JAMA子刊:别担心“晨吐”,这意味着流产风险在降低
2016/10/02
对于晨吐的原因,目前尚无定论。一项研究表明,孕期晨吐还可能与流产风险降低有关。

研究表明,孕早期出现恶心和呕吐可能对胎儿有保护作用,孕期晨吐还可能与流产风险降低有关。该研究由美国国家儿童健康与人类发展研究所的Enrique Schisterman 引领,相关结论发表在《JAMA Internal Medicine》杂志中。

在该项调查中,50%至80%在孕早期出现恶心和呕吐现象,这种现象被称为“晨吐”(morning sickness),孕妇在一天中的任何时间都可能受到影响。该研究共包含了797名孕妇,调查结果发现,恶心和呕吐与流产风险降低50%-75%有关。

在该研究中,受试对象均有过1至2个流产先例,研究人员追踪了她们的恶心症状。以往的研究也曾表明恶心和呕吐与流产风险降低有关。一些专家认为,感觉到恶心可能会导致孕妇饮食减少,从而降低胎儿暴露于毒素中的风险。研究还显示,食物摄入量的减少还会降低循环胰岛素的水平,并促进胎儿的生长。

对于晨吐的原因,目前尚无定论。最主流的理论认为,妊娠期间身体内激素水平发生变化,而呕吐是身体对此做出的应激反应。研究已经证实,怀孕期间胎盘会分泌人体绒毛膜促性腺激素(hCG),而且该激素峰值出现的时间与孕吐密集的时间一致。

呕吐由后脑最后区(postrema)调控。重要的是,这一大脑区域缺少血脑屏障,意味着它能够检测血液和脑脊液中的毒素。研究表明,这一区域含有hCG激素的受体,这或许可以解释为什么怀孕期间对激素水平特别敏感。

遗憾的是,《JAMA Internal Medicine》的这项新研究并未探讨恶心和呕吐降低流产风险的机制。贝斯以色列女执事医疗中心(Beth Israel Deaconess Medical Center)的 Siripanth Nippita和哈佛医学院的Laura Dodge在JAMA上的一篇社论中肯定了该研究的价值,其中包括研究规模以及方法的严谨性,他们写道,“与以往的研究相比,该研究在方法上表现出了一定的优势,我们希望这样的研究能够进一步加深我们对孕妇恶心和呕吐的根本原因的理解。”

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  • Association of Nausea and Vomiting During Pregnancy With Pregnancy Loss A Secondary Analysis of a Randomized Clinical Trial

    Importance Nausea and vomiting during pregnancy have been associated with a reduced risk for pregnancy loss. However, most prior studies enrolled women with clinically recognized pregnancies, thereby missing early losses. Objective To examine the association of nausea and vomiting during pregnancy with pregnancy loss. Design, Setting, and Participants A randomized clinical trial, Effects of Aspirin in Gestation and Reproduction, enrolled women with 1 or 2 prior pregnancy losses at 4 US clinical centers from June 15, 2007, to July 15, 2011. This secondary analysis was limited to women with a pregnancy confirmed by positive results of a human chorionic gonadotropin (hCG) test. Nausea symptoms were ascertained from daily preconception and pregnancy diaries for gestational weeks 2 to 8. From weeks 12 to 36, participants completed monthly questionnaires summarizing symptoms for the preceding 4 weeks. A week-level variable included nausea only, nausea with vomiting, or neither. Main Outcomes and Measures Peri-implantation (hCG-detected pregnancy without ultrasonographic evidence) and clinically recognized pregnancy losses. Results A total of 797 women (mean [SD] age, 28.7 [4.6] years) had an hCG-confirmed pregnancy. Of these, 188 pregnancies (23.6%) ended in loss. At gestational week 2, 73 of 409 women (17.8%) reported nausea without vomiting and 11 of 409 women (2.7%), nausea with vomiting. By week 8, the proportions increased to 254 of 443 women (57.3%) and 118 of 443 women (26.6%), respectively. Hazard ratios (HRs) for nausea (0.50; 95% CI, 0.32-0.80) and nausea with vomiting (0.25; 95% CI, 0.12-0.51) were inversely associated with pregnancy loss. The associations of nausea (HR, 0.59; 95% CI, 0.29-1.20) and nausea with vomiting (HR, 0.51; 95% CI, 0.11-2.25) were similar for peri-implantation losses but were not statistically significant. Nausea (HR, 0.44; 95% CI, 0.26-0.74) and nausea with vomiting (HR, 0.20; 95% CI, 0.09-0.44) were associated with a reduced risk for clinical pregnancy loss. Conclusions and Relevance Among women with 1 or 2 prior pregnancy losses, nausea and vomiting were common very early in pregnancy and were associated with a reduced risk for pregnancy loss. These findings overcome prior analytic and design limitations and represent the most definitive data available to date indicating the protective association of nausea and vomiting in early pregnancy and the risk for pregnancy loss.

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