Lack of catch‑up in weight gain may intermediate between pregnancies with hyperemesis gravidarum and reduced fetal growth: the Japan Environment and Children’s Study

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  • Morisaki, Naho
    Department of Social Medicine, National Center for Child Health and Development
  • Nagata, Chie
    Center for Postgraduate Education and Training, National Center for Child Health and Development
  • Morokuma, Seiichi
    Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University
  • Nakahara, Kazushige
    Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University
  • Kato, Kiyoko
    Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University
  • Sanefuji, Masafumi
    Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University Research Center for Environment and Developmental Medical Sciences, Kyushu University
  • Shibata, Eiji
    Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health Japan Environment and Children’s Study, UOEH Subunit Center, University of Occupational and Environmental Health
  • Tsuji, Mayumi
    Japan Environment and Children’s Study, UOEH Subunit Center, University of Occupational and Environmental Health Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health
  • Shimono, Masayuki
    Japan Environment and Children’s Study, UOEH Subunit Center, University of Occupational and Environmental Health Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health
  • Kawamoto, Toshihiro
    Japan Environment and Children’s Study, UOEH Subunit Center, University of Occupational and Environmental Health
  • Ohga, Shouichi
    Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University Research Center for Environment and Developmental Medical Sciences, Kyushu University
  • Kusuhara, Koichi
    Japan Environment and Children’s Study, UOEH Subunit Center, University of Occupational and Environmental Health Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health
  • Japan Environment, Children’s Study Group

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  • Lack of catch-up in weight gain may intermediate between pregnancies with hyperemesis gravidarum and reduced fetal growth: the Japan Environment and Children’s Study

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Background: Women with nausea and vomiting of pregnancy (NVP) have higher birth weight infants, while those with hyperemesis gravidarum, a severe manifestation of NVP, have lower birth weight infants. We aimed to investigate the associations between maternal weight loss (a consequence of hyperemesis gravidarum), NVP, and infant birth weight. / Methods: This study was a secondary analysis of a nationwide birth cohort in Japan. Singleton pregnancies delivered at 28-41 weeks of gestation were included in the analysis. Women were categorized based on their weight change in the 1st trimester (as a proportion to their pre-pregnancy weight: > + 3%, > 0 to + 3%, > -3 to 0%, > -5 to -3%, ≤ -5%) and severity of NVP (no nausea, only nausea, vomiting but able to eat, vomiting and unable to eat). The effects of weight change and severity of NVP on infant birth weight and small for gestational age (SGA) were assessed using regression models. We further examined how these effects could be modified by maternal weight gain up to the 2nd trimester. / Results: Among 91,313 women, 5,196 (5.7%) lost ≥ 5% of their pre-pregnancy weight and 9,983 (10.9%) experienced vomiting and were unable to eat in the 1st trimester. Women with weight loss ≥ 5% in the 1st trimester had infants 66 (95% CI: 53, 78) g lighter and higher odds of SGA (aOR: 1.29; 95% CI: 1.14, 1.47) than women who gained > 3% during the same period. However, when adjusting for weight gain up to the 2nd trimester, women with weight loss ≥ 5% in the 1st trimester had infants 150 (95% CI: 135, 165) g heavier and lower odds of SGA (aOR: 0.39; 95% CI: 0.33, 0.46) than those who gained > 3% during the same period. In contrast, women with more severe NVP tended to have infants with larger birth weight and lower odds of SGA compared to women without NVP. These trends were strengthened when adjusting for weight gain up to the 2nd trimester. Conclusions: Our study suggests the possibility that reduced fetal growth in pregnancies with hyperemesis gravidarum may be caused by the lack of catch-up in gestational weight gain up to the 2nd trimester.

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