Evaluation of zonulin levels in pregnant women with hyperemesis gravidarum

Hyperemesis gravidarum (HG) represents a serious pregnancy complication which affects 0.5-2% of pregnancies through severe nausea and vomiting that causes dehydration and weight loss and disrupts electrolyte levels. The exact causes of HG remain unknown but research suggests that hormonal shifts and genetic susceptibility and gastrointestinal problems all play a role. The research investigated serum zonulin levels in pregnant women with HG to determine their relationship with disease severity. This case-control study included 44 pregnant women with HG aged 18–35 years with a BMI < 25 and 44 healthy pregnant women with similar demographic characteristics. Pregnant women with HG were divided into three groups based on PUQE scores: mild (n = 16), moderate (n = 19), and severe (n = 9). Serum zonulin levels were measured in all participants using the ELISA method, and their relationship with clinical parameters was investigated. Zonulin levels were significantly lower in the HG group (33.7 ± 11.2 ng/ml) compared to the control group (46.8 ± 6.5 ng/ml) (p < 0.001). Zonulin levels decreased progressively with increasing severity of HG; they were 41.8 ± 5.0 ng/ml in the mild group, 35.2 ± 7.8 ng/ml in the moderate group, and 24.9 ± 9.2 ng/ml in the severe group (p = 0.002). A strong negative correlation was found between zonulin levels and HG severity (r=-0.72, p < 0.001), daily vomiting frequency (r=-0.65, p < 0.001), keton positivity (r=-0.58, p < 0.001), and electrolyte imbalance (r=-0.47, p = 0.002). ROC analysis showed a cut-off point of 40.2 ng/ml with 77.3% sensitivity and 84.1% specificity (AUC = 0.83). The low serum zonulin levels in pregnant women with HG and their negative correlation with disease severity suggest that alterations in intestinal barrier function may play an important role in the pathogenesis of HG. Zonulin may be used as a potential biomarker for the diagnosis and severity assessment of HG.