Hyperemesis gravidarum Shaping future research, effects on offspring's health and nutritional intake

This thesis consists of three parts, starting with a general introduction. In Part I we describe the development of an international definition, a core outcome set and a core measurement set. These will help to structure future studies on hyperemesis gravidarum, it will reduce research waste and improve harmonization of research. In Part II we studied the nutritional intake among people with hyperemesis gravidarum, who participated in the Maternal and Offspring outcomes after Treatment of HyperEmesis by Refeeding randomized controlled trial and observational cohort. Our findings suggests that undernutrition is widely present among people with hyperemesis gravidarum. Caloric and nutritional deficiencies persist well beyond the first trimester and could have potential detrimental (long term) effects for the health of pregnant people and their offspring.

 In Part III the effects of hyperemesis gravidarum on both perinatal and long-term outcomes of offspring is described by doing a systematic review and meta-analysis. Meta-analyses showed that hyperemesis gravidarum was associated with an increased risk of preterm birth < 34 weeks, low birth weight, neonatal resuscitation, neonatal intensive care unit admission and placental abruption. Hyperemesis gravidarum was associated with a reduced risk of having a baby with a birthweight >4000g and stillbirth. In the long term a second systematic review and meta-analysis showed that hyperemesis gravidarum gives an increased risk of neurodevelopmental disorders (such as ADHD and autism), mental disorders (such as sleep problems and anxiety disorders) and possibly testicular cancer, but further research is needed to investigate this association.