Is hyperemesis gravidarum associated with

placental weight and the placental weight-tobirth weight ratio? A population-based

Norwegian cohort study
Presented by: dr. Ronny Adrian
Moderator: Dr. dr. H. Ferry Yusrizal, SpOG (K), M.Kes
Opponent: dr. Muchlas Fahmi
dr. M. Dasawarsa
dr. Aripin Syarifudin

Hyperemesis gravidarum

Adverse Effect

HG and Placenta

Intractable nausea and vomiting

during pregnancy

Adverse exposure in utero

might affect future health,
although birth weight is within
normal range

Placental weight relative to the

childs birth weight
(PW/BWratio)
A more nuanced measurement
of placental efficiency as
apposed birth weight and
placental weight alone

Aim of this study was to explore associations between HG

and placental weight and PW/BW ratio using data obtained
from the Medical Birth Registry of Norway (MBRN)

BACKGROUND

METHODS
Study design
Population-based
cohort study
Data source:
Medical Birth
Registry of Norway
(MBRN)

Study sample

Exclusions Criteria

Singleton births of
primiparous women
Babies born
between
gestational week
23-44
Placental weight
was reported
between 100 and
2500 g
Birth weight of the
child was between
500 and 6000 g
Total 212,653 births

Missing or
undecided gender,
placental weight,
smoking habits
Woman with clinical
condition related to
placenta wich could
affect placental
measurement

 Bivariate analysis between HG and being below or above the

10th percentile and 90th percentile on placental weight and
PW/BW ratio was performed using Pearson Chi Square test.
Outcome variables were subsequently analyzed both as
continuous (grams) and dichotomous outcomes using
multiple linear and logistic regression analysis
Crude and adjusted odds ratios were calculated as an
estimate of relative risk with 95% confidence intervals
p-value of <0.05
SPSS for windows v.20.0 (SPSS Inc., Chicago, IL) was used for
all calculations

Statistical Analysis

RESULTS

RESULTS

RESULTS

RESULTS

RESULTS
The prevalence of HG was 1.2%.

Women with HG and female offspring had

significantly higher risk of a PW/BW-ratio above
the 90th percentile (OR= 1.17, 95% CI: 1.03-1.34).

HG and PW/BW-ratio below the 10th percentile

were inversely associated (OR=0.70, 95% CI:
0.56e0.89).

For male offspring no association was observed

for HG and PW/BW-ratio below the 10th or above
the 90th percentile.

higher circulating levels

of estrogen and hCG
largely produced by the
placenta of female
offspring
high PW/BW-ratio
observed among female
offspring, is more likely
to be due to a
disproportionally heavier
placenta compared to
the childs birth weight.

Unknown cause

HG and
Fetal
gender

HG

Restricted period of
famine during early
gestation

Effort to secure
optimal nutrient
supply to the fetus

Permanent adaptions
of the placental
vascular tissue and an
impaired metabolism

Negative stimulus
during a critical period
of development

Long term adverse

health implications

Limitation

Strength

How and when the placenta is

weighed in different hospitals bias

Size of the data sample

Information on mode of conception

including assisted reproduction not
available

Population based

Underreporting and misclassification

of HG underestimation of the
effects of HG

Valid data source

Conclusions
There was a positive associations between
HG and high PW/BW ratio limited to
female offspring only.
The high PW/BW-ratio suggests that there
may be a possible link between HG and
adult health.