The Association of Helicobacter Pylori in the Pathogenesis of Hyperemesis Gravidarum in Pregnant Women

Abstract

Nausea and vomiting in early pregnancy are very common, affecting approximately 80% of pregnancies, hyperemesis gravidarum is a severe form of nausea and vomiting affecting 0.3% to 1% of pregnancies (Niebyl, 2010). Helicobacter pylori is one of the commonest bacterial infection world wide and accepted as the cause of chronic active gastritis (type B). Most patients continue through life with a chronic superficial gastritis while some develop either duodenal or gastric ulcer. Helicobacter pylori is a gram negative, spiral shaped, micro-aerophilic bacteria. the prevalence rate is higher in developing countries than developed countries. The possible transmission route may be oral –oral, faecal –oral, iatrogenic transmission and vectorial spread (Mansour GM, Nashaat, 2011). Stool samples were tested by using one step H.pylori stool antigen test (CER TEST BIOTEC) to detect H. pylori antigen in stool samples of hyperemesis gravidarum pregnant women and to explore the association between hyperemesis gravidarum in pregnant women and H.pylori infection. The current case - control study was conducted at Ain Shams University Maternity Hospital from March 2015 to December 2015. 128 participants were recruited and assessed for eligibility, 106 women were randomized into 2 groups. Just 90 completed and were included in the final analysis. Group A included 46 pregnant women who suffered from nausea and vomiting with pregnancy and admitted in the hospital ward as case of hyperemesis gravidarum and Group B included 44 Pregnant women attended to the out-patient clinics for routine antenatal care of the same gestational age, same age range and same socioeconomic standard as cases Two groups were subjected to detailed history, physical examination, investigation, abdominal ultrasound and Helicobacter Pylori stool antigen test (non invasive, easy, fast to perform and diagnostic) for detection of H. pylori antigen. The current study found significant difference between two groups regarding positivity of HPSA. Positive stool antigen were found in 39 out of 46 of hyperemesis gravidarum (84.8%) compared with 27 out of 44 controls (58.7%). the rate of H. pylori infection was higher in HG patients than that in non-HG patients and the difference was found to be significant (P <0.05).