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Helicobacter pylori infection and Hyperemesis gravidarum. An institution-based case–control study

  • Infectious Diseases
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Abstract

Background The etiology of Hyperemesis gravidarum (HG) is unclear. To test the hypothesis of an association between Helicobacter pylori infection and HG, an institution-based case–control study was performed at Aker University Hospital (AUH) during 1994–1999. Material and method From the same source population, 244 incident cases of HG and 244 pregnant women free of the disease (controls) were consecutively identified. Results H. pylori were noted in 105 cases and 58 control subjects. The presence of H. pylori increased the risk of HG more than two fold (OR = 2.42, 95% CI: 1.64–3.57, P < 0.001). This association was much stronger in Africans as compared to non-Africans (OR = 5.26, 95% CI: 1.04–26.57 vs. OR = 1.67, 95% CI: 1.07–2.61) after controlling for the confounding effect of maternal age. A gradient effect of exposure to H. pylori, determined by presence of specific IgG antibody in serum, and increased frequency of HG was present in Africans (test for linear trend P = 0.05) and non-Africans (test for linear trend P = 0.004). Conclusion These results indicate that H. pylori increase the risk of HG with a dose–response pattern and stronger in Africans.

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Abbreviations

H. pylori :

Helicobacter pylori

HG:

Hyperemesis gravidarum

HpIgG Ab:

Helicobacter pylori-specific IgG antibodies

STROBE:

Strengthening the reporting of observational studies in epidemiology

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Authors and Affiliations

  1. Centre of Clinical Research, Unit of Epidemiology and Biostatistics, Ullevål University Hospital, 0407, Oslo, Norway

    Irene Sandven & Michael Abdelnoor

  2. Department of Microbiology, Ullevål University Hospital, Oslo, Norway

    Marianne Wethe & Kjetil K. Melby

  3. Woman and Child Division, Department of Obstetrics, Ullevål University Hospital, Oslo, Norway

    Britt-Ingjerd Nesheim, Åse Vikanes & Halvard Gjønnes

Authors
  1. Irene Sandven
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  2. Michael Abdelnoor
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  3. Marianne Wethe
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  4. Britt-Ingjerd Nesheim
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  5. Åse Vikanes
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Correspondence to Irene Sandven.

Appendix

Appendix

Calculation of the crude effect of Heliobacter pylori on Hyperemesis gravidarum, adjusted for misclassification of exposure to H. pylori.

Observed data: OR = 2.42 [1.64–3.57]

Hyperemesis gravidarum

H. pylori

Yes

No

Yes

105

58

No

139

186

$$ {\text{SeE}} = { }0.91{\text{ SpE}} = { }0.92\, q = {\text{SeE }} + {\text{ SpE}} - 1{ } = { }0.91 + { }0.92{ } - { }1{ } = { }0.83 $$
$$ A = \frac{{\left[ {aSpE - c\left( {1 - SpE} \right)} \right]}}{q} = \frac{{\left[ {\left( {105 * 0.92} \right) - 139\left( {1 - 0.92} \right)} \right]}}{{0.83}} = \frac{{96.6 - 11.12}}{{0.83}} = \underline {102.99} $$
$$ B = \frac{{\left[ {bSpE - d\left( {1 - SpE} \right)} \right]}}{q} = \frac{{\left[ {\left( {58 * 0.92} \right) - 186\left( {1 - 0.92} \right)} \right]}}{{0.83}} = \frac{{53.36 - 14.88}}{{0.83}} = \underline {46.36} $$
$$ C = \frac{{\left[ {cSeE - a\left( {1 - SeE} \right)} \right]}}{q} = \frac{{\left[ {\left( {139 * 0.91} \right) - 105\left( {1 - 0.91} \right)} \right]}}{{0.83}} = \frac{{126.49 - 9.45}}{{0.83}} = \underline {141.01} $$
$$ D = \frac{{\left[ {dSeE - b\left( {1 - SeE} \right)} \right]}}{q} = \frac{{\left[ {\left( {186 * 0.91} \right) - 58\left( {1 - 0.91} \right)} \right]}}{{0.83}} = \frac{{169.26 - 5.22}}{{0.83}} = \underline {197.64} $$

Hyperemesis gravidarum

H. pylori

Yes

No

Yes

102.99

46.36

No

141.01

197.64

Adjusted value of the exposed diseased will be 102.99 instead of the observed value 105, for the exposed non-diseased an adjusted value 46.36 instead of the observed value 58, for the non-exposed diseased an adjusted value 141.01 instead of the observed value 139 and for the non-exposed non-diseased an adjusted value 197.64 instead of the observed value 186. The consequence is that the new crude OR adjusted for misclassification of H. pylori will be 3.11 with a 95% CI [2.07–4.68] instead of the observed 2.42 [1.64–3.57].

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Sandven, I., Abdelnoor, M., Wethe, M. et al. Helicobacter pylori infection and Hyperemesis gravidarum. An institution-based case–control study. Eur J Epidemiol 23, 491–498 (2008). https://doi.org/10.1007/s10654-008-9261-3

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