Treatments for hyperemesis gravidarum: A systematic review.

INTRODUCTION: Hyperemesis gravidarum affects 0.3%-3% of pregnant women each year and is the leading cause of hospitalization in early pregnancy. Previous systematic reviews of available treatments have found a lack of consistent evidence, and few studies of high quality. Since 2016, no systematic review has been conducted and an up-to date review is requested. In a recent James Lind Alliance collaboration, it was clear that research on effective treatments is a high priority for both patients and clinicians. MATERIAL AND METHODS: Searches without time limits were performed in the AMED, CINAHL, Cochrane Library, EMBASE, Medline, PsycINFO, and Scopus databases until June 26, 2023. Studies published before October 1, 2014 were identified from the review by O'Donnell et al., 2016. Selection criteria were randomized clinical trials and non-randomized studies of interventions comparing treatment of hyperemesis gravidarum with another treatment or placebo. Outcome variables included were: degree of nausea; vomiting; inability to tolerate oral fluids or food; hospital treatment; health-related quality of life, small-for-gestational-age infant; and preterm birth. Abstracts and full texts were screened, and risk of bias of the studies was assessed independently by two authors. Synthesis without meta-analysis was performed, and certainty of evidence was assessed using the GRADE approach. PROSPERO (CRD42022303150). RESULTS: Twenty treatments were included in 25 studies with low or moderate risk of bias. The certainty of evidence was very low for all treatments except for acupressure in addition to standard care, which showed a possible moderate decrease in nausea and vomiting, with low certainty of evidence. CONCLUSIONS: Several scientific knowledge gaps were identified. Studies on treatments for hyperemesis gravidarum are few, and the certainty of evidence for different treatments is either low or very low. To establish more robust evidence, it is essential to use validated scoring systems, the recently established diagnostic criteria, clear descriptions and measurements of core outcomes and to perform larger studies.

The Association Between Covariates, with Emphasis on Maternal Body Mass Index, and Duration of Exclusive and Total Breastfeeding.

Objective: The aim of this study was to evaluate the association between possible covariates, with emphasis on maternal body mass index (BMI), on exclusive breastfeeding and on total breastfeeding during the first postnatal year. Design: A longitudinal study encompassing 723 women who were followed during the first postnatal year Methods: Data concerning pregnancy, delivery, neonatal period, and breastfeeding were extracted from respective medical records. Sociodemographic data on the participants were self-reported. The Cox Proportional Hazard Model was used for investigating the effects of different covariates. Results: Compared with women with BMI <25.0, obese women ran a higher risk of ceasing exclusive breastfeeding prematurely (Hazard ratio [HR] = 1.38, p = 0.009). Multiparous women had a lower risk of ceasing the exclusive breastfeeding prematurely, than primiparous women (HR = 0.78, p = 0.009). Concerning exclusive breastfeeding as well as total breastfeeding, the risk of prematurely ceasing the breastfeeding decreased with increasing age (p = 0.028 and p ≤ 0.001, respectively). Median duration of exclusive breastfeeding was shorter among obese women compared with women with BMI <30.0 (3.0 months versus 6.0 months). Corresponding figures for total breastfeeding were 4.0 months versus 8.0 months. Concerning parity and exclusive breastfeeding, there was no difference in median duration between primiparous women and multiparous women (4.0 months), whereas multiparous women had a longer median duration of total breastfeeding, than primiparous women (8.0 months versus 7.0 months). Conclusion: The risk of ceasing exclusive breastfeeding prematurely is high among obese women. This result indicates the need for targeted supportive interventions, individualized according to BMI. With increasing age, the risk of ceasing breastfeeding prematurely decreases, and compared with primiparous women, multiparous women run a lower risk of ceasing exclusive breastfeeding prematurely.

Pregnant women's intention to breastfeed; their estimated extent and duration of the forthcoming breastfeeding in relation to the actual breastfeeding in the first year postpartum-A Swedish cohort study.

OBJECTIVES: To investigate the prenatal intention to breastfeed and the estimated extent and duration of the forthcoming breastfeeding among nulliparous and multiparous women in different Body Mass Index (BMI) classes. Furthermore, in a sub-group we study the actual breastfeeding in relation to the prenatal intended extent and duration. DESIGN: A prospective cohort study. METHODS: A total of 775 pregnant women answered a questionnaire concerning their intention to breastfeed and how they estimated the extent and duration of the forthcoming breastfeeding. In a sub-group of 174 women, data from the actual breastfeeding were obtained. FINDINGS: There was no difference concerning intention to breastfeed among underweight and normal weight women, overweight or obese nulliparous or multiparous women. Fewer multiparous women with BMI <25 judged that the forthcoming breastfeeding would be partial, compared to multiparous women with overweight and obesity (p = 0.003). Furthermore, there was a significant difference within the group of nulliparous women concerning the prenatal intended extent and the actual breastfeeding at two weeks and five months postnatally (p = 0.000 and p = 0.041). There were more underweight and normal weight and overweight women who breastfed exclusively two weeks postnatally, compared with obese women. Additional, at five months postnatally there were more obese women who had ceased to breastfeed, than underweight and normal weight women. CONCLUSIONS: Among pregnant multiparous women there were more overweight and obese women who judged that the forthcoming breastfeeding would be partial, than pregnant underweight and normal weight women. The prenatal estimated extent of the forthcoming breastfeeding differed from the actually extent of breastfeeding among nulliparous women. IMPLICATIONS FOR PRACTICE: The antenatal breastfeeding information and education should be tailored to prepare every woman/couple, irrespective of maternal body composition for the forthcoming task and furthermore, the continuum of care, from antenatal care to Child Health Service should offer a supportive atmosphere to protect and promote breastfeeding.

Effects of a gestational weight gain restriction program for obese women: Sibling pairs' weight development during the first five years of life.

OBJECTIVES: Successful gestational weight gain (GWG) restriction programs for obese (Body Mass Index (BMI) ≥ 30 kg/m2) pregnant women, have not, so far, shown convincing effects on infant's weight development. An intervention starting during the pregnancy might be too late and a pre-conceptional life style change may be preferable. Thus, the aim of this study was to follow children born to mothers who had participated in a weight gain restriction program during pregnancy, and make comparisons with their younger siblings. STUDY DESIGN AND MAIN OUTCOME MEASURES: An extended analysis of 262 children belonging to an intervention group and a control group. The effects of BMI at five years of age and weight-for-length/height development from two months of age until five years of age were assessed. RESULTS: In the intervention group there was a difference in BMI at five years of age, between index boys and their younger sisters (p = 0.016). Mean BMI was lower among the boys compared with their younger female siblings. Regarding maternal GWG or the Swedish national reference data there was no difference between the index children and their younger siblings within the intervention or control groups or between younger siblings in the two groups. CONCLUSIONS: Maternal pre-conceptional lifestyle change may have a positive effect on the child's weight development during the five first years of age. However, the effect of participation in an extensive GWG restriction program when it comes to the impact on the offspring's weight development is still unclear and further research is required.

"You just need to leave the room when you breastfeed" Breastfeeding experiences among obese women in Sweden - A qualitative study.

BACKGROUND: The benefits of breastfeeding for the infant as well for the mother are well-known. It is recognized that obese (Body Mass Index ≥30 kg/m2) women may have less antenatal intention to breastfeed, and shortened duration of breastfeeding compared with normal-weight women. This may result in adverse short- and long-term health for both mother and child, such as a shortened lactational amenorrhoea and decreased protection against breast cancer for the women, and an increased risk for infectious diseases and overweight/obesity among the children. Therefore, it is important to gain more knowledge and understanding of obese women's experiences of breastfeeding in order to attain good health care. Hence, the aim of this study was to identify and describe obese women's experiences of breastfeeding. METHODS: This is an explorative study. Data was collected 2 - 18 months after childbirth through semi-structured face-to-face interviews with 11 obese women with breastfeeding experience. The interviews were recorded and transcribed verbatim. Thematic analysis was used. RESULTS: Three themes emerged from the data analysis: Breastfeeding - a part of motherhood, the challenges of breastfeeding, and support for breastfeeding. The women described an antenatal hope for breastfeeding, the body's ability to produce milk fascinated them, and the breast milk was seen as the best way to feed the child and also as promoting the attachment between mother and child. Breastfeeding was described as a challenge even though it is natural. The challenges concerned technical difficulties such as the woman finding a good body position and helping the child to achieve an optimum grip of the nipple. Another challenge was the exposure of the body connected to public breastfeeding. Support of breastfeeding was described as the importance of being confirmed as an individual behind the obesity, rather than an individual with obesity, and to obtain enough professional breastfeeding support. CONCLUSIONS: Breastfeeding was experienced as a natural part of being a mother. There were practical challenges for obese women concerning how to manage breastfeeding and how to handle the public exposure of the body. There was a need for realistic information about breastfeeding concerning both the child and the woman.

'I just want to be normal' - A qualitative study of pregnant women's blogs who present themselves as overweight or obese.

OBJECTIVE: to describe what pregnant women who present themselves as overweight or obese write about their pregnancy in their blogs. SETTING: Swedish private blogs. DESIGN: a qualitative study, using 13 Internet blogs as the source of data. Google was used to find the blogs. The blog content was analysed using thematic analysis. FINDINGS: three main themes were identified: Pregnancy as an excuse, Perspectives on the pregnant body and Becoming a mother. The pregnancy was used as an excuse for breaking the norms, 'I am normal because I am pregnant', and gaining weight, 'I normalise my weight and weight gain'. The women expressed different perspectives of their body through ' For me it is important to look pregnant', 'How others seem to see me' and 'Labelled a risk pregnancy at the antenatal care'. The transition to motherhood was described in 'How the pregnancy affects my life', and there was disappointment when the women experienced 'Unmet expectations'. KEY CONCLUSION: the women described themselves as normal behind the obesity and saw their pregnancy as an excuse for their body size and behaviour. They did not identify themselves as a risk group and they did not recognise the midwife's support during the pregnancy. IMPLICATION FOR PRACTICE: midwives may have to address overweight and obese pregnant women's attitude towards weight and weight gain in weight gain interventions.

Maternal obesity (Class I-III), gestational weight gain and maternal leptin levels during and after pregnancy: a prospective cohort study.

BACKGROUND: Maternal obesity is accompanied by maternal and fetal complications during and after pregnancy. The risks seem to increase with degree of obesity. Leptin has been suggested to play a role in the development of obesity related complications. Whether maternal leptin levels differ between obese and morbidly obese women, during and after pregnancy, have to our knowledge not been previously described. Neither has the association between maternal leptin levels and gestational weight gain in obese women. The aim was to evaluate if maternal plasma leptin levels were associated with different degrees of maternal obesity and gestational weight gain. METHODS: Prospective cohort study including women categorized as obesity class I-III (n = 343) and divided into three gestational weight gain groups (n = 304). Maternal plasma leptin was measured at gestational week 15, 29 and 10 weeks postpartum. Maternal Body Mass Index (BMI) was calculated from early pregnancy weight. Gestational weight gain was calculated using maternal weight in delivery week minus early pregnancy weight. The mean value and confidence interval of plasma-leptin were analysed with a two-way ANOVA model. Interaction effect between BMI and gestational weight gain group was tested with a two-way ANOVA model. RESULTS: The mean maternal leptin concentrations were significantly higher in women with obesity class III compared to women in obesity class I, at all times when plasma leptin were measured. The mean leptin concentrations were also significantly higher in women with obesity class II compared to women in obesity class I, except in gestational week 29. There was no difference in mean levels of plasma leptin between the gestational weight gain groups. No significant interaction between BMI and gestational weight gain group was found. CONCLUSIONS: Plasma leptin levels during and after pregnancy were associated with obesity class but not with degree of gestational weight gain. These results are in concordance with epidemiological findings where the risk of obstetric complications increases with increased maternal obesity class. The effect on obstetric outcome by degree of gestational weight gain is less pronounced than the adverse effects associated with maternal obesity.

Effects of a Gestational Weight Gain Restriction Program for Obese Pregnant Women: Children's Weight Development during the First Five Years of Life.

BACKGROUND: Maternal prepregnancy obesity (BMI ≥30 kg/m(2)) and excessive gestational weight gain (GWG) have shown a strong positive association with a higher BMI and risk of obesity in the offspring. The aim of this study is to estimate the effect of a GWG restriction program for obese pregnant women on the children's BMI at 5 years of age and weight-for-length/height (WL/H) development from 2 months of age until 5 years of age. METHODS: This was a follow-up study of 302 children (137 children in an intervention group and 165 children in a control group) whose mothers participated in a weight gain restriction program during pregnancy. RESULTS: BMI at five years of age did not differ between girls and boys in the intervention and control group. The degree of maternal GWG, <7 kg or ≥7 kg, did not affect the offspring's WL/H. Compared with Swedish reference data, just over half of the children in both the intervention and control group had a BMI within the average range, whereas slightly more than one-third of the children had a higher BMI. CONCLUSION: Despite a comprehensive gestational intervention program for obese women containing individual weekly visits and opportunity to participate in aqua aerobic classes, there were no differences between BMI or weight development among the offspring at 5 years of age in the intervention and control group.

Lifestyle habits and women's attitudes towards discussing them at a visit for contraceptive advice.

OBJECTIVE: The aims of this study was to use visits for contraceptive counselling as opportunities for examining women's actual life style habits with the main focus being placed on alcohol consumption but also to evaluate the women's opinions about discussing their alcohol and tobacco habits and their weight status. METHODS: A total of 535/802 (67%) women completed a study-specific anonymous questionnaire after a contraceptive counselling visit with a midwife. RESULTS: A majority of the women thought that a discussion concerning alcohol habits at a contraceptive counselling session was important (85.5%) and not intrusive (86.4%) neither embarrassing (81.7%). Women with high-risk drinking habits were younger, more often tobacco users and more often planning for childbirth in the future, compared with women who did not display high-risk drinking behaviour. A significantly higher percentage of women who practiced high-risk drinking thought that a discussion of alcohol was intrusive (10.9%) and embarrassing (46.7%), compared with women not practicing high-risk alcohol consumption. Most women (72.9%) stated that no other caregiver during the preceding year except the midwife had discussed drinking habits with them. The weight was a good thing that the midwife brought up for discussion according to 82.5% of the women but the discussions about weight was more often found embarrassing (18.4%) than the discussion about alcohol habits. CONCLUSION: Women who came for contraceptive counselling found the discussion concerning alcohol habits important, not intrusive or embarrassing and a good thing to be brought up by the midwife.

Physical activity and psychological well-being in obese pregnant and postpartum women attending a weight-gain restriction programme.

OBJECTIVE: the objective of the study was to compare the differences in psychological well-being and quality of life during pregnancy and post partum of obese physically active women and obese physically inactive women enroled in a weight gain restriction programme. We also wanted to explore whether physical activity influences weight change or health status during pregnancy. DESIGN: a prospective intervention study. SETTING: antenatal care clinic. PARTICIPANTS: a total of 74 obese pregnant women in a physically active group and 79 obese women in a physically inactive group. MEASUREMENTS: the women kept diaries of their physical activity during pregnancy and answered the Beck Anxiety Inventory, the Edinburgh Postnatal Depression Scale and Medical Study Short-Form Health Survey in gestational weeks 15 and 35 and 11 weeks post partum. Physical activity was measured in metabolic equivalents. FINDINGS: the physically active women experienced fewer depressive symptoms and estimated an improved quality of life during their pregnancies as measured by physical functioning, bodily pain, social functioning, role limitations due to emotional problems and general mental health as compared with the physically inactive women. There were no differences between the groups in gestational weight gain or weight change from early pregnancy to post partum or in prevalence of complications. KEY CONCLUSIONS: physical activity among obese pregnant women provides better psychological well-being and improved quality of life, but does not prevent weight change. IMPLICATIONS FOR PRACTICE: staff at Antenatal Care Clinics that face obese pregnant women, should encourage and emphasise the benefits of being physically active throughout pregnancy.

Weight six years after childbirth: a follow-up of obese women in a weight-gain restriction programmme.

OBJECTIVE: to compare weight development in an intervention group and a control group, six years after participation in a gestational weight-gain restriction programme. DESIGN: follow-up of a prospective intervention study. SETTINGS: antenatal care clinics. PARTICIPANTS: a total of 129 women (88.4%) from the original intervention group and 166 women (88.8%) from the original control group. MEASUREMENTS: the women answered a study specific questionnaire, covering socio-demographic data and health- and weight status. FINDINGS: after adjusting for socio-demographic factors, the mean weight was lower (4.1kg) among the women in the intervention group, compared to the controls (p=0.028). Furthermore, the mean weight change, e.g. the weight at the six year assessment compared with the weight at the start of the intervention at the first antenatal care visit, was greater in the intervention group than in the control group. The women in the intervention group had a larger mean weight change (-5.2kg), e.g. weighed less than the women in the control group (-1.9kg) (p=0.046). Mean weight change expressed in 5kg classes also showed a significant difference between the two groups (p=0.030). KEY CONCLUSIONS: the results indicate that attending a gestational weight-gain-restriction programme can have a positive effect on weight up to six years after the intervention. IMPLICATION FOR PRACTISE: a restrictive gestational weight gain can result in a positive weight development during the first years after childbirth. It might provide both short- and long term medical health benefits for the mother as well as the child.

Leptin and adiponectin in cord blood from children of normal weight, overweight and obese mothers.

AIM: To study cord blood concentrations of adiponectin and leptin in children born by normal weight, overweight and obese mothers and to study these parameters in relation to a weight gain intervention programme for obese mothers. METHODS: Ten millilitre cord blood was collected and analysed for leptin and adiponectin concentrations in children with gestational age >37 weeks born by 60 normal weight, 45 overweight and 145 obese mothers. 82 obese mothers took part in a weight gain intervention programme. RESULTS: Concentrations of leptin and adiponectin were higher in cord blood from children of overweight and obese mothers compared with children of normal weight mothers (leptin: Md 13.2, 30, 3 and 90.2 ng/mL respectively, p < 0.001; adiponectin 35.9, 205.4, 213.8 ng/L p < 0.001). No differences were found between overweight and obese mothers. The weight gain intervention programme for obese pregnant women had significant effects on the weight gain during pregnancy but had no effects on cord blood serum concentrations of leptin and adiponectin. CONCLUSION: Cord blood leptin and adiponectin concentrations were higher in children born by overweight or obese women compared with children of normal weight mothers. A weight gain intervention programme for obese pregnant women did not affect these results. Intrauterine exposition to high concentrations of leptin and adiponectin may play a role in weight development later in life.

Effects of a weight-gain restriction programme for obese pregnant women on sickness absence and pregnancy benefits.

OBJECTIVE: To evaluate the effect of a weight-gain restriction programme for obese pregnant women on sickness absence days and pregnancy benefit days during pregnancy and postpartum. DESIGN: A prospective, controlled intervention study. The Swedish Social Security Agency's records were utilized to compile sickness absence and pregnancy benefit information. SETTING: Antenatal care clinics in the south-east of Sweden. SUBJECTS: One hundred fifty-five obese pregnant women who participated in a weight restriction program with weekly structured motivational and behavioural talks combined with aqua-aerobics during pregnancy. A total of 193 obese pregnant women with no intervention served as controls. MAIN OUTCOME MEASURES: Sickness absence benefits and pregnancy benefits expressed as a percentage. RESULTS: On average women in the intervention group had 76.68 total full days of sickness absence benefit compared with 53.09 days in the control group. Total full days of pregnancy benefits were 39.66% days and 41.41% for the intervention and control groups respectively. For the women who were on sick leave there were no differences between the groups in the amount of days taken. CONCLUSIONS: Given the complexity of factors that have an influence on sickness absence leave, it is possible that programmes that do not address the influence of social aspects and attitudes towards sickness absence have limited effect.

Weight after childbirth: a 2-year follow-up of obese women in a weight-gain restriction program.

OBJECTIVE: To investigate the effects of a weight-gain restriction program on weight development or weight maintenance 2 years after childbirth. DESIGN: A case-control intervention study. SETTING: Antenatal care clinics in the southeast of Sweden. SAMPLE: One hundred and fifty-five obese pregnant women who participated in a weight-gain restriction program with weekly support during pregnancy and every 6 months during the two first years after childbirth. The control group consisted of 193 obese pregnant women. METHODS: Follow-up weight measurements were done at 12 and 24 months after childbirth. MAIN OUTCOME MEASURES: Weight change in kilogram at 12 and 24 months postpartum. RESULTS: A greater percentage of women in the intervention group showed a weight loss 24 months after delivery than did women in the control group at that same time (p= 0.034). Women in the intervention group who gained less than 7 kg during pregnancy had a significantly lower weight than the controls at the 24 months follow-up (p= 0.018). The mean value of weight change in the intervention group was -2.2 kg compared to +0.4 kg in the control group from early pregnancy to the follow-up 12 months after childbirth (p= 0.046). CONCLUSIONS: An intervention program with weekly motivational support visits during pregnancy and every 6 months after childbirth seems to have an impact on weight gain up to 24 months after childbirth for those women in the intervention group who succeeded in restricting their gestational weight gain to less than 7 kg.

Prevalence of anxiety and depressive symptoms among obese pregnant and postpartum women: an intervention study.

BACKGROUND: Although studies have shown an association between anxiety and depression and obesity, psychological health among obese women during and after pregnancy has not been carefully studied. The aim of this study was to investigate psychological well-being using symptoms of depression and/or anxiety among obese pregnant women attending a weight gain restriction program and to then compare this group with a control group receiving traditional antenatal care. METHODS: 151 obese pregnant women in an intervention group and 188 obese pregnant women in a control group answered the Beck Anxiety Inventory (BAI) and the Edinburgh Postnatal Depression Scale (EPDS). Group differences between the two groups were estimated by using the χ2 - test on categorical variables. The Student's t-test on continuous, normally distributed variables measuring changes in mean score on BAI and EPDS over time was used. To make a more comprehensive assessment of group differences, between as well as within the two groups, logistic regressions were performed with the BAI and EPDS as dependent variables, measured at gestational weeks 15 and 35 and 11 weeks postnatal. The grouping variable has been adjusted for socio-demographic variables and complications. RESULTS: The prevalence of symptoms of anxiety during pregnancy varied between 24% and 25% in the intervention group and 22% and 23% in the control group. The prevalence of symptoms of anxiety postnatally was 9% in the intervention group and 11% in the control group. Five percent of the women in the intervention group and 4% of the women in the control group showed symptoms of anxiety during the course of pregnancy and at the postpartum assessment. The prevalence of symptoms of depression during pregnancy varied between 19% and 22% in the intervention group but was constant at 18% in the control group. Postnatal prevalence was 11% in both groups. Six percent of the women in the intervention group and 4% in the control group showed symptoms of depression during the course of pregnancy and at the postpartum assessment. We found no differences between the two groups as concerns demographic characteristics, weight gain in kg, or the distribution of scores on anxiety and depressive symptoms nor did we find differences in the fluctuation of anxiety and depressive symptoms over time between the women in the intervention group and in the control group. CONCLUSION: Obese pregnant women attending an intervention program seem to have the same risk of experiencing anxiety and/or depressive symptoms as do obese pregnant and postnatal women in general.

Weight gain restriction during pregnancy is safe for both the mother and neonate.

The objective of this study was to investigate whether pregnancy, delivery, and neonatal outcome among obese pregnant women who took part in an intervention study for weight restriction differed from a group of obese pregnant women attending regular antenatal care. The intervention group consisted of 155 obese pregnant women and 193 obese pregnant women who formed a control group. We found that a weight gain restriction of less than 7 kg during pregnancy is safe for both the mother and the neonate.

Consumer satisfaction with a weight-gain intervention programme for obese pregnant women.

OBJECTIVE: to investigate women's attitudes and satisfaction with a weight-gain intervention programme during pregnancy. DESIGN: exploratory, descriptive study. Data were collected via interviews. SETTING: University hospital. PARTICIPANTS: 56 obese pregnant women who attended antenatal care at the University Hospital of Linköping's obstetrical department and took part in an intervention programme aimed at reducing weight gain during pregnancy, between November 2003 and August 2004. FINDINGS: the interviews comprised several questions concerning attitudes and opinions of the programme. Most of the women expressed positive experiences with the treatment and would attend the programme if they became pregnant again. Most of the women stated that they had changed their eating and exercise habits during pregnancy, and almost all of them had continued with these new habits. Even though the weight gain goal of a maximum 6.9 kg was reached by less than half of the participants, most of the women were satisfied with their weight gain. A total of 71.4% of the women participated in aqua aerobics classes. They stated that they were most satisfied with this form of exercise, and that it also was a good social experience. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: a pregnant woman herself must be actively involved in setting her own goals to prevent excessive weight gain during pregnancy. Considerable effort and support must be placed on discussing strategies, pitfalls and risks. In order for the woman to maintain the change in attitude and habits, she must probably be given continuous feedback and reinforcement over the long term.