Hyperemesis gravidarum severity, enteral tube feeding and cardiometabolic markers in offspring cord blood

Kelly Nijsten*, Marjette H. Koot, Joke M.J. Bais, Carrie Ris-Stalpers, Rik Van Eekelen, Henk A. Bremer, David P. Van Der Ham, Wieteke M. Heidema, Anjoke Huisjes, Gunilla Kleiverda, Hinke Kruizenga, Simone M. Kuppens, Judith O.E.H. Van Laar, Josje Langenveld, Flip Van Der Made, Dimitri Papatsonis, Marie José Pelinck, Paula J. Pernet, Leonie Van Rheenen-Flach, Robbert J. RijndersHubertina C.J. Scheepers, Tatjana Vogelvang, Ben W. Mol, Iris J. Grooten, Tessa J. Roseboom, Rebecca C. Painter

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


The present study aimed to investigate the association between hyperemesis gravidarum (HG) severity and the effect of early enteral tube feeding on cardiometabolic markers in offspring cord blood. We included women admitted for HG, who participated in the MOTHER randomized controlled trial (RCT) and observational cohort. The MOTHER RCT showed that early enteral tube feeding in addition to standard care did not affect symptoms or birth outcomes. Among RCT and cohort participants, we assessed how HG severity affected lipid, c-peptide, glucose and free thyroxine cord blood levels. HG severity measures were: severity of vomiting at inclusion and three weeks after inclusion, pregnancy weight gain and 24-hour energy intake at inclusion, readmissions and duration of hospital admissions. Cord blood measures were also compared between RCT participants allocated to enteral tube feeding and those receiving standard care. Between 2013-2016, 215 women were included: 115 RCT and 100 cohort participants. Eighty-one cord blood samples were available. Univariable, not multivariable regression analysis showed that lower maternal weight gain was associated with higher cord blood glucose levels (β:-0.08, 95% CI:-0.16;-0.00). Lower maternal weight gain was associated with higher apolipoprotein-B cord blood levels in multivariable regression analysis (β:-0.01, 95% CI:-0.02;-0.01). No associations were found between other HG severity measures or allocation to enteral tube feeding and cord blood cardiometabolic markers. In conclusion, while lower maternal weight gain was associated with higher apolipoprotein-B cord blood levels, no other HG severity measures were linked with cord blood cardiometabolic markers, nor were these markers affected by enteral tube feeding.

Original languageEnglish
Pages (from-to)2421 - 2431
Number of pages10
JournalBritish Journal of Nutrition
Issue number12
Early online date24 Feb 2022
Publication statusPublished - 28 Dec 2022

Bibliographical note

We thank all participating women of the MOTHER study and all staff who made this study possible, including staff from the Amsterdam UMC laboratory who helped us analysing frozen stored blood samples (Resources contributor role).

The MOTHER study was conducted with support of a research grant from North West Hospital Group, Alkmaar, the Netherlands (grant number 2013T085). The follow-up study analysing maternal and cord blood samples was conducted with support of a research grant from the Amsterdam Reproduction and Development (AR&D) research institute, Amsterdam UMC, the Netherlands (project number 23346).

I. J. G., K. N., M. H. K., R. C. P. and T. J. R.: formulated research questions and designed the study; K. N. and R. C. P. carried out the study; J. M. J. B., C. R-S., H. A. B., D. Pvd. H., W. M. H., A. H., G. K., S. M. K., J. O. E.Hv. L., J. L., Fvd. M., D.P., M-J. P., P. J. P., LvR. F., R. J. R., H. C. J. S., T. V., B. W. M., M. H. K., I. J. G. and R. C. P.: performed recruitment and data collection of the original MOTHER study; H. K.: gave perspective on the interpretation of dietary results; K. N., supervised by R. C. P. and Rv. E.: analysed data; K. N. drafted the manuscript. All authors critically reviewed the manuscript and approved the final draft.

Dr. B.W. Mol was supported by a NHMRC investigator grant. Dr. B.W. Mol also reports consultancy for Guerbet and has received research funding from Guerbet, Ferring and Merck. Drs. K. Nijsten and all other authors report no conflict of interests.

Data Availability Statement

For supplementary materials referred to in this article, please visit https://doi.org/10.1017/S0007114522000587


  • Cardiometabolic risk factors
  • cardiovascular diseases
  • fetal blood
  • fetal nutrition disorders
  • hyperemesis gravidarum
  • nutrition
  • CVD


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