Study of the association of pregnancy unique quantification of emesis score with adverse feto-maternal outcomes in pregnancy: a prospective observational cohort study
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20260174Keywords:
Hyperemesis gravidarum, Pregnancy-unique quantification of emesis, Nausea and vomiting of pregnancyAbstract
Background: Nausea and vomiting of pregnancy (NVP) affect up to 80% of gestations, ranging from mild discomfort to severe hyperemesis gravidarum. While often dismissed as a benign condition, NVP may be linked to significant adverse feto-maternal outcomes. This prospective study evaluated the clinical utility of the pregnancy-unique quantification of emesis (PUQE-24) scoring system as a prognostic tool for predicting complications among 300 pregnant women at a tertiary care hospital in Eastern India.
Methods: This prospective observational study (April 2023–March 2025) categorized 300 first-trimester participants into mild (≤6), moderate (7–12), and severe (13–15) NVP groups using the PUQE-24 scale. Demographic data, clinical markers (ketonuria, liver enzymes), and hospitalization metrics were documented. All participants were followed through delivery to record maternal outcomes (anemia, GDM, and hypertension) and fetal outcomes (birth weight and gestational age).
Results: NVP was classified as mild (46.3%), moderate (35.0%), and severe (18.7%). Severe cases showed significant correlations with maternal age ≤30 years. 100% of severe cases required hospitalization (mean 4.4 days) with an 83.9% readmission rate. Severe NVP also demonstrated significantly higher rates of anemia (78.6%), GDM (58.9%), preterm delivery (83.0%), and low birth weight (94.3%) compared to mild cases.
Conclusions: The PUQE-24 score is a vital prognostic tool. Strong associations between NVP severity and adverse outcomes like preterm birth and fetal growth restriction necessitate early standardized assessment and targeted intervention, especially in resource-limited settings.
Metrics
References
Einarson TR, Piwko C, Koren G. Quantifying the global rates of nausea and vomiting of pregnancy: A meta analysis. J Popul Ther Clin Pharmacol. 2013;20(2):e171-83.
Liu C, Zhao G, Qiao D, Wang L, He Y, Zhao M, et al. Emerging Progress in Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum: Challenges and Opportunities. Front Med (Lausanne). 2022;8:809270. DOI: https://doi.org/10.3389/fmed.2021.809270
Heitmann K, Nordeng H, Havnen GC, Solheimsnes A, Holst L. The burden of nausea and vomiting during pregnancy: severe impacts on quality of life, daily life functioning and willingness to become pregnant again - results from a cross-sectional study. BMC Pregnancy Childbirth. 2017;17(1):75. DOI: https://doi.org/10.1186/s12884-017-1249-0
London V, Grube S, Sherer DM, Abulafia O. Hyperemesis gravidarum: a review of recent literature. Pharmacology. 2017;100(3-4):161-71. DOI: https://doi.org/10.1159/000477853
Nelson-Piercy C, Dean C, Shehmar M, Gadsby R, O'Hara M, Hodson K, et al. The Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum (Green-top Guideline No. 69). BJOG. 2024;131(7):e1-30. DOI: https://doi.org/10.1111/1471-0528.17739
Sanu O, Lamont RF. Hyperemesis gravidarum: pathogenesis and the use of antiemetic agents. Expert Opin Pharmacother. 2011;12(5):737-48. DOI: https://doi.org/10.1517/14656566.2010.537655
Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 189: Nausea And Vomiting Of Pregnancy. Obstet Gynecol. 2018;131(1):e15-30. DOI: https://doi.org/10.1097/AOG.0000000000002456
Matthews A, Dowswell T, Haas DM, Doyle M, O'Mathúna DP. Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst Rev. 2010;(9):CD007575. DOI: https://doi.org/10.1002/14651858.CD000145.pub2
Clark SM, Costantine MM, Hankins GD. Review of NVP and HG and Early Pharmacotherapeutic Intervention. Obstet Gynecol Int. 2012;2012:252676. DOI: https://doi.org/10.1155/2012/252676
Koren G, Boskovic R, Hard M, Maltepe C, Navioz Y, Einarson A. Motherisk-PUQE (pregnancy-unique quantification of emesis and nausea) scoring system for nausea and vomiting of pregnancy. Am J Obstet Gynecol. 2002;186(5):S228-31. DOI: https://doi.org/10.1067/mob.2002.123054
Koren G, Piwko C, Ahn E, Boskovic R, Maltepe C, Einarson A, et al. Validation studies of the Pregnancy Unique-Quantification of Emesis (PUQE) scores. J Obstet Gynaecol. 2005;25(3):241-4. DOI: https://doi.org/10.1080/01443610500060651
Lacasse A, Rey E, Ferreira E, Morin C, Bérard A. Validity of a modified Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scoring index to assess severity of nausea and vomiting of pregnancy. Am J Obstet Gynecol. 2008;198(1):71.e1-7. DOI: https://doi.org/10.1016/j.ajog.2007.05.051
Ebrahimi N, Maltepe C, Bournissen FG, Koren G. Nausea and vomiting of pregnancy: Using the 24-hour Pregnancy-Unique Quantification of Emesis (PUQE-24) scale. J Obstet Gynaecol Can. 2009;31(9):803-7. DOI: https://doi.org/10.1016/S1701-2163(16)34298-0
Dodds L, Fell DB, Joseph KS, Allen VM, Butler B. Outcomes of pregnancies complicated by hyperemesis gravidarum. Obstet Gynecol. 2006;107(2 Pt 1):285-92. DOI: https://doi.org/10.1097/01.AOG.0000195060.22832.cd
Bolin M, Åkerud H, Cnattingius S, Stephansson O, Wikström AK. Hyperemesis gravidarum and risks of placental dysfunction disorders: a population-based cohort study. BJOG. 2013;120(5):541-7. DOI: https://doi.org/10.1111/1471-0528.12132
Mitchell-Jones N, Gallos I, Farren J, Tobias A, Bottomley C, Bourne T. Psychological morbidity associated with hyperemesis gravidarum: a systematic review and meta-analysis. BJOG. 2017;124(1):20-30. DOI: https://doi.org/10.1111/1471-0528.14180
Veenendaal MV, van Abeelen AF, Painter RC, van der Post JA, Roseboom TJ. Consequences of hyperemesis gravidarum for offspring: a systematic review and meta-analysis. BJOG. 2011;118(11):1302-13. DOI: https://doi.org/10.1111/j.1471-0528.2011.03023.x
Wang H, Rolls ET, Du X, Du J, Yang D, Li J, et al. Severe nausea and vomiting in pregnancy: psychiatric and cognitive problems and brain structure in children. BMC Med. 2020;18(1):228. DOI: https://doi.org/10.1186/s12916-020-01701-y
Agmon N, Sade S, Pariente G, Rotem R, Weintraub AY. Hyperemesis gravidarum and adverse pregnancy outcomes. Arch Gynecol Obstet. 2019;300(2):347-53. DOI: https://doi.org/10.1007/s00404-019-05192-y
Porgador O, Sheiner E, Pariente G, Wainstock T. Pregnancy outcomes by hyperemesis gravidarum severity and time of diagnosis: A retrospective cohort study. Int J Gynaecol Obstet. 2024;167(3):1075-83. DOI: https://doi.org/10.1002/ijgo.15760
Aminu MB, Alkali M, Audu BM, Abdulrazak T, Bathna D. Prevalence of hyperemesis gravidarum and associated risk factors among pregnant women in a tertiary health facility in Northeast, Nigeria. Int J Reprod Contracept Obstet Gynecol 2020;9(9):3557-62. DOI: https://doi.org/10.18203/2320-1770.ijrcog20203827
Louik C, Hernandez-Diaz S, Werler MM, Mitchell AA. Nausea and vomiting in pregnancy: maternal characteristics and risk factors. Paediatr Perinat Epidemiol. 2006;20(4):270-8. DOI: https://doi.org/10.1111/j.1365-3016.2006.00723.x
Lacroix R, Eason E, Melzack R. Nausea and vomiting during pregnancy: a prospective study of its frequency, intensity, and patterns of change. Am J Obstet Gynecol. 2000;182:931-7. DOI: https://doi.org/10.1016/S0002-9378(00)70349-8
Vikanes A, Skjaerven R, Grjibovski AM, Gunnes N, Vangen S, Magnus P. Recurrence of hyperemesis gravidarum across generations: population based cohort study. BMJ. 2010;340:c2050. DOI: https://doi.org/10.1136/bmj.c2050
Simanjuntak TP, Andrian SA, Wibowo R, Kurniawan SA, Elingasari NM. Hyperemesis Gravidarum: A Holistic Review and Approach to Etiopathogenesis, Clinical Diagnostic and Management Therapy. J South Asian Feder Obst Gynae. 2019;11(4):266-72. DOI: https://doi.org/10.5005/jp-journals-10006-1700
Fejzo MS, Poursharif B, Korst LM, Munch S, MacGibbon KW, Romero R, et al. Symptoms and pregnancy outcomes associated with extreme weight loss among women with hyperemesis gravidarum. J Womens Health (Larchmt). 2009;18(12):1981-7. DOI: https://doi.org/10.1089/jwh.2009.1431
Popa SL, Barsan M, Caziuc A, Pop C, Muresan L, Popa LC, et al. Life-threatening complications of hyperemesis gravidarum. Exp Ther Med. 2021;21(6):642. DOI: https://doi.org/10.3892/etm.2021.10074
Birkeland E, Stokke G, Tangvik RJ, Torkildsen EA, Boateng J, Wollen AL, et al. Norwegian PUQE (Pregnancy-Unique Quantification of Emesis and nausea) identifies patients with hyperemesis gravidarum and poor nutritional intake: a prospective cohort validation study. PLoS One. 2015;10(4):e0119962. DOI: https://doi.org/10.1371/journal.pone.0119962
Chiossi G, Neri I, Cavazzuti M, Basso G, Facchinetti F. Hyperemesis gravidarum complicated by Wernicke encephalopathy: background, case report, and review of the literature. Obstet Gynecol Surv. 2006;61(4):255-68. DOI: https://doi.org/10.1097/01.ogx.0000206336.08794.65
Trovik J, Vikanes Å. Hyperemesis Gravidarum is associated with substantial economic burden in addition to severe physical and psychological suffering. Isr J Health Policy Res. 2016;5:43. DOI: https://doi.org/10.1186/s13584-016-0099-y
Gazmararian JA, Petersen R, Jamieson DJ, Schild L, Adams MM, Deshpande AD, et al. Hospitalizations during pregnancy among managed care enrollees. Obstet Gynecol. 2002;100:94-100. DOI: https://doi.org/10.1097/00006250-200207000-00015
Maslin K, Shaw V, Brown A, Dean C, Shawe J. What is known about the nutritional intake of women with Hyperemesis Gravidarum?: A scoping review. Eur J Obstet Gynecol Reprod Biol. 2021;257:76-83. DOI: https://doi.org/10.1016/j.ejogrb.2020.12.003
Hinkle SN, Mumford SL, Grantz KL, Silver RM, Mitchell EM, Sjaarda LA, et al. Association of nausea and vomiting during pregnancy with pregnancy loss: a secondary analysis of a randomized clinical trial. JAMA Intern Med. 2016;176(11):1621-7. DOI: https://doi.org/10.1001/jamainternmed.2016.5641
Fiaschi L, Nelson-Piercy C, Gibson J, Szatkowski L, Tata LJ. Adverse maternal and birth outcomes in women admitted to hospital for hyperemesis gravidarum: a population-based cohort study. Paediatr Perinat Epidemiol. 2018;32(1):40-51. DOI: https://doi.org/10.1111/ppe.12416
Jansen LAW, Nijsten K, Limpens J, van Eekelen R, Koot MH, Grooten IJ, et al. Perinatal outcomes of infants born to mothers with hyperemesis gravidarum: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2023;284:30-51. DOI: https://doi.org/10.1016/j.ejogrb.2023.03.004
Koudijs HM, Savitri AI, Browne JL, Amelia D, Baharuddin M, Grobbee DE, et al. Hyperemesis gravidarum and placental dysfunction disorders. BMC Pregnancy Childbirth. 2016;16(1):374. DOI: https://doi.org/10.1186/s12884-016-1174-7
Koren G, Madjunkova S, Maltepe C. The protective effects of nausea and vomiting of pregnancy against adverse fetal outcome--a systematic review. Reprod Toxicol. 2014;47:77-80. DOI: https://doi.org/10.1016/j.reprotox.2014.05.012
Downloads
Published
How to Cite
Issue
Section
