吐組有7.0%需要超過三天的住院期,而對照組則只有4.0%需要同樣的住院期;剖腹生產者,孕期劇吐組有12.0%需要住院超過5天,對照組則為6.4%(相對風險2.0)。
  
  出生兒體重方面,孕期劇吐組相較於對照組,有較大部分低於2500g(孕期劇吐組6.4%,對照組4.7%,相對風險1.3);低於28週的早產,孕期劇吐組為0.6%,對照組為0.3%(相對風險2.1)。
  
  在對研究的優缺點作評論時,Soltis醫師解釋,因為這些資料是以普遍人口為基礎,研究的結果足以代表所有的產科患者;其間,研究人員也認同,孕期劇吐的診斷標準,會隨著不同的醫療機構而有所不同。
  
  Soltis醫師及Brunson小姐總結指出,本項研究傳達給醫師及準母親們的訊息,是孕期劇吐會導致嚴重的併發症,我們必須充分了解這樣的狀況及所造成的後果,然後才可以做出有效的預防措施,避免對母體及嬰兒構成危害。

Severe Vomiting During Pregnan

By
Medscape Medical News

Eurona Earl Tilley

Feb. 18, 2005 (Washington) — The risk of premature delivery, a low-birth-weight neonate, as well as prenatal and postnatal complications are increased among mothers hospitalized for hyperemesis gravidarum compared with pregnant women not hospitalized for this condition. Michele A. Soltis, MD, from the Madigan Army Medical Center in Tacoma, Washington, and Emily K. Brunson, from the University of Washington in Seattle, presented these findings here at Preventive Medicine 2005, the annual meeting of the American College of Preventive Medicine.

The two researchers explained in their poster presentation that hyperemesis gravidarum, or severe vomiting during pregnancy, often requires hospitalization. These women suffer from volume depletion, metabolic disturbance, and weight loss. It is believed that this condition affects between 0.1% and 2.0% of all pregnant women and may be a result of hormonal aberrations, autonomic irregularities, or mechanical impingement.

Due to the nutritional deprivation associated with hyperemesis gravidarum, Dr. Soltis and Ms. Brunson hypothesized that it may be responsible for placental pathologies, premature delivery, low birth weights among infants, and increased fetal anomalies. To assess the affects of hyperemesis gravidarum on pregnancy difficulties, delivery complications, and adverse infant outcomes, they developed a population-based, retrospective cohort study of singleton, live-born pregnancies.

Birth certificate data and hospitalization records from Washington state between 1987 and 2002 were analyzed. The researchers identified 4,808 pregnant women hospitalized at nonfederal institutions with hyperemesis gravidarum. The records of these women were compared with those of 9,616 randomly selected mothers not hospitalized for hyperemesis gravidarum. The two groups were further analyzed by year of delivery. Exclusion criteria were a pregnancy ending with fetal demise, a multiple-birth pregnancy, or a delivery at a federal institution. Stratified analysis using relative risk estimates was used to determine the effects of hyperemesis gravidarum on pregnancy, delivery, and infant outcome.

Results of the analysis showed that women hospitalized with hyperemesis gravidarum had an increased risk of preeclampsia compared with those not hospitalized for the condition. Of the women with hyperemesis gravidarum, 5.7% suffered from preeclampsia compared with 4.3% of the women without hyperemesis gravidarum (relative risk [RR], 1.3; 95% confidence interval [CI], 1.1 - 1.6).

In addition, women with hyperemesis gravidarum required extended hospital stays after both vaginal and cesarean delivery. Among the vaginal deliveries within the two groups of women, 7.0% of the hyperemesis gravidarum group required a hospital stay longer than three days compared with 4.0% of the control group (RR, 1.8; 95% CI, 1.5 - 2.1). Likewise, among the cesarean deliveries, 12.0% of the hyperemesis gravidarum group required a hospital stay longer than five days compared with 6.4% of the control group (RR, 2.0; 95% CI, 1.5 - 2.7).

Infants born to the group of women with hyperemesis gravidarum were also more likely to weigh less than 2500 g (6.4% of infants born to women with hyperemesis gravidarum vs 4.7% of infants born to women without hyperemesis gravidarum; RR, 1.3; 95% CI, 1.2 - 1.6). Furthermore, premature deliveries (before 28 weeks' gestational age) occurred in 0.6% of the pregnancies of women with hyperemesis gravidarum compared with 0.3% of the women without hyperemesis gravidarum (RR, 2.1; 95% CI, 1.2 - 4.0).

In evaluating the strengths and weaknesses of their research, Dr. Soltis and Ms. Brunson explained in their poster presentation that “since data is population based, results will prove to be generalized to the obstetric patient population at large.” The researchers recognize, though, that there are variations in the diagnostic criteria of hyperemesis gravidarum among providers and healthcare systems.

Dr. Soltis and Ms. Brunson concluded in their poster presentation that “this study may inform physicians and expectant mothers of the complications that may occur secondary to hyperemesis gravidarum. Awareness of this condition and its potentially deleterious consequences may influence the implementation of better treatment modalities and affect the prevention of such adverse maternal and infant outcomes.”

ACPM 2005: Poster 6. Presented Feb. 17, 2005.

Reviewed by Gary D. Vogin, MD

Eurona Earl Tilley is a freelance writer for Medscape.

    
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