title: Antihistamines and other prognostic factors for adverse outcome in hyperemesis gravidarum.
abstract: OBJECTIVE
  The purpose of this study is to determine the frequency of adverse perinatal outcome in women with hyperemesis gravidarum and identify prognostic factors.
  
  
  METHODS
  This is a case-control study in which outcomes of first pregnancies were compared between 254 women with hyperemesis gravidarum treated with intravenous fluids and 308 controls. Prognostic factors were identified by comparing the clinical profile of patients with hyperemesis gravidarum with a normal and an adverse pregnancy outcome. Binary responses were analyzed using either a Chi-square or Fisher exact test and continuous responses were analyzed using a t-test.
  
  
  RESULTS
  Women with hyperemesis gravidarum have over a 4-fold increased risk of poor outcome including preterm birth and lower birth weight (p<0.0001). Among maternal characteristics, only gestational hypertension had an influence on outcome (p<0.0001). Treatment as an outpatient and/or by alternative medicine (acupuncture/acupressure/Bowen massage) was associated with a positive outcome (p<0.0089). Poor outcomes were associated with early start of symptoms (p<0.019), and treatment with methylprednisolone (p<0.0217), promethazine (p<0.0386), and other antihistamines [diphenhydramine (Benadryl), dimenhydrinate (Gravol), doxylamine (Unisom), hydroxyzine (Vistaril/Atarax), doxylamine and pyridoxine (Diclectin/Bendectin)] (p<0.0151) independent of effectiveness. Among these medications, only the other antihistamines were prescribed independent of severity: they were effective in less than 20% of cases and were taken by almost 50% of patients with an adverse outcome.
  
  
  CONCLUSIONS
  Poor outcomes are significantly greater in women with HG and are associated with gestational hypertension, early symptoms, and antihistamine use. Given these results, there is an urgent need to address the safety and effectiveness of medications containing antihistamines in women with severe nausea of pregnancy.
authors.affiliation: University of California, Los Angeles, Department of Obstetrics and Gynecology, Los Angeles, CA, USA. Electronic address: mfejzo@mednet.ucla.edu.
authors.forename: Marlena S
authors.initials: MS
authors.lastname: Fejzo
authors.forename: Aromalyn
authors.initials: A
authors.lastname: Magtira
authors.forename: Frederic Paik
authors.initials: FP
authors.lastname: Schoenberg
authors.forename: Kimber
authors.initials: K
authors.lastname: MacGibbon
authors.forename: Patrick
authors.initials: P
authors.lastname: Mullin
authors.forename: Roberto
authors.initials: R
authors.lastname: Romero
authors.forename: Khalil
authors.initials: K
authors.lastname: Tabsh
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006633:Histamine Antagonists / Q000009:adverse effects*; D006801:Humans; D006939:Hyperemesis Gravidarum / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D006633:Histamine Antagonists
keywords: Antihistamines; Fetal outcome; Hyperemesis gravidarum; Nausea; Pregnancy