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Obstetrics & Gynecology 2007;110:695-703
© 2007 by The American College of Obstetricians and Gynecologists
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REVIEWS

Hyperemesis Gravidarum and Helicobacter pylori Infection

A Systematic Review

Deborah Golberg, MD, CCFP1, Andrew Szilagyi, MD, FRCPC2 and Lisa Graves, MD, CCFP1

From the Departments of 1Family Medicine and 2Gastroenterology, SMBD Jewish General Hospital, McGill University, Montreal, Canada.

OBJECTIVE: To systematically review studies examining the relationship between hyperemesis gravidarum and Helicobacter pylori (H pylori) infection.

DATA SOURCES: A 1966 to January 2007 search using MEDLINE/PubMed, EMBASE, and Web of Science included MeSH terms: "Helicobacter pylori," "Helicobacter infections," "hyperemesis gravidarum," and the text words "nausea," "vomit," "pregnancy," and "Helicobacter." References of selected papers were examined for additional relevant studies.

METHODS OF STUDY SELECTION: We evaluated studies investigating a relationship between hyperemesis gravidarum and H pylori infection. Studies were included in which the diagnosis of hyperemesis gravidarum was made at or before entry into the study, and H pylori diagnosis was made by serum antibody sample, gastric biopsy, saliva test, or stool sample. The search produced 169 titles; 22 were reviewed in further detail.

TABULATION, INTEGRATION, AND RESULTS: Fourteen case-control studies met established criteria, involving 1,732 participants and controls tested for H pylori infection. Studies were evaluated according to patient demographics and study methodology (case definition, exclusion criteria, H pylori testing). An estimate of the odds ratios with 95% confidence intervals was calculated by using a random effects model for dichotomous variables with review article software. Ten studies showed a significant association between hyperemesis gravidarum and H pylori infection. Odds ratios varied from 0.55 to 109.33; three results were less than 1.0. Tests for heterogeneity applied to several subgroups were considerable with values above 75% for all groups.

CONCLUSION: An association between hyperemesis gravidarum and H pylori infection is suggested by this systematic review. However, the considerable heterogeneity among studies highlights study limitations.




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A. Einarson, C. Maltepe, R. Boskovic, and G. Koren
Treatment of nausea and vomiting in pregnancy: An updated algorithm
Can Fam Physician, December 1, 2007; 53(12): 2109 - 2111.
[Abstract] [Full Text] [PDF]


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