Long-term health outcomes of children born to mothers with hyperemesis gravidarum: a systematic review and meta-analysis

Am J Obstet Gynecol. 2022 Sep;227(3):414-429.e17. doi: 10.1016/j.ajog.2022.03.052. Epub 2022 Mar 30.


Objective: Hyperemesis gravidarum is characterized by severe nausea and vomiting in pregnancy, frequently resulting in severe maternal nutritional deficiency. Maternal undernutrition is associated with adverse offspring health outcomes. Whether hyperemesis gravidarum permanently affects offspring health remains unclear. This review aimed to evaluate the effects of maternal hyperemesis gravidarum on offspring health.

Data sources: MEDLINE and Embase were searched from inception to September 6, 2021.

Study eligibility criteria: Studies reporting on health at any age beyond the perinatal period of children born to mothers with hyperemesis gravidarum were included.

Methods: Two reviewers independently selected studies and extracted data. The Newcastle-Ottawa Quality Assessment Scale was used to assess risk of bias. We conducted a narrative synthesis and meta-analysis where possible. In meta-analyses with high heterogeneity (I2>75%), we did not provide a pooled odds ratio.

Results: Nineteen studies were included in this systematic review (n=1,814,785 offspring). Meta-analysis (n=619, 2 studies: 1 among adolescents and 1 among adults) showed that hyperemesis gravidarum was associated with anxiety disorder (odds ratio, 1.74; 95% confidence interval, 1.04-2.91; I2, 0%) and sleep problems in offspring (odds ratio, 2.94; 95% confidence interval, 1.25-6.93; I2, 0%). Hyperemesis gravidarum was associated with testicular cancer in male offspring aged up to 40 years on meta-analysis (5 studies, n=20,930 offspring), although heterogeneity was observed on the basis of a wide 95% prediction interval (odds ratio, 1.60; 95% confidence interval, 1.07-2.39; I2, 0%; 95% prediction interval, 0.83-3.08). All 6 studies reporting on attention deficit (hyperactivity) disorder and autism spectrum disorder reported an increase among children of mothers with hyperemesis gravidarum in comparison with children of unaffected mothers. Meta-analysis showed high heterogeneity, precluding us from reporting a pooled odds ratio. Most studies reporting on cognitive and motor problems found an increase among hyperemesis gravidarum-exposed children. One study investigated brain structure and found smaller cortical volumes and areas among children from hyperemesis gravidarum-affected pregnancies than among those from unaffected pregnancies. Studies evaluating anthropometry and cardiometabolic disease risk of hyperemesis gravidarum-exposed children had inconsistent findings.

Conclusion: Our systematic review showed that maternal hyperemesis gravidarum is associated with small increases in adverse health outcomes among children, including neurodevelopmental disorders, mental health disorders, and possibly testicular cancer, although evidence is based on few studies of low quality.

Keywords: autism spectrum disorder; cardiometabolic risk factors; dyssomnias; hyperemesis gravidarum; long-term effects; meta-analysis; neurodevelopmental disorders; systematic review; testicular neoplasms.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Autism Spectrum Disorder* / complications
  • Child
  • Female
  • Humans
  • Hyperemesis Gravidarum* / epidemiology
  • Male
  • Neoplasms, Germ Cell and Embryonal
  • Outcome Assessment, Health Care
  • Pregnancy
  • Testicular Neoplasms* / complications

Supplementary concepts

  • Testicular Germ Cell Tumor