{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T06:05:11Z","timestamp":1790661911457,"version":"4.1.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Ambient air pollutants and temperature may influence the clinical severity of hyperemesis gravidarum (HG), but their relative contributions remain unclear. This study aimed to determine whether particulate matter (PM\u2081\u2080), sulfur dioxide (SO\u2082), and ambient temperature were independently associated with severe ketonuria in pregnant women with HG.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective observational study included 211 pregnant women diagnosed with HG. Clinical severity was defined by ketonuria category (severe \u22652\u202f+\u202fvs. non-severe &amp;lt;2+). Covariates (maternal age, gestational week, BMI, Healthy Eating Index [HEI], gravida, PM\u2081\u2080, SO\u2082, and ambient temperature) were selected\n                      <jats:italic>a priori<\/jats:italic>\n                      based on literature and univariate screening. Multivariable binary logistic regression was used; model discrimination was assessed via ROC analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The autumn\/winter group showed significantly higher maternal age, gravida, and PM\u2081\u2080 exposure, and lower ambient temperature than the spring\/summer group (all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). In multivariable analysis, only lower ambient temperature (OR\u202f=\u202f0.890, 95% CI: 0.845\u20130.938,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) and higher maternal age (OR\u202f=\u202f1.143, 95% CI: 1.057\u20131.237,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) were independently associated with severe ketonuria; PM\u2081\u2080, SO\u2082, HEI, gestational week, BMI, and gravida were not significant (all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;gt;\u202f0.05). The model correctly classified 81.5% of cases (Nagelkerke\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f0.426). ROC analysis confirmed ambient temperature (AUC\u202f=\u202f0.799) and PM\u2081\u2080 (AUC\u202f=\u202f0.754) as significant discriminators for severe versus non-severe ketonuria, while SO\u2082 was not (AUC\u202f=\u202f0.532).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Ambient temperature showed the strongest discriminative performance for HG severity among the environmental parameters examined, while the association of PM\u2081\u2080 was attenuated after adjustment for temperature. Maternal age was also independently associated with HG severity. These findings should be interpreted as associations rather than causal effects. Further prospective, multi-site studies incorporating individual-level exposure assessments are warranted to confirm these associations and elucidate the underlying mechanisms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1957434","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T05:46:40Z","timestamp":1790660800000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Seasonal ambient temperature and particulate matter as discriminators of hyperemesis gravidarum severity: a retrospective comparative observational study"],"prefix":"10.3389","volume":"14","author":[{"given":"\u015eahide","family":"Akbulut","sequence":"first","affiliation":[{"name":"Department of Nursing, Faculty of Health Sciences, Batman University","place":["Batman, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erhan","family":"Okuyan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Private Zilan Hospital","place":["Batman, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00fclaim","family":"Sizer","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Batman Training and Research Hospital","place":["Batman, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0130lyas","family":"Turan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Private Zilan Hospital","place":["Batman, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emre","family":"G\u00fcnakan","sequence":"additional","affiliation":[{"name":"School of Medicine, At\u0131l\u0131m University","place":["Ankara, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e15","DOI":"10.1097\/AOG.0000000000002456","article-title":"ACOG practice bulletin no. 189: nausea and vomiting of pregnancy","volume":"131","year":"2018","journal-title":"Obstet Gynecol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"809270","DOI":"10.3389\/fmed.2021.809270","article-title":"Emerging progress in nausea and vomiting of pregnancy and hyperemesis gravidarum: challenges and opportunities","volume":"8","author":"Liu","year":"2022","journal-title":"Front Med"},{"key":"ref3","author":"Vadakekut","year":"2025"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1038\/s41572-019-0110-3","article-title":"Nausea and vomiting of pregnancy and hyperemesis gravidarum","volume":"5","author":"Fejzo","year":"2019","journal-title":"Nat Rev Dis 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