Elevated circulating nitric oxide levels correlates with enhanced oxidative stress in patients with hyperemesis gravidarum.

Since the biochemical and molecular mechanisms responsible for ongoing oxidative stress in hyperemesis gravidarum (HEG) patients have not yet been fully elucidated, the aim of this study was to evaluate the possible role of nitric oxide (NO), malondialdehyde (MDA) and other oxidative stress markers in the disease pathophysiology. Moreover, the relation between oxidative stress markers and Helicobacter pylori (H. pylori) infection was also investigated. Women with pregnancies complicated by HEG (n = 33) were compared with pregnant women without HEG (n = 30) and with healthy non-pregnant women (n = 31). Serum NO, MDA, total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI) and H. pylori infection status were determined for each subject. Serum NO levels and OSI index were found to be increased (p = .001 and .013, respectively) and TAS levels were decreased (p < .001) in HEG patients compared with both controls regardless of H. pylori infection status. Serum MDA and TOS levels were not different between the study groups. Helicobacter pylori infection rates were similar in each group. The reduced antioxidant activities, as well as the increased OSI and NO levels in HEG patients indicate possible oxidative stress conditions in HEG patients. Moreover, serum NO levels may be used as an adjunctive marker to distinguish HEG patients from other causes of emesis during pregnancy. Impact statement What is already known on this subject? Current evidence suggests that oxidative stress is a significant factor responsible for a number of complications during pregnancy. What do the results of this study add? Hyperemesis gravidarum is an oxidative stress condition, as reflected by increased nitric oxide (NO) and decreased total antioxidant status activity, regardless of H. Pylori infection. What are the implications for clinical practice and/or further research? Full disclosure of the association between circulating NO and hyperemesis gravidarum would shed light on underlying biological mechanisms and could help clinical management of similar pregnancy-associated morbidity states.

The relationship between the helicobacter pylori seropositivity with systemic and local oxidative status and hyperemesis gravidarum: a pilot study.

OBJECTIVES: The aim of study was to determine the helicobacter pylori (HP) seropositivity and oxidative parameters in serum and saliva of pregnant women with poor oral hygiene and hyperemesis gravidarum (HG). METHODS: A case-control study was conducted involving 50 pregnant women in their first trimester of pregnancy. Twenty-five subjects had a diagnosis of HG, and remaining 25 were healthy pregnant women who served as control subjects were included. The groups were adjusted for age, parity and gestational week. All patients were subjected to the measurement of total oxidant status (TOS) and total antioxidant status in serum and saliva. Also HP seropositivity was investigated. RESULTS: Serum TAS and TOS values were similar, although oxidative burden in saliva of women with HG were significantly higher than controls. HP seropositivity was found to be 24% in women with HG and 4% of controls. CONCLUSIONS: Our results suggest that significantly increased oxidative burden and slightly decreased antioxidative capacity of saliva may be involved in the pathogenesis of HG and this condition may be the result of HP infection which was found to be significantly more common in women with poor oral hygiene and HG.

A meta-analysis of the association between Helicobacter pylori (H. pylori) infection and hyperemesis gravidarum.

BACKGROUND: Hyperemesis gravidarum remains a common, distressing, and significant yet poorly understood disorder during pregnancy. The association between maternal Helicobacter pylori (H. pylori) infection and hyperemesis gravidarum has been increasingly recognized and investigated. This study thus aimed to provide an updated review and meta-analysis of the topic. METHODS: Using the search terms (H. pyloriOR Helicobacter ORHelicobacter pyloriOR infection) AND (pregnancy OR emesis OR hyperemesis gravidarum OR nausea OR vomiting), a preliminary search on the PubMed, Ovid, Web of Science, Google Scholar, and WanFang database yielded 372 papers published in English between January 1st, 1960 and June 1st, 2017. RESULTS: A total of 38 cross-sectional and case-control studies, with a total of 10 289 patients were eligible for review. Meta-analysis revealed a significant association between H. pylori infection and hyperemesis gravidarum during pregnancy, with a pooled odds ratio of 1.348 (95% CI: 1.156-1.539, P < .001). Subgroup analysis found that serologic and stool antigen tests were comparable methods of detecting H. pylori as they yielded similar odds ratios. LIMITATIONS: Although the studies did not have high heterogeneity (I2  = 28%), publication bias was observed, and interstudy discrepancies in the diagnostic criteria adopted for hyperemesis gravidarum limit the reliability of findings. Also, 15 of the included studies were from the same country (Turkey), which could limit the generalizability of current findings. The prevalence of H. pylori infection varies throughout the world, and there may also be pathogenic differences as most strains of H. pylori in East Asia carry the cytotoxin-associated gene A gene. CONCLUSION: H. pylori infection was associated with an increased likelihood of hyperemesis gravidarum during pregnancy. Given the high prevalence of H. pylori infections worldwide, detecting H. pylori infection and the eradication of maternal H. pylori infection could be part of maternal hyperemesis gravidarum management. Further confirmation with robust longitudinal studies and mechanistic investigations are needed.

Helicobacter Pylori Stool Antigen Assay in Hyperemesis Gravidarum.

Hyperemesis gravidarum is the most severe form of nausea and vomiting in pregnancy that seriously affects the pregnancy outcome. It is a disease with unknown etiology and varieties of contributing factors like hormonal changes, psychological and immunological factors. A significantly high prevalence of Helicobacter pylori among pregnant women with Hyperemesis gravidarum has been revealed recently. A descriptive, cross-sectional study was carried out at antenatal ward, Department of Obstetrics and Gynaecology, Mymensingh Medical College Hospital, Mymensingh for a period of twenty-one months among purposively selected thirty-six patients with Hyperemesis gravidarum with a view to assess the involvement of H. pylori in Hyperemesis gravidarum. Data were collected through interview, physical examinations and laboratory investigations by using case record form. Statistical analysis was performed using SPSS version 20.0 for Windows. Highest number 16(44.44%) of respondents were in age group 20 to 24 years with a mean of 23.81 years and a standard deviation (SD) of 4.55 years. Majority 29(80.56%) of the women had education less than 12 years, as many as 28(77.78%) women were housewives, and at least 14(38.89%) women had unplanned pregnancies. An overwhelming majority 29(80.56%) of women had their pregnancy duration between 8 to 12 weeks with a mean duration of 10.64 weeks and a standard deviation of 2.35 weeks. Majority 20(55.56%) of women were pregnant for first time, as many as 19(52.78%) women had duration of illness for 5 to 9 weeks. Of 16 multi-gravid women, 7(43.75%) had history of similar condition in their previous pregnancies. As many as 9 (25.00%) women had family history of similar condition in their mothers and sisters. First trimester was time of manifestation of the condition.At least 11 (30.56%) stool samples were positive for H. pylori stool antigen. Family history of Hyperemesis gravidarum and presence of H. pylori stool antigen are statistically associated (p<0.05). Pregnancy at young age, low educational status of women, nulliparity, unplanned pregnancy, past history, family history and H. pylori infection are the identified risk factors of Hyperemesis gravidarum.

Helicobacter pylori infection and gastrointestinal symptoms on Chilean pregnant women.

OBJECTIVE: the aim of this research was to determine the prevalence of Helicobacter pylori infection on Chilean pregnant women and its relationship with the appearance and severity of hyperemesis and dyspepsia. METHODS: quantitative study of prevalence in a transversal cut with variable analysis. The sample was taken from 274 Chilean pregnant women from the Bío Bío province through vein puncture between June and December, 2005. Pregnant women were informed of this study, interviewed and signed an informed consent. The samples were processed using ImmunoComb II Helicobacter pylori IgG kit. Statistical analysis was performed by means of the Statistical Package for Social Sciences (SPSS) Program. RESULTS: out of the total number of pregnant women, 68.6% showed infection by Helicobacter pylori. 79.6% of the total sample had symptoms of dyspepsia, and 72.5% of this group presented Helicobacter pylori infection. 12.4% showed pregnancy hyperemesis; among them, 79.4% were infected with Helicobacter pylori. 73.4% of the pregnant women that showed gastric discomfort during the first three months had Helicobacter pylori infection. 53.7% of them continued with gastric discomfort after the first three months; of those, 95.8% were infected. Helicobacter pylori infection was present only in 1.5% of pregnant women without gastric discomfort. CONCLUSION: both, gastric discomfort of pregnant women and the continuity of severe symptoms of dyspepsia and hyperemesis after the first three months of gestation are significantly correlated with Helicobacter pylori infection.

Helicobacter pylori infection and gastrointestinal symptoms on Chilean pregnant women / Infecção por Helicobacter pylori e sintomas gastrointestinais em mulheres grávidas chilenas

Objective: the aim of this research was to determine the prevalence of Helicobacter pylori infection on Chilean pregnant women and its relationship with the appearance and severity of hyperemesis and dyspepsia. Methods: quantitative study of prevalence in a transversal cut with variable analysis. The sample was taken from 274 Chilean pregnant women from the Bío Bío province through vein puncture between June and December, 2005. Pregnant women were informed of this study, interviewed and signed an informed consent. The samples were processed using ImmunoComb II Helicobacter pylori IgG kit. Statistical analysis was performed by means of the Statistical Package for Social Sciences (SPSS) Program. Results: out of the total number of pregnant women, 68.6% showed infection by Helicobacter pylori. 79.6% of the total sample had symptoms of dyspepsia, and 72.5% of this group presented Helicobacter pylori infection. 12.4% showed pregnancy hyperemesis; among them, 79.4% were infected with Helicobacter pylori. 73.4% of the pregnant women that showed gastric discomfort during the first three months had Helicobacter pylori infection. 53.7% of them continued with gastric discomfort after the first three months; of those, 95.8% were infected. Helicobacter pylori infection was present only in 1.5% of pregnant women without gastric discomfort. Conclusion: both, gastric discomfort of pregnant women and the continuity of severe symptoms of dyspepsia and hyperemesis after the first three months of gestation are significantly correlated with Helicobacter pylori infection. .

Objetivo: o objetivo desta investigação foi determinar a prevalência da infecção por Helicobacter pylori em mulheres grávidas chilenas e a sua relação com o aparecimento e agravamento de hiperêmese e dispepsia. Métodos: estudo de prevalência, quantitativo de coorte transversal com análise de variáveis. A amostra foi tomada através de punção venosa em 274 mulheres grávidas chilenas, da província de Bío Bío, nos meses de junho a dezembro de 2005. As mulheres que participaram foram informadas, assinaram um consentimento e responderam uma pesquisa. As amostras foram processadas usando o kit ImmunoComb II Helicobacter pylori IgG. A análise estatística foi realizada com o programa Statistical Package for Social Sciences (SPSS). Resultados: do total de mulheres pesquisadas, 68,5% apresentam infecção por Helicobacter pylori. Do total, 80,7% tiveram sinais de dispepsia; dessa porcentagem, 72,5% apresentaram infecção por Helicobacter pylori. Uma porcentagem de 12,6% das pacientes apresentou hiperêmese gravídica; dessas, 79,4% tiveram a infecção. Do total das mulheres grávidas com moléstias gástricas no primeiro trimestre de gravidez, 73,4% registraram infecção por Helicobacter pylori. Uma porcentagem de 53,7% continuou com moléstias gástricas depois do primeiro trimestre e dentro desse grupo 95,8% tiveram a infecção. Infecção por Helicobacter pylori estava presente em apenas em 1,5% das mulheres grávidas sem desconforto gástrico. Conclusão: as moléstias gástricas das mulheres grávidas e o agravamento dos sinais de dispepsia e hiperêmese depois do primeiro trimestre de gravidez estão correlacionados significativamente à infecção por Helicobacter pylori. .

Helicobacter pylori seropositivity in patients with hyperemesis gravidarum.

BACKGROUND: Nausea and vomiting during pregnancy are the most common conditions affecting pregnancy, occurring in about 80% of all pregnancies and always disappearing on the 16th to 18th weeks of gestation. This may be mild and it does not affect the general condition of the patient (the condition is called emesis gravidarum), or it may be severe enough to affect the patient physically and psychologically, causing intractable vomiting, electrolyte imbalance, weight loss >5%, impairment of liver and kidney functions and dehydration. Helicobacter pylori is one of the most common bacterium affecting humans. It is a gram-negative helix-shaped microaerophilic bacterium transmitted by the oro-oral or feco-oral route. It is more prevalent in developing countries and affects young children. Acute infection manifests as acute gastritis and stomach pain, whereas chronic infection causes chronic gastritis and peptic ulcer, 2% of which may develop into stomach cancer. The authors tried to investigate the association between H pylori infection and hyperemesis gravidarum. METHODS: Fifty patients with hyperemesis gravidarum and 50 patients with normal pregnancy were included in the study. H pylori infection was determined using a 1-step H pylori test device (serum/plasma), which is a qualitative membrane-based immunoassay. RESULTS: Regarding maternal age, gestational age and socioeconomic status, there is no statistical difference between both groups. There is a marked statistical difference between both groups in terms of Helicobacter pylori seropositivity and frequency of vomiting. CONCLUSIONS: There is a powerful correlation between H pylori and hyperemesis gravidarum.

Association of Helicobacter pylori positivity with the symptoms in patients with hyperemesis gravidarum.

PURPOSE: To investigate the relationship between Helicobacter pylori (Hp) positivity and the severity of symptoms of nausea and vomiting in patients diagnosed with hyperemesis gravidarum (HG). DESIGN: Prospective controlled. METHODS: Ninety patients with the diagnosis of HG below the 20th week gestation, who had no additional disease and 50 pregnant women with no complaints were enrolled in the study. According to the severity of symptoms, the patients were divided into three groups as group I, II and III (mild, moderate and severe, respectively). The Rhode's scoring system was used to determine the severity of HG symptoms. HpIgG and IgM levels were determined in the blood samples and Hp DNA positivity with PCR was investigated in the saliva. RESULTS: In accordance with the Rhode's scoring system, 15.5 % of the pregnant women had mild, 58.9 % had moderate, and 25.6 % had severe symptoms (group I, II and III, respectively). HpIgG was determined as positive in 78.6, 84.9 and 82.6 % in groups I, II and III, respectively. HpIgM positivity was determined as 26.1 % only in group III (p = 0.847). HpDNA was determined as 7.2, 3.8, and 91.3 % in group I, II, and III, respectively (p<0.01). While HpIgG was positive in 60 %, HpDNA was found to be positive in 2 % and HpIgM was found to be negative in all the pregnant women in the control group. CONCLUSION: A positive relationship between the symptoms of HG and Hp positivity was determined using PCR.

Serologic and stool antigen assay of Helicobacter pylori infection in hyperemesis gravidarum: which test is useful during early pregnancy?

OBJECTIVE: To investigate the relationship between Helicobacter pylori infection and hyperemesis gravidarum (HG) during early pregnancy by using serologic and stool antigen tests in developing South Anatolia region of Turkey. MATERIALS AND METHODS: A prospective cross-sectional study was performed on 40 pregnant women with HG and 40 asymptomatic controls without gastric problems at 7-12 weeks of gestation. The sociodemographic characteristics were recorded. The presence of H pylori was analyzed in the sera of the study-group patients by serology-specific IgG test in serum and by a stool antigen test in fecal samples. RESULTS: The rates of serology-specific H pylori IgG positivity were 80% (32 of 40) in patients with HG and 35% (14 of 40) in control group. The difference between the two groups was significant [odds ratio: 6.9 (confidence interval: 2.2-22.1); p<0.01]. The rates of H pylori stool antigen test positivity were 87.5% (35 of 40) in patients with HG and 62.5% (25 of 40) in control groups. The difference between the two groups was significant (odds ratio: 4.5, confidence interval: 1.09-18.5); p=0.028. CONCLUSION: Both serology-specific IgG and stool antigen tests seem to be good screening methods to identify H pylori in our pregnant patient population with HG during early pregnancy.

Role of Helicobacter pylori in the pathogenesis of hyperemesis gravidarum.

PURPOSE: To evaluate the role of Helicobacter pylori (H. pylori) in the pathogenesis of hyperemesis gravidarum (HG) and the value of adding a non teratogenic regimen for its treatment in intractable cases. METHODS: Eighty hyperemesis gravidarum cases were recruited from Ain Shams University out patient clinics. A complete history was taken including history of medical disorders and chronic medications intake as non steroidal anti-inflammatory drugs. After general and local examination, ultrasound was done for all cases to exclude obstetric causes of hyperemesis. Eighty normal pregnant women acted as control. Serum test for H. pylori IgG antibody titre was done for all patients and controls. RESULTS: Seventy-one cases among the 80 HG cases and twenty-four out of the 80 controls were H. pylori positive. Eight HG cases developed severe intractable vomiting. Three of them developed attacks of hematemesis. Gastroscopy done for the eight cases revealed antral gastritis and duodenitis. Gastric and duodenal erosions were found in two cases. The eight patients received a non teratogenic regimen for treatment. Attacks of vomiting decreased and pregnancy continued till delivery of healthy newborns. CONCLUSION: Screening for H. pylori should be added to the investigations of hyperemesis gravidarum cases. Non teratogenic treatment can be considered in intractable cases.

Helicobacter pylori infection and hyperemesis gravidarum: a systematic review and meta-analysis of case-control studies.

OBJECTIVE: To summarize the evidence from epidemiological studies examining the association between Helicobacter pylori infection and hyperemesis gravidarum. DESIGN: Systematic review and meta-analysis of case-control studies. MATERIAL AND METHODS: We searched the Medline/PubMed, Embase, Cinahl, ISI Web of Science and Biological Abstracts databases from 1966 to 17 June 2008 and finally Google Scholar. A total of 25 case-control studies were identified. Both fixed-effect and random-effect models were used to synthesize the results of individual studies. The Cochran Q, tau(2) of between-study variance and index of heterogeneity (I(2)) were used to evaluate heterogeneity. Heterogeneity between studies was examined by subgroup and random effect meta-regression analyses. Publication bias was evaluated. RESULTS: Publication bias was not observed. The random model pooled estimate was odds ratio = 3.32, 95 % confidence interval (CI): 2.25-4.90. A high heterogeneity was pinpointed (I(2) = 80 %, 95 % CI: 65-89). Subgroup analysis and meta-regression showed a weaker association in studies with a clear definition of hyperemesis gravidarum compared to studies without this condition, and weaker association in recent studies compared to earlier studies. Meta-regression showed that these two study characteristics explained 40% of heterogeneity between studies. CONCLUSIONS: Exposure to H. pylori appears to be associated with an increased risk of hyperemesis gravidarum. The residual heterogeneity might have different reasons. Given the high prevalence of H. pylori, the public health consequence of H. pylori with regard to hyperemesis gravidarum may be important.

Helicobacter pylori infection and Hyperemesis gravidarum. An institution-based case-control study.

BACKGROUND: The etiology of Hyperemesis gravidarum (HG) is unclear. To test the hypothesis of an association between Helicobacter pylori infection and HG, an institution-based case-control study was performed at Aker University Hospital (AUH) during 1994-1999. MATERIAL AND METHOD: From the same source population, 244 incident cases of HG and 244 pregnant women free of the disease (controls) were consecutively identified. RESULTS: H. pylori were noted in 105 cases and 58 control subjects. The presence of H. pylori increased the risk of HG more than two fold (OR = 2.42, 95% CI: 1.64-3.57, P < 0.001). This association was much stronger in Africans as compared to non-Africans (OR = 5.26, 95% CI: 1.04-26.57 vs. OR = 1.67, 95% CI: 1.07-2.61) after controlling for the confounding effect of maternal age. A gradient effect of exposure to H. pylori, determined by presence of specific IgG antibody in serum, and increased frequency of HG was present in Africans (test for linear trend P = 0.05) and non-Africans (test for linear trend P = 0.004). CONCLUSION: These results indicate that H. pylori increase the risk of HG with a dose-response pattern and stronger in Africans.

Relationship between Helicobacter pylori seropositivity and hyperemesis gravidarum with the use of questionnaire.

AIM: The aim of the present study was to investigate the relationship between Helicobacter pylori (HP) infection and Hyperemesis gravidarum (HG) by using a questionnaire. METHODS: Twenty-five pregnant women with HG and 85 asymptomatic pregnant women (aged 14-40) of matching gestational age were enrolled between October 2004 and January 2006. Anti-HP immunoglobin G (IgG) serum antibody was tested to establish seropositivity. In our study we used a multi variable questionnaire (name, age, gravida, number of vomits daily etc.). The results were analyzed using chi squared and Mann-Whitney U- test. RESULTS: The prevalence of HP infection was 56% (14 of 25) among patients with Hyperemesis gravidarum and 48.2% (41 of 85) among control subjects (P>0.05, chi squared test). In the same study the HP seropositivity is not related to age of the woman (50%, 55 of 110 were HP positive, P>0.05 chi squared test) but there was a significantly association between number of deliveries and HP seropositivity (primigravida [+] 34.2% versus 65.8%, multigravida [+] 6.1% versus 38.9%, P<0.05 chi squared test). The history for gastrointestinal problems of the tested women and their husbands is not related to HP seropositivity(38.1% positive for HP and with gastrointestinal disorders she/he or both versus 61.8% positive and without problems both, P>0.05, Mann-Whitney U- test). Finally there was no relativity between the number of vomits daily and the HP seropositivity (48.2% with HP [+] and 0-3 vomits daily versus 56% with HP [+] and 4-8 vomits daily, P>0.05 chi squared). CONCLUSIONS: Our findings do not support any direct correlation between HP seropositivity and Hyperemesis gravidarum, number of vomits daily, age of woman, history for gastrointestinal problems but only with the number of deliveries.

Helicobacter pylori seropositivity and stool antigen in patients with hyperemesis gravidarum.

The objective of this paper is to investigate whether Helicobacter pylori is an etiologic factor in hyperemesis gravidarum. Thirty one patients with hyperemesis gravidarum and twenty nine pregnant controls without hyperemesis gravidarum were included in this prospective study. All pregnant women were examined both for Helicobacter pylori serum immunoglobulin G antibodies (HpIgG Ab), showing chronic infection, and Helicobacter pylori stool antigens (HpSA), showing active gastrointestinal colonization. Chi-square and Student t tests were used accordingly for statistical analysis. Helicobacter pylori seropositivity was 67.7% in the patients with hyperemesis gravidarum and 79.3% in the control group (chi(2) = 1.02, P = .31). HpSA was detected in 22.6% of patients with hyperemesis gravidarum, whereas 6.9% of patients in the control group. The difference was not statistically significant (chi(2) = 2.89, P = .08). In this study, no relation was found between Helicobacter pylori and hyperemesis gravidarum. The low social status of women in both groups could be one of the reasons for the high prevalence of Hp infection.

The prevalence of Helicobacter pylori in the Hispanic population affected by hyperemesis gravidarum.

OBJECTIVE: The purpose of this study was to determine the prevalence of Helicobacter pylori seropositivity in pregnant Hispanics affected by hyperemesis gravidarum. STUDY DESIGN: This was a prospective cross-sectional study conducted over a 22-month period. Serum from pregnant Hispanics affected by hyperemesis gravidarum and unaffected Hispanics matched for age, gravidity, parity, and country of origin were tested for H pylori immunoglobulin G (IgG). IgG levels specific for H pylori were determined by enzyme-linked immunosorbent assay (ELISA). Assuming the background prevalence of H pylori serum positivity in the Hispanic population is approximately 60%, 38 patients in each group were needed to detect a 30% difference in affected patients versus controls with a power of 80% and P = .05. Statistical analysis was performed using Yate's chi-square, Student t test, Mann-Whitney U, and binary logistic regression. RESULTS: A total of 82 patients between the ages of 18 to 39 years were enrolled. Of 40 patients diagnosed with hyperemesis gravidarum, 26 (65%) were seropositive for H pylori compared with 28 of 42 (67%) unaffected controls (P = 1.0). There were no statistical differences in maternal age or countries of origin between the 2 groups. CONCLUSION: The overall prevalence of H pylori seropositivity in this patient population is 66%. In pregnant Hispanics affected by hyperemesis gravidarum, H pylori seropositivity is not increased compared with unaffected controls.

Helicobacter pylori infection and platelet counts during pregnancy.

OBJECTIVE: To investigate whether there is any correlation between Helicobacter pylori infection and platelet counts during pregnancy. METHODS: One hundred and twenty pregnant women without any complications were evaluated. Platelet counts were determined during pregnancy and postpartum. H. pylori infection was assessed by the detection of serum antibodies at the 3rd day postpartum. Statistically significant differences of platelet count between H. pylori-positive and -negative patients were determined. RESULTS: H. pylori infection was found in 29 of 120 (24.2%). Platelet counts in the 3rd trimester were 22.7+/-4.7 x 10(3)/microl in H. pylori-positive group and 22.8+/-5.6 x 10(3)/microl in negative group (p=0.98). Platelet count in the 3rd trimester in positive and negative patients were 93+/-17% and 94+/-20%, respectively, of that of the 1st trimester (p=0.92). The incidence of hyperemesis gravidarum in both groups was not significant (p=0.28). CONCLUSION: A correlation between H. pylori infection and thrombocytopenia during pregnancy was not found in this study.

Efficient and non-invasive method for investigating Helicobacter pylori in gravida with hyperemesis gravidarum: Helicobacter pylori stool antigen test.

AIM: To investigate the relationship between Helicobacter pylori infection and severe hyperemesis gravidarum (H. Gravidarum) by using Helicobacter pylori Stool Antigen (HpSA) and other serologic test results. METHODS: Twenty-seven pregnant women with H. Gravidarum and 97 asymptomatic pregnant women of matching gestational age without gastric problems were enrolled in a prospective study. Serum samples collected from cases were investigated in terms of specific antibodies for H. pylori (immunoglobulin-IgG, IgA) and feces samples were investigated for HpSA. Statistical analysis of the data obtained from the groups was made by appropriate chi2 tests. RESULTS: Rate of HpSA positivity in patients with H. Gravidarum was 40.7%, while the same rate was 12.4% in the control group. The difference between the two groups was significant (P = 0.001). Rates of positivity for specific IgG formed against H. pylori in gravida with H. Gravidarum and in the asymptomatic gravida were 85.2% and 73.2%, respectively, and the rates for IgA were 48.1% and 41.2%, respectively. There was no difference between groups in terms of specific Igs formed against H. pylori (P > 0.05). CONCLUSION: The HpSA scan showed a statistically significant relation between H. pylori infection and H. Gravidarum. HpSA test gives more efficient, reliable and realistic results than specific Igs formed against H. pylori in the identification of H. pylori positivity in gravida with H. Gravidarum.

Positive serology for Helicobacter pylori and vomiting in the pregnancy.

INTRODUCTION: Recently, several investigators have suggested that H. pylori may be a contributory factor in hyperemesis gravidarum. The purpose of this study was to evaluate whether seropositivity for IgG antibodies to H. pylori may also be related to nausea, vomiting, heartburn and epigastric pain in pregnancy. MATERIALS AND METHODS: One hundred and eighty-five women, at term pregnancy, were included in the study. All women completed a questionnaire regarding information on the number of pregnancies and deliveries, weight gain, smoking and gastrointestinal complaints before and during pregnancy. The presence of H. pylori infection was determined by serology. RESULTS: The overall prevalence rate of H. pylori seropositivity was 45.9%. Women positive for H. pylori IgG were older (28.7+/-4.5 vs. 27.0+/-4.5, p=0.02), had more prior pregnancies (3.2+/-2.1 vs. 2.6+/-1.6, p=0.02) and deliveries (2.6+/-1.6 vs. 2.0+/-1.1, p=0.006) and reported vomiting in the first trimester more frequently than H. pylori negative patients (81.2% vs. 65%, p=0.004). On the other hand vomiting in the second trimester was reported more frequently among smokers during pregnancy compared to non-smokers. CONCLUSIONS: H. pylori seropositivity is significantly associated with emesis gravidarum but not with gastro-intestinal symptoms later in pregnancy. First trimester vomiting more than doubles the likelihood that the gravida is H. pylori IgG positive.

Helicobacter pylori seropositivity and hyperemesis gravidarum.

OBJECTIVE: To investigate the possible association between Helicobacter pylori seropositivity and hyperemesis gravidarum. STUDY DESIGN: We designed a case-control study to compare the prevalence of H pylori seropositivity in women diagnosed with hyperemesis gravidarum to that in a control population recruited from 2 university-based clinics, 1 inner city and 1 suburban. Results were tested for statistical significance by chi 2, Student t test and unconditional logistic regression analysis. RESULTS: Fifty-three subjects (30 inner city, 23 suburban) and 153 controls (75 inner city, 78 suburban) were enrolled. There was no significant difference in the prevalence of H pylori seropositivity between subjects and controls at either site (50% vs. 47%, P = .8 inner city; 17% vs. 13%, P = .6 suburban) or overall (36% vs. 29%, P = .39). In logistic regression analysis only race (African American) and age remained significantly associated with hyperemesis gravidarum, with adjusted odds ratios of 2.45 (95% CI 1.03-5.83) and .91 (95% CI .85-.98), respectively. CONCLUSION: This study found no association between hyperemesis gravidarum and H pylori seropositivity in 2 populations with disparate H pylori seroprevalence.