Association between Helicobacter pylori Infection and Pregnancy-Related Complications
DOI:
https://doi.org/10.24086/cuesj.v10n1y2026.pp63-68Keywords:
H. pylori, anemia, hyperemesis gravidarum, pregnancy-induced hypertension, gestational diabetes, pregnancy-related complicationsAbstract
Helicobacter pylori is one of the most common pathogens in the world, and its presence has been linked to numerous diseases both within and outside the digestive system. The association of H. pylori with pregnancy-related complications has received much attention in recent years. This study aimed to investigate this association in the Erbil–Kurdistan region to take measures to reduce the burden of these complications. This cross-sectional study included 149 pregnant women who were examined by the fecal H. pylori antigen enzyme-linked immunosorbent assay test for H. pylori infection. Data about the age, gestational age, gravidity, pruritus, hyperemesis gravidarum (HG), and blood pressure were recorded for each participant. Blood samples were collected for hemoglobin tests, fasting plasma glucose tests, and oral glucose tolerance tests. H. pylori infection, anemia, and HG were detected in 36.2%, 38.9%, and 8.7% of pregnant women, respectively. The finding showed H. pylori infection is an independent risk factor for anemia and HG (crude odds ratio [COR] = 2.4, 95% confidence interval [CI]: 0.9–6.3; adjusted odds ratios [AOR] = 2.6, 95% CI: 0.9–7.3; P < 0.05) and (COR = 1.4, 95% CI: 0.5–3.2; AOR = 1.5, 95% CI: 0.4–3.5; P < 0.05), respectively. There was no statistically significant association between H. pylori infection and pruritus, pregnancy-induced hypertension, or gestational diabetes mellitus (P > 0.05). H. pylori infection has a role in anemia and HG among pregnant women. Therefore, screening for H. pylori infection and treating positive cases is recommended to reduce the consequences of these complications and improve maternal and fetal health.
Downloads
References
1. A. Abay, H. W. Yalew, A. Tariku and E. Gebeye. Determinants of prenatal anemia in Ethiopia. Archives of Public Health, vol. 75, pp. 1-10, 2017. DOI: https://doi.org/10.1186/s13690-017-0215-7
2. J. B. Sharma and M. Shankar. Anemia in pregnancy. JIMSA, vol. 23, no. 4, pp. 253-260, 2010.
3. T. A. Gudeta and T. M. Regassa. Pregnancy induced hypertension and associated factors among women attending delivery service at Mizan-Tepi University Teaching Hospital, Tepi General Hospital and Gebretsadik Shawo Hospital, Southwest, Ethiopia. Ethiopian Journal of Health Sciences, vol. 29, no. 1, pp. 831-840, 2019. DOI: https://doi.org/10.4314/ejhs.v29i1.4
4. M. Paola Aghajanian, J. Jhingran, C.S. Dennis. Current Diagnosis and Treatment Obstetrics and Gynecology. McGraw-Hill, New York, USA, 2007.
5. F. P. McCarthy, J. E. Lutomski and R. A. Greene. Hyperemesis gravidarum: Current perspectives. International Journal of Women’s Health, vol. 6, pp. 719-725, 2014. DOI: https://doi.org/10.2147/IJWH.S37685
6. L. Li, L. Li, X. Zhou, S. Xiao, H. Gu and G. Zhang. Helicobacter pylori infection is associated with an increased risk of hyperemesis gravidarum: A meta-analysis. Gastroenterology Research and Practice, vol. 2015, p. 278905, 2015.
7. Y. Zhu and C. Zhang. Prevalence of gestational diabetes and risk of progression to type 2 diabetes: A global perspective. Current Diabetes Reports, vol. 16, p. 7, 2016. DOI: https://doi.org/10.1007/s11892-015-0699-x
8. D. Farrar, M. Simmonds, M. Bryant, T. A. Sheldon, D. Tuffnell, S. Golder, F. Dunne and D. A. Lawlor. Hyperglycaemia and risk of adverse perinatal outcomes: Systematic review and metaanalysis. BMJ, vol. 354, p. i4694, 2016. DOI: https://doi.org/10.1136/bmj.i4694
9. Y. Wu, B. Liu, Y. Sun, Y. Du, M. K. Santillan, D. A. Santillan, L. G. Snetselaar and W. Bao. Association of maternal prepregnancy diabetes and gestational diabetes mellitus with congenital anomalies of the newborn. Diabetes Care, vol. 43, no. 12, pp. 2983-2990, 2020. DOI: https://doi.org/10.2337/dc20-0261
10. L. Li, L. Li, X. Zhou, S. Xiao, H. Gu and G. Zhang. Helicobacter pylori infection is associated with an increased risk of hyperemesis gravidarum: A meta-analysis. Gastroenterology Research and Practice, vol. 2015, p. 278905, 2015. DOI: https://doi.org/10.1155/2015/278905
11. M. G. Bruce and H. I. Maaroos. Epidemiology of Helicobacter pylori infection. Helicobacter, vol. 13, pp. 1-6, 2008. DOI: https://doi.org/10.1111/j.1523-5378.2008.00631.x
12. D. A. Almashhadany, Z. F. Zefenkey and A. M. Zaki. Dental risk factors associated with oral Helicobacter pylori infection: A cross-sectional study based on saliva antigen test. Journal of Infection in Developing Countries, vol. 16, no. 3, pp. 516-521, 2022. DOI: https://doi.org/10.3855/jidc.15420
13. M. Azami, P. Nasirkandy, A. Mansouri, Z. Darvishi, S. Rahmati, G. Abangah, H. R. Dehghan, M. Borji and S. Abbasalizadeh. Global prevalence of Helicobacter pylori infection in pregnant women: A systematic review and meta-analysis study. International Journal of Women s Health and Reproduction Sciences, vol. 5, no. 1, pp. 30-36, 2017. DOI: https://doi.org/10.15296/ijwhr.2017.06
14. Z. Zefenkey. Influence of Helicobacter pylori infection on atherosclerosis risk factors in older people. Science Journal of University of Zakho, vol. 10, no. 1, pp. 24-28, 2022. DOI: https://doi.org/10.25271/sjuoz.2022.10.1.884
15. D. S. Tseng, D. Li, S. M. Cholleti, J. C. Wei, Y. Jodesty and H. V. Pham. Effect of Helicobacter pylori treatment on unexplained iron deficiency anemia. The Permanente Journal, vol. 23, pp. 18-195, 2019. DOI: https://doi.org/10.7812/TPP/18-195
16. N. Mubarak, G. I. Gasim, K. E. Khalafalla, N. I. Ali and I. Adam. Helicobacter pylori, anemia, iron deficiency and thrombocytopenia among pregnant women at Khartoum, Sudan. Transactions of the Royal Society of Tropical Medicine and Hygiene, vol. 108, no. 6, pp. 380-384, 2014. DOI: https://doi.org/10.1093/trstmh/tru044
17. S. Aytac, C. Türkay and M. Kanbay. Helicobacter pylori stool antigen assay in hyperemesis gravidarum: A risk factor for hyperemesis gravidarum or not? Digestive Diseases and Sciences, vol. 52, pp. 2840-2843, 2007. DOI: https://doi.org/10.1007/s10620-006-9709-9
18. A. V. Vikanes, N. C. Støer, N. Gunnes, A. M. Grjibovski, S. O. Samuelsen, P. Magnus and K. K. Melby. Helicobacter pylori infection and severe hyperemesis gravidarum among immigrant women in Norway: A case-control study. European Journal of Obstetrics Gynecology and Reproductive Biology, vol. 167, pp. 41-46, 2013. DOI: https://doi.org/10.1016/j.ejogrb.2012.11.007
19. S. H. Ahmed and S. A. K. Mohammed. Helicobacter pylori infection in pregnant women and its correlation with trace elements. Al Mustansiriyah Journal of Pharmaceutical Sciences, vol. 18, no. 2, pp. 41-50, 2018. DOI: https://doi.org/10.32947/ajps.v18i2.474
20. L. S. Shahab and A. I. Hamadamin. Relation of Helicobacter pylori and hyperemesis gravidarum in sample of pregnant women in maternity teaching hospital of Erbil city. Advanced Medical Journal, vol. 8, no. 1, pp. 15-21, 2023. DOI: https://doi.org/10.56056/amj.2023.193
21. J. Wise. Women with nausea and vomiting in pregnancy should be offered more support, say RCOG guidelines. BMJ, vol. 353,p. i3509, 2016. DOI: https://doi.org/10.1136/bmj.i3509
22. S. Pavord, B. Myers, S. Robinson, S. Allard, J. Strong, C. Oppenheimer and On Behalf of the British Committee for Standards in Haematology. UK guidelines on the management of iron deficiency in pregnancy. British Journal of Haematology,
vol. 156, no. 5, pp. 588-600, 2012. DOI: https://doi.org/10.1111/j.1365-2141.2011.09012.x
23. World Health Organization. Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy. WHO, Geneva, Switzerland, 2013.
24. R. T. Means. Iron deficiency and iron deficiency anemia: Implications and impact in pregnancy, fetal development, and early childhood parameters. Nutrients, vol. 12, no. 2, p. 447, 2020. DOI: https://doi.org/10.3390/nu12020447
25. World Health Organization. Prevalence of Anaemia in Pregnant Women. WHO, 2024. Available from: https://www.who.int [Last accessed on 2025 Dec 19].
26. I. Adam, Y. Ibrahim and O. Elhardello. Prevalence, types and determinants of anemia among pregnant women in Sudan: A systematic review and meta-analysis. BMC Hematology, vol. 18, pp. 31, 2018. DOI: https://doi.org/10.1186/s12878-018-0124-1
27. S. H. Nyarko, E. N. K. Boateng, K. S. Dickson, D. Adzrago, I. Y. Addo, E. Acquah and C. Ayebeng. Geospatial disparities and predictors of anaemia among pregnant women in Sub-Saharan Africa. BMC Pregnancy Childbirth, vol. 23, p. 743, 2023. DOI: https://doi.org/10.1186/s12884-023-06008-3
28. C. R. Dean, M. Shemer, G. A. U. Ostrowski and R. C. Painter. Management of severe pregnancy sickness and hyperemesis gravidarum. BMJ, vol. 363, p. k5000, 2018. DOI: https://doi.org/10.1136/bmj.k5000
29. C. Guarneri, M. Ceccarelli, L. Rinaldi, B. Cacopardo, G. Nunnari, F. Guarneri. Helicobacter pylori and skin disorders. European Review for Medical and Pharmacological Sciences, vol. 24, no. 23, pp. 12267-12287, 2020.
30. S. A. Alshareef, D. A. Rayis, I. Adam and G. I. Gasim. Helicobacter pylori infection, gestational diabetes mellitus and insulin resistance among pregnant Sudanese women. BMC Research Notes, vol. 11, p. 517, 2018. DOI: https://doi.org/10.1186/s13104-018-3642-9
31. J. Li, M. Fan, F. Ma, S. Zhang and Q. Li. The effects of Helicobacter pylori infection on pregnancy-related diseases and fetal development in diabetes in pregnancy. Annals of Translational Medicine, vol. 9, no. 8, p. 686, 2021. DOI: https://doi.org/10.21037/atm-21-1209
32. H. D. Salman Al-Shujiri, I. K. Abd Al-Shibly and H. H. Al-Hasnawy. Immunological study of Helicobacter pylori infections on pregnancy with gestational diabetes mellitus. Thi-Qar Medical Journal, vol. 26, no. 2, pp. 10-20, 2023. DOI: https://doi.org/10.4103/MJBL.MJBL_515_23
33. A. Bener, R. Micallef, M. Afifi, M. Derbala, H. M. Al-Mulla and M. A. Usmanil. Association between type 2 diabetes mellitus and Helicobacter pylori infection. Turkish Journal of Gastroenterology, vol. 18, no. 4, pp. 225-229, 2007.
34. C. He, Z. Yang, D. Cheng, C. Xie, Y. Zhu, Z. Ge, Z. Luo and N. Lu. Helicobacter pylori infection aggravates diet-inducedinsulin resistance in association with gut microbiota of mice. EBioMedicine, vol. 12, pp. 247-254, 2016. DOI: https://doi.org/10.1016/j.ebiom.2016.09.010
35. R. Galan, L. Pembrey, M. Bustamante, R. Aguilar, D. Mason, M. Vidal, M. Bañuls, T. Roumeliotaki, J. M. Delgado-Saborit, N. Marin, M. Vrijheid, V. Bempi, G. Moncunill, C. Dobaño, M. Kogevinas and M. Karachaliou. The association of Helicobacter pylori with adverse pregnancy outcomes in three European birth cohorts. BMC Pregnancy Childbirth, vol. 24, no. 1, p. 745, 2024. DOI: https://doi.org/10.1186/s12884-024-06901-5
36. A. A. Shabana, E. A. Amin, M. F. Ibrahim, M. E. Anter and T. A. Omar. Correlation of maternal Helicobacter pylori infection during pregnancy and pregnancy-induced hypertension. Menoufia Medical Journal, vol. 35, no. 4, pp. 1955-1963, 2023. DOI: https://doi.org/10.4103/mmj.mmj_320_22
37. M. Mirteimouri, S. S. Moghani, F. Khabir, M. Afiat, and S. Niroumand. Comparison of Helicobacter pylori infection in normal pregnancy and preeclampsia. Journal of Midwifery and Reproductive Health, vol. 12, no. 1, pp. 4148-4152, 2024.
38. B. Abdella, M. Ibrahim, I. Tadesse, K. Hassen and M. Tesfa. Association between Helicobacter pylori infection and occurrence of anemia among pregnant women. Anemia, vol. 2020, p. 6574358, 2020. DOI: https://doi.org/10.1155/2020/6574358
39. K. S. Hussein. Hyperemesis gravidarum in first-trimester pregnant Saudi women: Is Helicobacter pylori a risk factor? Frontiers in Physiology, vol. 11, p. 575, 2020. DOI: https://doi.org/10.3389/fphys.2020.00575
40. B. B. Eyoum Bille and L. B. Kouitcheu Mabeku. Relationship between active Helicobacter pylori infection and anemia, iron deficiency, iron deficiency anemia: A cross-sectional study in a Sub-Saharan setting. JGH Open, vol. 6, no. 8, pp. 554-568, 2022. DOI: https://doi.org/10.1002/jgh3.12787
41. M. N. A. Afsar, Z. N. Jhinu, M. A. I. Bhuiyan, Z. Islam and T. J. Siddiqua. Helicobacter pylori infection and micronutrient deficiency in pregnant women: A systematic review and meta-analysis. BMJ Open Gastroenterology, vol. 7, no. 1, p. e000490, 2020. DOI: https://doi.org/10.1136/bmjgast-2020-000490
42. S. Z. Hamdan, H. Z. Hamdan, M. Nimieri and I. Adam. The association between Helicobacter pylori infection and iron deficiency anemia in children. The Pediatric Infectious Disease Journal, vol. 17, no. 2, pp. 59-70, 2022. DOI: https://doi.org/10.1055/s-0042-1743502
43. R. K. Baingana, J. Kiboko Enyaru and L. Davidsson. Helicobacter pylori infection in pregnant women in four districts of Uganda. BMC Public Health, vol. 14, p. 915, 2014. DOI: https://doi.org/10.1186/1471-2458-14-915
44. B. Taye, F. Enquselassie, A. Tsegaye, A. Amberbir, G. Medhin, A. Fogarty, K. Robinson and G. Davey. Effect of early and current Helicobacter pylori infection on the risk of anaemia in 6.5-year-old Ethiopian children. BMC Infectious Diseases, vol. 15, p. 270, 2015. DOI: https://doi.org/10.1186/s12879-015-1012-y
45. H. Monzón, M. Forné, M. Esteve, M. Rosinach, C. Loras, J. C. Espinós, J. M. Viver, A. Salas and F. Fernández-Bañares. Helicobacter pylori infection as a cause of iron deficiency anaemia of unknown origin. World Journal of Gastroenterology, vol. 19, no. 26, p. 4166, 2013. DOI: https://doi.org/10.3748/wjg.v19.i26.4166
46. B. Annibale, M. Marignani, B. Monarca, G. Antonelli, A. Marcheggiano, G. Martino, F. Mandelli, R. Caprilli and G. Delle Fave. Reversal of iron deficiency anemia after Helicobacter pylori eradication. Annals of Internal Medicine, vol. 131, no. 9, pp. 668-672, 1999. DOI: https://doi.org/10.7326/0003-4819-131-9-199911020-00006
47. Y. Feng, Q. Huang, M. Luo, J. Wei, T. Gao, D. Chu, A. Jia, Y. Li, S. He and T. Duan. The association between Helicobacter pylori and gastrointestinal disorders during pregnancy: A Multicenter retrospective study. Helicobacter, vol. 29, no. 1, p. e13032, 2024. DOI: https://doi.org/10.1111/hel.13032
48. L. Asrade, D. Misikir, H. Alemu, A. Belachew and H. Almaw. Determinants of hyperemesis gravidarum among pregnant women attending antenatal care at public and private hospitals in Bahir Dar City, North-West Ethiopia, 2022: A multicenter unmatched case control study. BMC Womens Health, vol. 23, no. 1, p. 225, 2023. DOI: https://doi.org/10.1186/s12905-023-02386-0
49. V. Fait, S. Sela and E. Ophir. Hyperemesis gravidarum is associated with oxidative stress. American Journal of Perinatology, vol. 19, no. 2, pp. 93-98, 2002. DOI: https://doi.org/10.1055/s-2002-23554
50. M. Gong, S. S. Ling, S. Y. Lui, K. G. Yeoh and B. Ho. Helicobacter pylori gamma-glutamyl transpeptidase is a pathogenic factor in the development of peptic ulcer disease. Gastroenterology, vol. 139, no. 2, pp. 564-573, 2010. DOI: https://doi.org/10.1053/j.gastro.2010.03.050
51. K. Strachan, R. P. Jokhi and G. M. Filshie. Persistent hyperemesis gravidarum and Helicobacter pylori. Journal of Obstetrics and Gynaecology, vol. 20, no. 4, p. 427, 2000. DOI: https://doi.org/10.1080/01443610050112147
52. C. M. El Younis, O. Abulafia and D. M. Sherer. Rapid marked response of severe hyperemesis gravidarum to oral erythromycin. American Journal of Perinatology, vol. 15, no. 9, pp. 533-534, 1998. DOI: https://doi.org/10.1055/s-2007-994055
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Zean Zefenkey
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License [CC BY-NC-ND 4.0] that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
