Nausea and vomiting in late pregnancy

Testing effects of partner support and use of oral contraception during relationship formation on severity of nausea and vomiting in pregnancy

BACKGROUND

A recent study focusing on dietary predictors of nausea and vomiting in pregnancy (NVP) found that women with higher levels of partner support, and those who had used oral contraception (OC) when they met the father, both tended to report less severe NVP compared with previous non-users or those with less supportive partners. We provide a further test of these factors, using a large sample of women from four countries who retrospectively scored their NVP experience during their first pregnancy.

METHODS

We recruited women who had at least one child to participate in a retrospective online survey. In total 2321 women completed our questionnaire including items on demographics, hormonal contraception, NVP, and partner support. We used general linear models and path analysis to analyse our data.

RESULTS

Women who had used OC when they met the father of their first child tended to report lower levels of NVP, but the effect size was small and did not survive adding the participant's country to the model. There was no relationship between NVP and partner support in couples who were still together, but there was a significant effect among those couples that had since separated: women whose ex-partner had been relatively supportive reported less severe NVP. Additional analyses showed that women who were older during their first pregnancy reported less severe NVP, and there were also robust differences between countries.

CONCLUSIONS

These results provide further evidence for multiple influences on women's experience of NVP symptoms, including levels of perceived partner support.

Proportion of hyperemesis gravidarum and associated factors among pregnant women admitted into the obstetrics ward at Akesta general hospital, North East Ethiopia

INTRODUCTION

Hyperemesis gravidarum is a condition of intractable vomiting during pregnancy that leads to fluid and electrolyte imbalance, nutrition deficiency and weight loss often requiring hospital admission. Approximately 0.3%-10.8% of pregnant women experience nausea and vomiting during the first trimester of pregnancy. It has been associated with both maternal and fetal morbidity. There is limited evidence about the proportion of hyperemesis gravidarum and associated factors in the study area.

OBJECTIVE

The aim of this study was to determine the proportion of hyperemesis gravidarum and associated factors among pregnant women admitted into the obstetric ward at Akesta General Hospital, South Wollo Zone, Ethiopia.

METHODS

This is hospital-based cross-sectional study of 355 pregnant mothers in Akesta general hospital in northeast Ethiopia from September 1/2018- to August 30 /2020. A simple random sampling technique was used to select the patient card from the whole admission of pregnant women cards during the study period. The diagnosis of hyperemesis gravidarum include persistent vomiting not related to other causes, an objective measure of acute starvation, electrolyte abnormalities and acid-base disturbances, as well as weight loss. The data analysis was done using SPSS version 25. Bivariable and multivariable binary logistic regression analysis was conducted to identify factors associated with hyperemesis gravidarum. Adjusted odds ratio (AOR) with 95% confidence intervals (CI) was reported to show the strength of the association. Statistical significance was stated at P-value < 0.05.

RESULTS

The proportion of hyperemesis gravidarum was 11.3%. Women with previous history of hyperemesis gravidarum AOR (95%CI) = 10.9[2.46, 48.44], previous history of urinary tract infection AOR (95%CI) = 4.32[1.58, 11.86], previous history of gastrointestinal disease AOR (95% CI) = 4.12[1.40, 12.65], history of abortion AOR (95% CI) = 6.23[2.24, 17.52] were factors significantly associated with hyperemesis gravidarum.

CONCLUSION

In this study, the overall hospital proportion of hyperemesis gravidarum was high. History of gastrointestinal disease, previous history of urinary tract infection, history of hyperemesis gravidarum, and history of abortion were the major risk factors.

Nausea and Vomiting in Early Pregnancy of Adolescents: Relationship with Depressive Symptoms

STUDY OBJECTIVE

To determine the relationship between severity of nausea and vomiting during pregnancy (NVP) and depressive symptoms in pregnant adolescents.

DESIGN

Prospective cross-sectional study.

SETTING

A maternity research hospital outpatient clinic, Ankara, Turkey.

PARTICIPANTS

A total of 200 pregnant adolescents.

INTERVENTIONS AND MAIN OUTCOME MEASURES

Demographic features and obstetric histories of the participants were assessed. The Rhodes test was performed to determine nausea and vomiting severity in a face-to-face interview, and the self-reported Edinburgh Postnatal Depression Scale was administered with supervision.

RESULTS

The Rhodes test results showed that 52/200 patients (26%) were classified with none, 83/200 patients (41.5%) with mild, 48/200 patients (24.0%) with moderate, and 17/200 patients (8.5%) with severe symptoms. The mean depression score in the severe vomiting group was significantly higher than that in the no NVP and mild NVP groups (P = .028 and .041, respectively). No differences were found between the other groups.

CONCLUSION

Severe nausea and vomiting was associated with greater depressive symptom severity in pregnant adolescents.

Review of NVP and HG and Early Pharmacotherapeutic Intervention

NVP occurs in 50–90% of pregnancies, making it a common medical condition in pregnancy. Women present differently with any combination of signs and symptoms. It is appropriate to take the pregnancy-related versus nonpregnancy-related approach when determining the cause of nausea and vomiting but other causes should be considered. The most common etiologies for NVP include the hormonal changes associated with pregnancy, the physiologic changes in the gastrointestinal tract, and a genetic predisposition. Up to 10% of women will require pharmacotherapy to treat the symptoms of NVP despite conservative measures. ACOG currently recommends that a combination of oral pyridoxine hydrochloride and doxylamine succinate be used as first-line treatment for NVP if pyridoxine monotherapy does not relieve symptoms. A review of NVP and early pharmacotherapeutic management is presented due to the fact that NVP is largely undertreated, and investigations into the safe and effective pharmacotherapies available to treat NVP are lacking.

Maternal influences on nausea and vomiting in early pregnancy

Symptoms of nausea and vomiting in early pregnancy (NVP) are common among pregnant women, but whether some women are more likely than others to experience these symptoms has not been well established. We examined potential risk factors for NVP symptom severity, timing of onset, and duration. We included 2,407 newly pregnant women who participated in a prospective cohort study on early pregnancy health between 2000 and 2004 in three U.S. cities. Data on NVP and other health information were collected through telephone interviews, early gestation ultrasound, and medical record abstractions. Generalized linear models were used to model possible risk factors for each NVP characteristic. Eighty-nine percent of women had NVP; for 99% of these, symptoms started in the first trimester. None of the characteristics examined were associated with having NVP. Among those with NVP, increasing risk of delayed symptoms onset was associated with advancing maternal age; increased risks were also seen among non-Hispanic Black [Risk ratio (RR) = 4.3, 95% confidence interval (CI): 1.6,11.6] and Hispanic women (RR = 2.3, 95% CI:0.4,11.5). NVP symptoms for multigravidae were more likely to last beyond the first trimester with each additional pregnancy. Most pregnant women experienced NVP. Nearly all of them, regardless of characteristics examined, had symptoms beginning in the first trimester. Maternal age, race/ethnicity, and gravidity were associated with delayed onset and symptoms that persisted into the second trimester.

Optimal management of nausea and vomiting of pregnancy

Nausea and vomiting of pregnancy (NVP) is a common medical condition in pregnancy with significant physical and psychological morbidity. Up to 90% of women will suffer from NVP symptoms in the first trimester of pregnancy with up to 2% developing hyperemesis gravidarum which is NVP at its worst, leading to hospitalization and even death in extreme cases. Optimal management of NVP begins with nonpharmacological approaches, use of ginger, acupressure, vitamin B6, and dietary adjustments. The positive impact of these noninvasive, inexpensive and safe methods has been demonstrated. Pharmacological treatments are available with varying effectiveness; however, the only drug marketed specifically for the treatment of NVP in pregnancy is Diclectin^® (vitamin B6 and doxylamine). In addition, the Motherisk algorithm provides a guideline for use of safe and effective drugs for the treatment of NVP. Optimal medical management of symptoms will ensure the mental and physical wellbeing of expecting mothers and their developing babies during this often stressful and difficult time period. Dismissing NVP as an inconsequential part of pregnancy can have serious ramifications for both mother and baby.

Epidemiology of nausea and vomiting of pregnancy: prevalence, severity, determinants, and the importance of race/ethnicity

BACKGROUND

Studies that contributed to the epidemiology of nausea and vomiting of pregnancy have reported conflicting findings, and often failed to account for all possible co-variables necessary to evaluate the multidimensional associations. The objectives of this study were to: 1) Estimate the prevalence and the severity of nausea and vomiting of pregnancy during the 1st and the 2nd trimester of pregnancy, and 2) Identify determinants of presence and severity of nausea and vomiting of pregnancy during the 1st and 2nd trimesters separately, with a special emphasis on the impact of race/ethnicity.

METHODS

A prospective study including pregnant women attending the Centre Hospitalier Universitaire (CHU) Sainte-Justine or René-Laennec clinics for their prenatal care was conducted from 2004 to 2006. Women were eligible if they were > or = 18 years of age, and </= 16 weeks of gestation. Women were asked to fill out a 1st trimester self-administered questionnaire and were interviewed over the telephone during their 2nd trimester of pregnancy. Presence of nausea and vomiting of pregnancy was based on the reporting of pregnant women (yes/no); severity of symptoms was measured by the validated modified-PUQE index.

RESULTS

Of the 367 women included in the study, 81.2% were Caucasians, 10.1% Blacks, 4.6% Hispanics, and 4.1% Asians. Multivariate analyses showed that race/ethnicity was significantly associated with a decreased likelihood of reporting nausea and vomiting of pregnancy (Asians vs. Caucasians OR: 0.13; 95%CI 0.02-0.73; and Blacks vs. Caucasians OR: 0.29; 95%CI 0.09-0.99).

CONCLUSION

Our study showed that race/ethnicity was associated with the reporting of nausea and vomiting of pregnancy in the 1st trimester of pregnancy.

Determinants of early medical management of nausea and vomiting of pregnancy

BACKGROUND

Early medical management of nausea and vomiting during pregnancy is desirable but less than optimal. The aims of this study were to describe the management of nausea and vomiting during the first prenatal visit and to identify the determinants of 1) addressing the subject of nausea and vomiting during pregnancy with the health practitioner and 2) receiving an antiemetic prescription.

METHODS

A prospective study was conducted of 283 women who reported nausea and vomiting during the first trimester of pregnancy. Women were eligible if they were at least 18 years of age and < or = 16 weeks' gestation at the time of their first prenatal visit. Participants completed a questionnaire to determine their maternal characteristics, the presence of nausea and vomiting during pregnancy, and its management.

RESULTS

Of the 283 study participants, 79 percent reported that the condition was addressed during their first prenatal visit, 52 percent reported being asked about the intensity and severity of their symptoms, and 22 percent reported being questioned about the extent to which it disrupted their daily tasks. Health practitioners prescribed an antiemetic for 27 percent of women and recommended a nonpharmacological method for 14 percent. Multivariate models showed that the severity of the nausea and vomiting, previous use of an antiemetic, and smoking before pregnancy were significantly associated with an increased likelihood of addressing the subject of nausea and vomiting during pregnancy. Variables associated with an increased likelihood of women receiving an antiemetic prescription included nausea and vomiting severity, excessive salivation, previous antiemetic use, and work status.

CONCLUSIONS

Health practitioners can improve their management of nausea and vomiting during pregnancy based on the available guidelines for treatment and they should address important factors such as symptom severity and work status at the first prenatal visit to assess women's need for antiemetic treatment.