The first demonstration that a subset of women with hyperemesis gravidarum has abnormalities in the vestibuloocular reflex pathway.

OBJECTIVE: The vestibular system is a major pathway to nausea and vomiting, and the vestibuloocular reflex (VOR) is a central component; its function can be studied using the vestibular autorotation test (VAT). We hypothesize that women with hyperemesis gravidarum (HG) may have VOR abnormalities. STUDY DESIGN: Women with HG were compared with women without HG using the VAT. Horizontal and vertical VOR gains and phases were evaluated at 3 frequency ranges: low (2.0 to 3.5 Hz), medium (greater than 3.5 to 5.0 Hz), and high (greater than 5.0 to 6.0 Hz) during pregnancy and postpartum. RESULTS: Twenty women with HG and 48 unaffected women were evaluated in early pregnancy. Women with HG had higher horizontal gains at all 3 frequency ranges. Horizontal phase differences were also observed at medium frequencies. No VAT differences were noted postpartum. CONCLUSION: Women experiencing HG had a higher mean VOR horizontal gain and lower horizontal phase when compared with unaffected women.

Effect of pulmonary stenosis on pregnancy outcomes--a case-control study.

BACKGROUND: Pulmonary stenosis (PS) accounts for 10% to 12% of congenital heart disease in adults, and the probability of survival to child bearing age is high. The impact of PS on pregnancy has not been extensively studied in the recent era. METHODS: We evaluate the effect of isolated PS on maternal and fetal outcomes in a case-control study of 17 cases with PS in pregnancy from 1995 to 2006. The control group was matched by age, ethnicity, obstetrical history, and year of delivery. Patients with PS were assessed for maternal New York Heart Association (NYHA) functional class and other maternal complications at baseline and during pregnancy; and the 2 groups were compared for fetal and neonatal outcomes including birth weight, gestational age at delivery, Apgar scores, and placental weight. RESULTS: A total of 11 patients were in NYHA functional class I and 6 in class II at the time of presentation. All patients remained stable during pregnancy except for two. One of them deteriorated from NYHA functional class I to II, and the other from class II transiently to class III. There were no other maternal complications. In addition, there were no statistically significant differences in fetal/neonatal outcomes between patients and their controls and between patients with mild and severe PS. CONCLUSIONS: In contrast to mitral and aortic stenosis, PS does not adversely impact maternal or fetal outcomes of pregnancy.

Molecular epidemiology of preeclampsia.

UNLABELLED: Numerous articles have been published that address the possible genetic influences on the development of preeclampsia (PE). However, to our knowledge, a complete review of the results has not yet been completed. We undertook a MEDLINE search to identify English-language articles published after January 1, 1990 that examined the possible role of specific genes in the etiology of PE. After a brief introduction and a concise review of the prevailing etiologic hypotheses, we have categorized the candidate genes into six categories, based on their hypothesized role in PE etiology. The purpose of this paper is to review the literature, comment on its quality, and provide a reference for researchers interested in the molecular epidemiology of preeclampsia. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to list the prevailing etiologic hypotheses of preeclampsia, to outline the published data on possible genetic influence on the development of preeclampsia, and to clearly state the definition of preeclampsia.

Nausea and vomiting of pregnancy: an obstetric syndrome.

Although the cause of nausea and vomiting of pregnancy is not known, there is strong evidence linking human chorionic gonadoptropin or estrogens. Evidence is presented to show that the incidence and severity of nausea and vomiting of pregnancy is linked to temporal and pathologic alterations in these hormones during pregnancy. The way in which the pregnant woman responds to the primary stimulus to nausea and vomiting of pregnancy appears to depend on her susceptibility mediated by vestibular, gastrointestinal, olfactory, and behavioral pathways. Conceiving of nausea and vomiting of pregnancy as a syndrome suggests new pathways of investigation and possible therapies.