Dyspepsia in pregnancy is an enigma, and its etiology in early and late pregnancy is not completely understood. Certainly the symptoms can be distressing. In early pregnancy, nausea and vomiting of pregnancy affects about two thirds of all women, although there is considerable variation among countries.20 In our population, more than three quarters of all patients were affected. Nausea and vomiting of pregnancy must be distinguished from hyperemesis gravidarum. Hyperemesis gravidarum occurs in less than 1% of all pregnancies and is characterized by intractable nausea and vomiting so severe as to cause dehydration, weight loss, electrolyte-and metabolic disturbances, and nutritional deficiency, necessitating hospital admission.21
Heartburn, the symptom of gastroesophageal reflux disease, affects 30% to 50% of all pregnant patients, and up to 80% in some populations.22,23 Again, its pathophysiology is not clear. However, a relaxed lower esophageal sphincter, in response to raised estrogen and pro-gesterone levels, seems central to its occurrence.24,25 In the nonpregnant population, H pylori appears to have a role to play in the development of nonulcer dyspepsia.10 In our study population, more than 80% of patients reported dyspeptic symptoms at 30 to 32 weeks' gestation. Again, however, H pylori–infected patients were not more likely to report dyspeptic symptoms at this gestation when compared with controls.
A retrospective power calculation suggests that the study had 90% power to detect as statistically significant (P < .05) a difference in dyspepsia rates at 10 to 14 weeks' gestation of magnitude 77% versus 90% and a difference in dyspepsia rates at 30 to 32 weeks' gestation of magnitude 85% versus 95%.
The only maternal characteristic associated with an increased risk of infection with H pylori was smoking. Infection rates of H pylori are higher amongst lower socioeconomic groups.26 Smoking rates in these groups are also higher, which probably explains the association, rather than smokers being more susceptible to H pylori infection per se. We conclude that H pylori infection is not associated with dyspepsia in pregnancy. Furthermore, its presence is not associated with abnormal pregnancy outcome.
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