Hyperemesis Gravidarum and Osteoporosis
Condition: Hyperemesis Gravidarum
MeSH terms: Osteoporosis; Hyperemesis Gravidarum
Study type: Observational

Summary: 
      Hyperemesis Gravidarum (HG) is a common disorder for hospitalization in the first trimester
      of pregnancy and related to protracted vomiting and nausea. It can be accompanied by
      ketonuria, dehydration and weight loss. Our aim was to investigate osteoporosis in patients
      with HG. In our study, we investigated osteoporosis in a total of 79 patients (40 HG and 39
      control) by means of dual energy x-ray absorptiometry (DEXA) measurements and laboratory
      parameters related to HG.
    

Detailed description: 
      In our study, investigators prospectively enrolled gestational-age matched 40 women with
      history of HG and 39 women with history of healthy pregnancy in postpartum period, in Kayseri
      Education and Research Hospital, a tertiary teaching hospital in Kayseri, Turkey between
      january and december 2015. Ethics approval for the study was obtained from Erciyes School of
      Medicine and written informed consent was acquired from all subjects.

      A total of 40 primigravid singleton pregnant patients aged over 18 years diagnosed with
      hyperemesis gravidarum and treated with intravenous fluids in first trimester were included
      in our study as HG group. HG was defined and diagnosed according to the criteria such that
      the pregnant was admitted one or more times for antepartum hospitalization because of
      protracted vomiting and nausea accompanied by weight loss, disturbance of electrolyte
      balance, ketonuria, and dehydration. The first hospitalization had occurred before 20
      completed weeks of gestation.

      Patients in following conditions were excluded from our study:

        -  Patients with diagnostic confounders such as overt hyperthyroidism, stomach disease,
           cholelithiasis, or gastroenteritis

        -  Patients with chronic illness (e.g.Crohn's disease, colitis ulcerosa, chronic liver
           disease, diabetes, thyroid disfunction, hyperparathyroidism) and multigenerational
           pregnancies,

        -  Patients with history of thyroid surgery, calcium and/or hormone producing tumours,
           systemic lupus erythematodes,

        -  Patients with eating disorders,

        -  Patients with usage of steroids, antiepileptic drugs and/or low molecular weight heparin
           (long term medication known to affect bone metabolism) and also patients with history of
           steroid usage for fetal lung maturation.

        -  Patients with history of osteoporosis, bone fracture in young ages in family. The
           control group consisted of healthy pregnant women. All patients gave birth between 37-40
           gestational weeks. History of supplement containing vitamin usage during pregnancy were
           noted and also the data regarding demographic variables including age, parity, gravida,
           abortions, vitamin usage in pregnancy and body mass index (BMI) were asked and recorded.

      All patients were performed on a standard dual energy x-ray absorptiometry (DEXA, Hologic
      Discovery Wi S/N 80848) during early postpartum period ( frequently in two days after birth
      before discharge of patients) by a single technician. Results for bone area, bone mineral
      density (BMD), bone mineral content (BMC), T and Z scores for lumbar spine (anteroposterior
      projection at L1-L4) and right hip were recorded. The radiation dose for all of the scans for
      lumbar spine and right hip were 4.3 µSv, 4.9 µSv, respectively. According to the World Health
      Organization (WHO) classification system , T-score ≤-2.5 is classified as osteoporosis and
      T-score between -2.5 and -1 is classified as osteopenia. In deed, a bone mass reduction more
      than 2.5 standard deviations compared to young adults of the same gender in DEXA scan (T
      score) is said to be osteoporosis in WHO criteria . Z score is the number of standard
      deviations above or below the mean for the patient's age, sex, and ethnicity while T score is
      the number of standard deviations above or below the mean for healthy 30 year old adult of
      the same sex, and ethnicity .

      Biochemical analysis Blood samples (10 mL) were drawn at the time of DEXA scans in postpartum
      period and collected into ethylenediaminetetraacetate (EDTA) containing sterile tubes and
      serum separator tubes (SSTs). Samples were centrifugated at 3000 rpm for 10 minutes at room
      temperature. Serum and plasma of samples were than separated and stored at -80 ºC until the
      assay. Serum phosphorus (P) and calcium (Ca) were measured by Ion selective electrode (ISE)
      and alkaline phosphatase (ALP) activity was measured by kinetic enzymatic method, with
      reagents of Beckman Coulter, on an auto-analyser (Olympus AU5400, Beckman Coulter, Inc.,
      U.S.A.). Serum intact parathormone (iPTH) was analyzed by two-site immunoenzymatic method and
      25-hydroxy D levels were analyzed by competitive immunoenzymatic method on UniCel DxI 800
      Immunoassay System (Beckman Coulter, Inc., U.S.A.).

      Statistical analysis:

      The statistical analyses were performed using SPSS for Windows 13.0. Descriptive statistics
      of all variables were calculated. Some data have been reported as the mean±standard deviation
      and percentage where necessary. The t-test was performed to compare means between two groups
      for normally distributed data, and the Mann-Whitney U-test was used for the non-normally
      distributed data. The χ2-test was used to compare proportions among groups for categorical
      data. Values of P<0.05 was accepted as statistically significant.
    

Intervention name(s): DEXA
Intervention type(s): Diagnostic Test
Intervention description(s): Blood samples (10 mL) were drawn at the time of DEXA scans in postpartum period
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        primigravid singleton pregnant patients
      
Biospecimen description: 
      Serum and plasma of samples were than seperated and stored at -80 ºC until the assay. Serum
      phosphorus (P) and calcium (Ca) were measured by Ion selective electrode (ISE) and alkaline
      phosphatase (ALP) activity was measured by kinetic enzymatic method, with reagents of Beckman
      Coulter, on an auto-analyser (Olympus AU5400, Beckman Coulter, Inc., U.S.A.). Serum intact
      parathormone (iPTH) was analyzed by two-site immunoenzymatic method and 25-hidroxy D levels
      were analyzed by competetive immunoenzymatic method on UniCel DxI 800 Immunoassay System
      (Beckman Coulter, Inc., U.S.A.).