Relationship between Nausea , Vomiting and Helicobacter pylori IgG Seropositivity in Pregnants

Helicobacter pylori is a helix-molded gram-negative bacterium. It is a worldwide distribution. In the current study sixty serum samples from a pregnant woman with vomiting and nausea (emesis gravidarum) plus thirty pregnant without vomiting and nausea (control group) done in Kirkuk general hospital were collected to recognize IgG -H. pylori antibody by utilizing Enzyme linked immunosorbent assay. The obtained information includes age, gestational period and residence, during the period of August December /2015.The actual study was achieved which aimed to focused the light on association of H. pylori in the pathogenesis of emesis gravidarum. The results showed that mean age ± Standard deviation for pregnant with vomiting and nausea (32.18 ± 1.8) and for pregnant without vomiting and nausea (8.7 ± 0.79). P.value < 0.05. The outcomes appeared the propagation of Helicobacter pylori IgG antibody positive in pregnant with vomit and nausea in the first-trimester of gestation was 9(42.8%) with Pvalue = 0.001 when matched with standard group while during second trimester, the H. pylori IgG antibody positiverate in emesis gravidarum group was 30(76.9) and in control group was 2(16.6%), P. value = 0.0001. The current result also reviewed a positive significant contrast between H.pylori IgGpositive and the residence, Pvalue=0.04.


Introduction
Helicobacter pyloruswas initially named Campylobacter pyloridis (later changed to the thought to be a types of Helicobacter). (1,2,3).Helicobacter Pylori is gram negative, spiral shaped, motile, microaerophilic, motile and slow growing bacteria (4) .Infection with H. pylori happens around the world; however, the prevalence differs extremely amidst countries and between inhabitance collections inside the similar country (5,6) .The conceivable transmission of of H. pylori may be individual to individual transmission including oral to oral; oral to fecal and saliva routes, waterborne transmission; zoonotic or vectorborne transmission and iatrogenic transmission (7) .The human stomach appears the principal store of infection and person to person contact is thought to be the fundamental course of transsmition (8) .H. pylori infection is explored in gastric disease even through gestation; inparticular such bacterium appears related to vomiting and nausea during pregnancy (9) .Vomiting plus Nausea is a great grievance in 70 to 80 percentage of pregnant.The exemplary onset is inter alia 4 -8 weeks and persist to 16-18 weeks of gestation.Vomiting and nausea in pregnancy named emesis gravidarum (8,10) .The reasons for queasiness and vomiting in pregnant remain obscure, so various conceivable causes have been researched (11) .The infection by H. pylori in all probability was obtained prior to pregnancy, it is extensively though that immunological and hormonal modification occurring during pregnancy could activate latent (inactive).H. pylori effects the fetus in addition to maternal health (12 ,13) .The linkage among H. pylori infection and vomiting at early period of pregnancy raised aggregation of fluid and displacement of extracellular and intracellular volume happen as a consequence of the excess steroid hormones, which alternately induces an alteration in pH; such variation of acidity could prompt to activate of inactiveH.pylori infection.Another clarification for such correlation are declined defensive mechanism versus H. pylori and reduced gastrointestinal motility in pregnancy (14).Aim of the study: was directed to shed a light about determine the possible presence of any association of Helicobacter pylorus in the pathogenesis of emesis gravidarum in pregnants by identify Helicobacter pylori IgG antibody markers and compare them with control group.

Materials and Methods
Blood samples collected from total 90 pregnants (60 pregnant with vomiting plus nausea) and (30 pregnant without nausea and vomiting, as a control group), Five ( 5

Results
The pattern about distribution of examined groups regarding to the age is noticeable in table (1), which demonstrate that among the patient group (pregnants with nausea plus vomiting)  Table (2) show the incidence of H. pylori IgG antibody positive according to duration of gestation (first trimester); 9(42.8%)pregnants with vomiting & nausea have H. pylori IgG positive whereas absent with the control group (pregnant women in the first trimester without nausea and vomiting).Statistically, there was significant difference P.value (0.001) between the studied groups regarding to duration of gestation (first trimester).

Discussion
Helicobacter pylorus is one of the generality well-known infectious illnesses on earth.More spread rate are present in developing nation at lesser distribution in developed countries.
Vomiting and Nausea are the more widely recognized disturbance affect pregnants (15)  .Our data observed there was non-significant (P.value = 0.4) as regards to age difference among the studied collections.Those outcomes in agreement to gether with other consequence that showed the difference was (pvalue:0.45),also the current outcomes in approval with others that founds the women whose have repeated vomit at first trimester& were positive for H.pylori were significantly elder than those negative for H.pylori (22,23).Another study may be agree with the current results which showed that the H. pylori IgG positive in pregnant with emesis gravidarum were 68 % (24).Ehab etal.got that the H.
pylori considered as one of the reseans of emesis gravidarum (25).Mashaallah etal.study was nearly in agreement with current study how showed no significant differences according to ages, also reported that the H. pylori infection is elevated within emesis gravidarum cases and may be considered a risk factor (26).In current study, the occurance of it bacteria was significantly riser in pregnant with nausea and vomiting 39 (65%) out of 60 than control group 2(7%) out of 30.This goes with another study, who point that H. pylori antibody in serum samples positive in 54 from 62 and patient's cases (87%) while in controls were 20 from 62 (32%) (27).Other study done by Ahmed Erdem, Mural Arslan etal.They found the propagation from H. pylori was high in pregnant with emesis gravidarum when compared with control groups (28) (29).Our detecting, indicated distribution of H. pylori infection in urban residents (28.8%) low comparison to rural (71.2%) (P.value = 0.008) was in line with a report elsewhere and it may be contributed to agents affined to back of safe water providing

5
) ml blood samples was collected by vein puncture using disposable syringes from each patients & controls; was placed in plain test tube and left to clot at room temperature then separated by centrifugation; and obtain sera.All sera were immediately frozen at (-20C°) till used.Then screened for presence of Helicobacter pylori antibody (IgG) by classical ELISA technique.Criteria for Vol: 14 No:1, January 2018 DOI : http://dx.doi.org/10.24237/djps.1401.347AP-ISSN: 2222-8373 E-ISSN: 2518-9255 selection were absence or presence of nausea and vomiting, age, residence and the intervalof gestation.The IgG -Helicobacter pylori antibody kit is based on the enzyme immunoassay (EIA).Helicobacter antigen is coated on the surface of micro-titer stripe.Diluted patient sera or standards (ready-to utilize) were added in wells of the micro-titer plats.Binds among IgG antibodies of the serum and the immobilized Helicobacter antigen occur.After one-hour incubation at room temperatures the plate was washed with wash buffer which is diluted, to clear unbound materials.Subsequently the conjugate (ready-to use, anti-human IgG peroxidase) were added and incubated for 30 minutes, unbounded conjugate removed by a subsequent washing, as well the substrate tetra-methylbenzidine (TMB) solution were pipetted and 20 minutes were incubated inducing the development of a blue dye in the wells.The expansion of color is terminated by the additing of a stop solution, which alters the color from blue to yellow.The resulting dye was measured at 450 nm.The intensity of color of solution was directly proportional to the concentration of the IgG antibody that present in the serum (Demeditec Diagnostics, Germany).Interpretation of outcomes: Cut-off = 0.If the result is above 0.5 is indicate the value is Positive.;If the result is less than 0.5 is indicating the value is Negative.Statistical analysis: χ² (Chi-square) test was used.The significant level used was Pvalue< 0.05.

Vol: 14
No:1, January 2018 DOI : http://dx.doi.org/10.24237/djps.1401.347AP-ISSN: 2222-8373 E-ISSN: 2518-9255 Else, proposed the relation among emesis gravidarum and H. pylori infection is a result of raised fluid cumulating and the displacement of both intracellular and extracellular volumes in the coming early stage of gestation according to outcomes of of raised steroid hormone in turn results in an altar of pH inside gastro-intestinal tract.Such variation in acidity prompts to activate latent H. pylori bacteria.Another illustration with regard to combination are reduced defensive mechanisms of pregnant versus H. pylori; this related to alteration in cell-mediated immunity adding to hormones (16) .The maternal age means in pregnant with emesis gravidarum is (32-18 ± 0.5) but in controls is (8.71 ± 0.2); There is statistically significant variance among two groups regards to ages (P.value =0.1).Furthermore, no difference (P.value > 0.05) in the term of age and H. pylori-IgG.This results in agreement to previous study performed in Dubai which showed no significance among age and the H. pylori-IgG positive (P.value = 0.45).Also the current search showed the incidence of H. pylori -IgG between patient and control groups are highly significant (P.value =0.01) and this results agreed with another study which reviewedthat there was very significant in distribution in controls and patient (P.value < 0.01) (17) .

Table 1 :
Allocation of H. pylori IgG in examined groups according to age

Table 2 :
The incidence of H. pylori IgG antibody positive according to duration of gestation (first

Table ( 3
) observed the occurance of H. pylori IgG positive according to duration of gestation

Table 3 :
Distribution of H. pylori IgG in patient groups according to appearanceof

Table ( 4
) reviewed the incidence of patients and controls according to residence.Among the urban residence 14(34.1%)have the H. pylori IgG positive.otherwise, among the rural residence 27(55.1)have H. pylori IgG positive.

Table 4 :
Incidence of patients and controls according to residence

Table ( 5
) reveals the prevalence of H.pylori IgG antibody titer between Pregnant with nausea & vomiting and Pregnant without nausea &vomiting.

Table 5 :
Distribution of H. pylori IgG antibody titer between pregnant with nausea and vomiting and pregnant without nausea and vomiting.