Is the severity of vomiting in pregnancy associated with future child neurobehavioural outcomes?

Objectives Much of the literature on psychosocial burden of Hyperemesis Gravidarum (HG) relates to the mother. Yet, little is known about the psychological and behavioural outcomes of children exposed to maternal HG. One study linked in utero exposure of HG with long-term affective disorders in adulthood; however, how the severity of maternal vomiting relates to behaviours in early childhood is not clearly documented. Methods Data were obtained from the Growing Up in Singapore towards Healthy Outcomes (GUSTO) study (n = 1247). Pregnant women of Chinese, Indian, and Malay ethnicity were recruited in their first trimester of pregnancy and 1172 with singleton pregnancies responded to a structured questionnaire at 26-28 weeks of gestation about first and second trimester nausea and vomiting. Medical records were utilized to confirm the severity of the vomiting, including antiemetic medications and admissions. Cases were categorised into 3 severity groups: 1) no vomiting (n = 296), 2) mild-moderate vomiting (n = 686), 3) severe vomiting (n = 190), of which 35% required hospital admission for rehydration. Children underwent at least 15 developmental assessment visits in their first 7 years of life. The outcomes of this study were behaviours from the 12-month Infant-Toddler Social and Emotional Assessment (ITSEA), total score from the 18-month Quantitative Checklist for Autism in Toddlers (Q-CHAT), cognitive score from the 24-month Bayley Scales of Infant and Toddler Development, T-scores from the 24-month Child Behavior Checklist (CBCL), and composite IQ score from the Kaufman Brief Intelligence Test (KBIT). Analyses were adjusted for gestational age, birthweight Z-scores, maternal age, gestational diabetes, pre-eclampsia, smoking, baby gender, breastfeeding, antenatal and postnatal maternal anxiety and depression, and household income. Results Among the women in this Asian study, 22% had severe vomiting and 58.5% mild-moderate vomiting. After controlling for pregnancy, child, and maternal factors, the severity of vomiting (no, mild-moderate, severe) was predictive of socialemotional functioning of the child at 12 months (externalizing symptoms beta=0.117, P = 0.006; dysregulation beta=0.106, P = 0.005), autism symptoms at 18 months (beta=3.737, P = 0.036) and a variety of behavioural problems at 24 months (Total behavioural problem beta=5.552, P = 0.005 affective disorders beta=3.805, P = 0.003, sleep beta=2.423, P = 0.026, attention problem beta=3.511, P = 0.002, and poor emotional control beta=2.383, P = 0.017). Severity of vomiting did not predict cognitive and IQ skills in the Bayley Scales (beta=-2.360, P = 0.297) and KBIT-2 (beta=-2.639, P = 0.300), respectively. Conclusion HG is highly prevalent in this Asian cohort. Compared to no maternal vomiting, severe vomiting during pregnancy was associated with multiple child neurobehavioural problems and autism-related symptoms in early childhood.