title: Neurodevelopmental delay in children exposed in utero to hyperemesis gravidarum.
abstract: OBJECTIVE
  The purpose of this study is to determine the frequency of emotional, behavioral, and learning disorders in children exposed in utero to hyperemesis gravidarum (HG) and to identify prognostic factors for these disorders.
  
  
  METHODS
  Neurodevelopmental outcomes of 312 children from 203 mothers with HG were compared to neurodevelopmental outcomes from 169 children from 89 unaffected mothers. Then the clinical profiles of patients with HG and a normal child outcome were compared to the clinical profiles of patients with HG and a child with neurodevelopmental delay to identify prognostic factors. Binary responses were analyzed using either a Chi-square or Fisher Exact test and continuous responses were analyzed using a t-test.
  
  
  RESULTS
  Children exposed in utero to HG have a 3.28-fold increase in odds of a neurodevelopmental diagnosis including attention disorders, learning delay, sensory disorders, and speech and language delay (P<0.0005). Among characteristics of HG pregnancies, only early onset of symptoms (prior to 5 weeks gestation) was significantly linked to neurodevelopmental delay. We found no evidence for increased risk of 13 emotional, behavioral, and learning disorders, including autism, intellectual impairment, and obsessive-compulsive disorder. However, the study was not sufficiently powered to detect rare conditions. Medications, treatments, and preterm birth were not associated with an increased risk for neurodevelopmental delay.
  
  
  CONCLUSIONS
  Women with HG are at a significantly increased risk of having a child with neurodevelopmental delay. Common antiemetic treatments were not linked to neurodevelopmental delay, but early symptoms may play a role. There is an urgent need to address whether aggressive treatment that includes vitamin and nutrient supplementation in women with early symptoms of severe nausea of pregnancy decreases the risk of neurodevelopmental delay.
authors.affiliation: University of California, Los Angeles, Department of Obstetrics, Gynecology, and Medicine, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Department of Maternal-Fetal Medicine, Los Angeles, CA, USA. Electronic address: mfejzo@mednet.ucla.edu.
authors.forename: Marlena S
authors.initials: MS
authors.lastname: Fejzo
authors.affiliation: University of California, Los Angeles, Department of Statistics, Los Angeles, CA, USA.
authors.forename: Aromalyn
authors.initials: A
authors.lastname: Magtira
authors.affiliation: University of California, Los Angeles, Department of Statistics, Los Angeles, CA, USA.
authors.forename: Frederic Paik
authors.initials: FP
authors.lastname: Schoenberg
authors.affiliation: Hyperemesis Education and Research Foundation, Leesburg, VA, USA.
authors.forename: Kimber
authors.initials: K
authors.lastname: Macgibbon
authors.affiliation: Keck School of Medicine, University of Southern California, Department of Maternal-Fetal Medicine, Los Angeles, CA, USA.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Mullin
mesh_terms: D000328:Adult; D002648:Child; D005260:Female; D005865:Gestational Age; D006801:Humans; D006939:Hyperemesis Gravidarum / Q000150:complications*; D008297:Male; D065886:Neurodevelopmental Disorders / Q000453:epidemiology*; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D012307:Risk Factors
keywords: Attention, learning, sensory, speech; Hyperemesis gravidarum; Nausea; Neurodevelopmental delay; Outcome; Pregnancy