Pregnant, miserable, and starving in 21st century America.
Pregnant, miserable, and starving in 21st century America.
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DOI：
10.1016/j.xagr.2022.100141
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发表时间：
2023-02
期刊：
影响因子：
--
通讯作者：
Wisner KL
中科院分区：
文献类型：
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作者：
Fejzo MS;MacGibbon KW;Wisner KL
严重的恶心和呕吐怀孕是太常见和毁灭性的，不能再被轻视了。最近研究的作者观察到，在子宫内暴露于怀孕期间严重恶心和呕吐的儿童患自闭症谱系障碍的风险增加，大脑皮质体积减少，发育缺陷。对妊娠期严重恶心呕吐和妊娠剧吐的研究进展缓慢，令人不安。直到2021年才公布了一个国际共识定义。妊娠剧吐开始于妊娠16周前，表现为严重恶心伴或不伴呕吐，不能正常饮食，严重限制日常活动。产妇的痛苦是由持续的恶心、顽固性干呕或呕吐、精神错乱、脱水、反流、营养不良和社会孤立造成的。妊娠剧吐是妊娠住院的第二大常见原因。三分之一的体重极度减轻的人的症状会持续到分娩。已确定妊娠剧吐与多种不良后果之间存在显著关联。产妇因妊娠剧吐死亡的报道仍在继续，而妊娠剧吐与高胎儿流产率和终止妊娠率有关。这些严峻的发现强调了早期治疗妊娠期严重恶心和呕吐对公共卫生的重要意义，以减轻妊娠期及以后危及孕产妇和后代健康的严重并发症。尽管极度虚弱，妊娠剧吐患者报告说，他们的经历被医疗保健专业人员忽视，导致治疗终止、自杀意念、围产期抑郁症和创伤后应激障碍。妊娠剧吐必须及早发现并积极治疗，经常监测。虽然药物可以有效地减轻症状，但许多患者并没有得到充分的缓解，需要新的治疗方法。基因发现为治疗提供了一条很有希望的新途径。这种名为生长分化因子-15的基因编码一种由胎盘产生的恶心和呕吐激素，是妊娠呕吐最大的遗传风险因素，目前治疗癌症的方法正在临床试验中。然而，在治疗普遍有效之前，必须为难治性妊娠剧吐提供人工流产服务。在此，我们强调自最近的美国妇产科学院报告（2018年）以来发表的数据，例如暴露于妊娠剧吐的后代的长期神经精神后果，并建议采取干预措施防止早期症状发展为妊娠剧吐。
Severe nausea and vomiting of pregnancy is too common and devastating to be trivialized any longer. Authors of recent studies observed that children exposed in utero to severe nausea and vomiting of pregnancy had an increased risk for autism spectrum disorder, a decreased brain cortical volume, and developmental deficits. Research on severe nausea and vomiting of pregnancy and hyperemesis gravidarum has been disturbingly slow. It was not until 2021 that an international consensus definition was published. Hyperemesis gravidarum starts before 16 weeks’ gestation, is characterized by severe nausea with or without vomiting and an inability to eat and drink normally, and greatly limits daily activities. Maternal misery is caused by unrelenting nausea, intractable retching or vomiting, ptyalism, dehydration, reflux, malnutrition, and social isolation. Hyperemesis gravidarum is the second most common reason for hospitalization in pregnancy. Symptoms can persist until delivery in one-third of individuals who experience extreme weight loss. Significant associations have been identified between hyperemesis gravidarum and multiple adverse outcomes. Maternal deaths owing to hyperemesis gravidarum continue to be reported, and hyperemesis gravidarum is associated with high fetal loss and termination rates. These grim findings highlight the critical public health importance of treating severe nausea and vomiting of pregnancy early to mitigate serious complications that compromise maternal and offspring health during pregnancy and beyond. Despite suffering extreme debility, individuals with hyperemesis gravidarum report feeling that their experiences were dismissed by healthcare professionals, contributing to therapeutic termination, suicidal ideation, perinatal depression, and posttraumatic stress disorder. Hyperemesis gravidarum must be recognized early and treated aggressively with frequent monitoring. Although medications can be effective in reducing symptoms, many patients do not gain adequate relief, and new treatments are needed. A promising new avenue for treatment comes from genetic discoveries. The gene, growth differentiation factor-15, which codes for a nausea and vomiting hormone produced by the placenta, is the greatest genetic risk factor for hyperemesis gravidarum, and therapies are currently in clinical trials in cancer. However, until treatment is universally effective, abortion access must be available for refractory hyperemesis gravidarum. Herein, we emphasize data published since the most recent American College of Obstetrics and Gynecology report (2018), such as long-term neuropsychiatric consequences in offspring exposed to hyperemesis gravidarum and suggest interventions anticipated to prevent progression of early symptoms to hyperemesis gravidarum.