Abstract
Objective
To assess the association between ketonuria and hyperemesis gravidarum (HG) disease
severity.
Study design
We included pregnant women hospitalised for HG who participated in the Maternal and
Offspring outcomes after Treatment of HyperEmesis by Refeeding (MOTHER) trial and
women who were eligible, chose not to be randomised and agreed to participate in the
observational cohort. Between October 2013 and March 2016, in 19 hospitals in the
Netherlands, women hospitalised for HG were approached for study participation. The
presence of ketonuria was not required for study entry. Ketonuria was measured at
hospital admission with a dipstick, which distinguishes 5 categories: negative and
1+ through 4 + . The outcome measures were multiple measures of HG disease severity
at different time points: 1) At hospital admission (study entry): severity of nausea
and vomiting, quality of life and weight change compared to pre-pregnancy weight,
2) One week after hospital admission: severity of nausea and vomiting, quality of
life and weight change compared to admission, 3) Duration of index hospital admission
and readmission for HG at any time point
Results
215 women where included. Ketonuria was not associated with severity of nausea and
vomiting, quality of life or weight loss at hospital admission, nor was the degree
of ketonuria at admission associated with any of the outcomes 1 week after hospital
admission. The degree of ketonuria was also not associated with the number of readmissions.
However, women with a higher degree of ketonuria had a statistically significant longer
duration of hospital stay (per 1+ ketonuria, difference: 0.27 days, 95 % CI: 0.05
to 0.48).
Conclusions
There was no association between the degree of ketonuria at admission and severity
of symptoms, quality of life, maternal weight loss, or number of readmissions, suggesting
that ketonuria provides no information about disease severity or disease course. Despite
this, women with a higher degree of ketonuria at admission were hospitalised for longer.
This could suggest that health care professionals base length of hospital stay on
the degree of ketonuria. Based on the lack of association between ketonuria and disease
severity, we suggest it has no additional value in the clinical management of HG.
Keywords
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Article info
Publication history
Published online: August 25, 2020
Accepted:
August 21,
2020
Received in revised form:
July 30,
2020
Received:
February 8,
2020
Identification
Copyright
© 2020 Published by Elsevier B.V.
