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Emmott EH. Re-examining the adaptive function of nausea and vomiting in pregnancy. Evol Med Public Health 2024; 12:97-104. [PMID: 39015511 PMCID: PMC11250205 DOI: 10.1093/emph/eoae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/29/2024] [Indexed: 07/18/2024] Open
Abstract
Nausea and vomiting in pregnancy (NVP) have been proposed to have a prophylactic function. In this review, I re-examine NVP from an evolutionary perspective in light of new research on NVP. First, current evidence suggests that the observed characteristics of NVP does not align well with a prophylactic function. Further, NVP is typically associated with high costs for pregnant women, while moderate-to-severe NVP is associated with increased risks of poorer foetal/birth outcomes. In contrast, mild NVP limited to early pregnancy may associate with improved foetal outcomes-indicating a potential evolutionary benefit. Second, researchers have recently identified growth differentiation factor 15 (GDF15) to cause NVP, with implications that low-levels of pre-conception GDF15 (associated with lower cellular stress/inflammation) may increase risks/symptoms of NVP. If so, NVP in contemporary post-industrialized populations may be more severe due to environmental mismatch, and the current symptomology of NVP in such populations should not be viewed as a typical experience of pregnancy.
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Affiliation(s)
- Emily H Emmott
- UCL Anthropology, University College London, London WC1H 0BW, UK
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Li Y, Zhang L, Liu J, Wu M, Li C, Yang J, Wang L. Environmental concentrations of cadmium and zinc and associating metabolomics profile alternations in urine of pregnant women in the first trimester: A prospective cohort study in Taiyuan, North China. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 267:115611. [PMID: 37897977 DOI: 10.1016/j.ecoenv.2023.115611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/13/2023] [Accepted: 10/15/2023] [Indexed: 10/30/2023]
Abstract
especially to pregnant women. In recent years, zinc (Zn) supplementation has attracted increasing attention among pregnant women. Thus, understanding the effects and interactions of Cd and Zn in pregnant women is critical. This study aimed to assess the urinary levels of Cd and Zn in pregnant women during early pregnancy, examine associated alterations in urine metabolomics, and identify potential metabolic biomarkers among distinct Cd and Zn groups. Urine samples from 185 pregnant women were collected, and inductively coupled plasma mass spectrometry (ICP-MS) was used to detect Cd and Zn contents. The women were then divided into four groups according to median contents of Cd and Zn. Alterations in the metabolite profile were assessed using a liquid chromatograph mass spectrometer (LC-MS). The results showed that the gravidity of pregnant women was closely related to urinary Cd levels and that the urinary Zn contents of pregnant women with morning sickness in the first trimester were lower than that of non-morning-sick pregnant women. A total of 51 metabolites exhibited significant differential expression in the high level of Cd and Zn (HCdHZn) compared with low level of Cd and Zn (LCdLZn), the diagnostic performance of these 51 metabolites were assessed using receiver operating characteristic curve analysis and revealed that octadecylamine was a promising diagnostic indicator for evaluating the combined effects of Zn and Cd. Metabolomics analysis showed that the arginine and proline pathways were upregulated in HCdHZn compared with that in LCdLZn, suggesting a potential risk of obesity. Although higer levels of bovinic acid in HCdHZn vs. HCdLZn (high level of Cd and low level of Zn) indicated that Zn has antioxidant and anti-inflammatory properties, excessive Zn may still cause harmful effect to the human health and should be supplemented with caution. The study findings may be valuable for potential risk ahissessment of the combined effects of Cd-Zn and their interactions in pregnant women.
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Affiliation(s)
- Yingjun Li
- Department of Child and Adolescent Health, School of Public Health, Shanxi Medical University, Taiyuan 030001, China
| | - Liuyuan Zhang
- Department of Child and Adolescent Health, School of Public Health, Shanxi Medical University, Taiyuan 030001, China
| | - Jin Liu
- Department of Child and Adolescent Health, School of Public Health, Shanxi Medical University, Taiyuan 030001, China
| | - Meiqiong Wu
- Department of Child and Adolescent Health, School of Public Health, Shanxi Medical University, Taiyuan 030001, China
| | - Changqing Li
- Taiyuan Center for Disease Control and Prevention, Taiyuan 030000, China
| | - Jia Yang
- Department of prevention and health care, Shanxi Provincial Children's Hospital, Taiyuan 030013, China
| | - Li Wang
- Department of Child and Adolescent Health, School of Public Health, Shanxi Medical University, Taiyuan 030001, China.
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Nishihara N, Haruna M, Usui Y, Yonezawa K, Hikita N, Sasagawa E, Nakano K, Tanaka M, Ohori R, Aoyama S, Sasaki S, Fujita M, Matsuzaki M, Suetsugu Y, Sato Y. Dietary Intake and Its Association with Birth Outcomes in Women with Nausea and Vomiting during the Second Trimester of Pregnancy: A Prospective Cohort Study in Japan. Nutrients 2023; 15:3383. [PMID: 37571320 PMCID: PMC10421251 DOI: 10.3390/nu15153383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Nausea and vomiting in pregnancy (NVP) is a common symptom. Although the influence of NVP during the first trimester on dietary intake and birth outcomes has been revealed, no study has focused on NVP during the second trimester. This study aimed to reveal whether NVP severity during the second trimester is associated with dietary intake, gestational weight gain (GWG), birth weight, and delivery week. Participants completed a questionnaire at 18-27 gestational weeks. NVP severity was assessed using the modified Pregnancy-Unique Quantification of Emesis and Nausea scale in the questionnaire. Dietary habits were assessed using a brief-type diet history questionnaire. In total, 825 responses were analyzed: 202 (24.5%), 135 (16.4%), and 8 (1.0%) women reported mild, moderate, and severe NVP, respectively; 480 (58.2%) women did not have NVP during the second trimester. No significant association was observed between energy and nutrient intake and no/mild and moderate/severe NVP. Women with moderate/severe NVP had lower total GWG than those with no/mild NVP (p = 0.007). There was no significant difference in low birth weight and preterm birth rates (p = 0.246 and p = 0.604). This is the first study to investigate whether NVP severity during the second trimester is associated with dietary intake and birth outcomes.
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Affiliation(s)
- Nao Nishihara
- Department of Midwifery and Women’s Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (N.N.); (Y.U.); (K.Y.); (N.H.); (E.S.); (K.N.); (M.T.); (R.O.); (S.A.)
| | - Megumi Haruna
- Department of Midwifery and Women’s Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (N.N.); (Y.U.); (K.Y.); (N.H.); (E.S.); (K.N.); (M.T.); (R.O.); (S.A.)
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Yuriko Usui
- Department of Midwifery and Women’s Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (N.N.); (Y.U.); (K.Y.); (N.H.); (E.S.); (K.N.); (M.T.); (R.O.); (S.A.)
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Kaori Yonezawa
- Department of Midwifery and Women’s Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (N.N.); (Y.U.); (K.Y.); (N.H.); (E.S.); (K.N.); (M.T.); (R.O.); (S.A.)
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Naoko Hikita
- Department of Midwifery and Women’s Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (N.N.); (Y.U.); (K.Y.); (N.H.); (E.S.); (K.N.); (M.T.); (R.O.); (S.A.)
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; (Y.S.); (Y.S.)
| | - Emi Sasagawa
- Department of Midwifery and Women’s Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (N.N.); (Y.U.); (K.Y.); (N.H.); (E.S.); (K.N.); (M.T.); (R.O.); (S.A.)
- Department of International Health Care and Midwifery, Graduate School of Nursing, Japanese Red Cross College of Nursing, Tokyo 150-0012, Japan
| | - Keiko Nakano
- Department of Midwifery and Women’s Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (N.N.); (Y.U.); (K.Y.); (N.H.); (E.S.); (K.N.); (M.T.); (R.O.); (S.A.)
| | - Moeko Tanaka
- Department of Midwifery and Women’s Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (N.N.); (Y.U.); (K.Y.); (N.H.); (E.S.); (K.N.); (M.T.); (R.O.); (S.A.)
| | - Riko Ohori
- Department of Midwifery and Women’s Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (N.N.); (Y.U.); (K.Y.); (N.H.); (E.S.); (K.N.); (M.T.); (R.O.); (S.A.)
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Satoko Aoyama
- Department of Midwifery and Women’s Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; (N.N.); (Y.U.); (K.Y.); (N.H.); (E.S.); (K.N.); (M.T.); (R.O.); (S.A.)
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, School of Public Health, The University of Tokyo, Tokyo 113-0033, Japan;
| | - Megumi Fujita
- Department of Clinical Nursing, Graduate School of Medical Science, Yamagata University, Yamagata 990-9585, Japan;
| | - Masayo Matsuzaki
- Department of Reproductive Health Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan;
- Department of Children and Women’s Health, Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan
| | - Yoshiko Suetsugu
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; (Y.S.); (Y.S.)
| | - Yoko Sato
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; (Y.S.); (Y.S.)
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Cheng W, Li L, Long Z, Ma X, Chen F, Ma L, Zhang S, Lin J. Association between Dietary Patterns and the Risk of Hyperemesis Gravidarum. Nutrients 2023; 15:3300. [PMID: 37571237 PMCID: PMC10420833 DOI: 10.3390/nu15153300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/22/2023] [Accepted: 07/23/2023] [Indexed: 08/13/2023] Open
Abstract
(1) Background: Although studies have suggested that dietary interventions may have potential benefits over conventional medical treatments, research on the association between dietary patterns and hyperemesis gravidarum (HG) in pregnant women is scarce. (2) Methods: To explore the relationship between dietary patterns and the risk of HG, a cross-sectional study was conducted in Xi'an, China from April 2021 to September 2022. Dietary intake was assessed by a semi-quantitative food-frequency questionnaire, and then factor analysis was used to derive dietary patterns. HG was defined as persistent and severe nausea and vomiting with weight loss ≥ 5%, pregnancy-unique quantification of emesis (PUQE) score ≥ 13, or hospitalization due to vomiting. Logistic regression models were used to estimate ORs and 95% CIs for HG according to dietary pattern scores. Stratified analyses and tests for interaction were performed by potential confounders. (3) Results: Of the 3122 pregnant women enrolled, 2515 individuals (mean age: 31.2 ± 3.4 years) were included in the final analysis. In total, 226 (8.9%) pregnant women were identified as having HG. Five dietary patterns were identified. After adjusting for covariates, the highest quartile of the "fish, shrimp and meat" and "egg, milk and water drinking" patterns was associated with a 37% and 58% lower risk of HG compared with the lowest quartile, respectively (p-trend < 0.05). Conversely, the highest quartile of the "beverage" pattern was associated with a 64% higher risk of HG compared with the lowest quartile (p-trend = 0.02). Furthermore, significant interactions were observed between the "egg, milk and water drinking" pattern and parity, employment status and nutritional supplement use (p-interaction < 0.05). (4) Conclusions: A diet rich in eggs, milk, seafood and unprocessed poultry and animal meat may be a protective factor against HG, while a diet high in beverages may be detrimental to HG. These associations may vary by parity, employment status and nutritional supplement use.
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Affiliation(s)
- Wenjie Cheng
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (W.C.); (L.L.); (Z.L.); (X.M.); (F.C.); (L.M.)
| | - Lintian Li
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (W.C.); (L.L.); (Z.L.); (X.M.); (F.C.); (L.M.)
| | - Zhaoqing Long
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (W.C.); (L.L.); (Z.L.); (X.M.); (F.C.); (L.M.)
| | - Xiuxiu Ma
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (W.C.); (L.L.); (Z.L.); (X.M.); (F.C.); (L.M.)
| | - Fangyao Chen
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (W.C.); (L.L.); (Z.L.); (X.M.); (F.C.); (L.M.)
| | - Le Ma
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (W.C.); (L.L.); (Z.L.); (X.M.); (F.C.); (L.M.)
| | - Shunming Zhang
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (W.C.); (L.L.); (Z.L.); (X.M.); (F.C.); (L.M.)
| | - Jing Lin
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China; (W.C.); (L.L.); (Z.L.); (X.M.); (F.C.); (L.M.)
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi’an 710061, China
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Nausea and Vomiting during Early Pregnancy among Chinese Women and Its Association with Nutritional Intakes. Nutrients 2023; 15:nu15040933. [PMID: 36839295 PMCID: PMC9962185 DOI: 10.3390/nu15040933] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/10/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
Nausea and vomiting in pregnancy (NVP) is one of the most common uncomfortable symptoms of women in early pregnancy. A total of 303 Chinese pregnant women from 10 urban cities in their first trimester were recruited in this study to collect their sociodemographic characteristics and their NVP occurrence. Their dietary nutrient and food intakes were also collected by a 24 h dietary recall and a semi-quantitative food frequency questionnaire (SFFQ). Using the univariate analysis and multiple linear regression analysis to estimate the correlation between NVP and dietary intake, we found that 255 (84.1%) pregnant women experienced NVP during their first trimester. The intake of energy, protein, fat, vitamin A, thiamin, riboflavin, vitamin E, phosphorus, potassium, iron and zinc was lower in women with NVP than in those with no NVP. Additionally, women with NVP were more likely to have insufficient intake of protein, riboflavin, calcium, phosphorus and selenium. In terms of specific food groups, the average daily intake of mushrooms, algae, nuts and seeds, meat, eggs and dairy products in the NVP group was lower. Women in the severe NVP group even had insufficient gestational weight gain. We should pay more attention to women who experience nausea and vomiting during pregnancy and provide them with targeted nutritional support.
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Fiurašková K, Havlíček J, Roberts SC. Dietary and psychosocial correlates of nausea and vomiting in pregnancy. Food Qual Prefer 2021. [DOI: 10.1016/j.foodqual.2021.104266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Santander Ballestín S, Giménez Campos MI, Ballestín Ballestín J, Luesma Bartolomé MJ. Is Supplementation with Micronutrients Still Necessary during Pregnancy? A Review. Nutrients 2021; 13:3134. [PMID: 34579011 PMCID: PMC8469293 DOI: 10.3390/nu13093134] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/26/2021] [Accepted: 09/06/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Proper nutrition during pregnancy is important to prevent nutritional imbalances that interfere with pregnancy. Micronutrients play critical roles in embryogenesis, fetal growth, and maternal health, as energy, protein, vitamin, and mineral needs can increase during pregnancy. Increased needs can be met by increasing the intake of dietary micronutrients. Severe micronutrient deficiency or excess during pregnancy can have negative effects on fetal growth (intrauterine growth retardation, low birth weight, or congenital malformations) and pregnancy development (pre-eclampsia or gestational diabetes). We investigate whether it is necessary to continue micronutrient supplementation during pregnancy to improve women's health in this stage and whether this supplementation could prevent and control pathologies associated with pregnancy. AIM The present review aims to summarize evidence on the effects of nutritional deficiencies on maternal and newborn morbidity. METHODS This aim is addressed by critically reviewing results from published studies on supplementation with different nutrients during pregnancy. For this, major scientific databases, scientific texts, and official webpages have been consulted. PubMed searches using the terms "pregnancy" OR "maternal-fetal health" AND "vitamins" OR "minerals" OR "supplementation" AND "requirement" OR "deficiency nutrients" were performed. RESULTS There are accepted interventions during pregnancy, such as folic acid supplementation to prevent congenital neural tube defects, potassium iodide supplementation to correct neurodevelopment, and oral iron supplementation during the second half of pregnancy to reduce the risk of maternal anemia and iron deficiency. A number of micronutrients have also been associated with pre-eclampsia, gestational diabetes mellitus, and nausea and vomiting in pregnancy. In general, experimental studies are necessary to demonstrate the benefits of supplementation with different micronutrients and to adjust the recommended daily doses and the recommended periconceptional nutrition for mothers. CONCLUSIONS Presently, there is evidence of the benefits of micronutrient supplementation in perinatal results, but indiscriminate use is discouraged due to the fact that the side effects of excessive doses are not known. Evidence supports the idea that micronutrient deficiencies negatively affect maternal health and the outcome of pregnancy. No single micronutrient is responsible for the adverse effects; thus, supplementing or correcting one deficiency will not be very effective while other deficiencies exist.
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Affiliation(s)
- Sonia Santander Ballestín
- Department of Pharmacology, Physiology and Legal and Forensic Medicine, Faculty of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | | | | | - María José Luesma Bartolomé
- Department of Human Anatomy and Histology, Faculty of Science, University of Zaragoza, 50009 Zaragoza, Spain;
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Tan GN, Tan PC, Hong JGS, Kartik B, Omar SZ. Rating of four different foods in women with hyperemesis gravidarum: a randomised controlled trial. BMJ Open 2021; 11:e046528. [PMID: 33986063 PMCID: PMC8126296 DOI: 10.1136/bmjopen-2020-046528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 04/03/2021] [Accepted: 04/26/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate four foods in women with hyperemesis gravidarum (HG) on their agreeability and tolerability. DESIGN Prospective, randomised, within-subject cross-over trial. SETTING Single-centre, tertiary, university hospital in Malaysia. PARTICIPANTS 72 women within 24-hour of first admission for HG who were 18 years or above, with confirmed clinical pregnancy of less than 16 weeks' gestation were recruited and analysed. Women unable to consume food due to extreme symptoms, known taste or swallowing disorder were excluded. INTERVENTIONS Each participant chewed and swallowed a small piece of apple, watermelon, cream cracker and white bread in random order and was observed for 10 min after each tasting followed by a 2 min washout for mouth rinsing and data collection. OUTCOME MEASURES Primary outcome was food agreeability scored after 10 min using an 11-point 0-10 Visual Numerical Rating Scale (VNRS). Nausea was scored at baseline (prior to tasting) and 2 and 10 min using an 11-point VNRS. Intolerant responses of gagging, heaving and vomiting were recorded. RESULTS On agreeability scoring, apple (mean±SD 7.2±2.4) ranked highest followed by watermelon (7.0±2.7) and crackers (6.5±2.6), with white bread ranked lowest (6.0±2.7); Kruskal-Wallis H test, p=0.019. Apple had the lowest mean nausea score and mean rank score, while white bread had the highest at both 2 and 10 min; the Kruskal-Wallis H test showed a significant difference only at 10 min (p=0.019) but not at 2 min (p=0.29) in the ranking analyses. The intolerant (gagged, heaved or vomited) response rates within the 10 min study period were apple 3/72 (4%), watermelon 7/72 (10%), crackers 8/72 (11%) and white bread 12/72 (17%): χ2 test for trend p=0.02. CONCLUSION Sweet apple had the highest agreeability score, the lowest nausea severity and intolerance-emesis response rate when tasted by women with HG. White bread consistently performed worst.
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Affiliation(s)
- Gi Ni Tan
- Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur, Malaysia
| | - Peng Chiong Tan
- Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Balaraman Kartik
- Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Zawiah Omar
- Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur, Malaysia
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Reijonen JK, Tihtonen KMH, Uotila JT, Vihtamäki T, Luukkaala TH. Dietary fibre intake and lifestyle characteristics in relation to nausea or vomiting during pregnancy-a questionnaire-based cohort study. J OBSTET GYNAECOL 2021; 42:35-42. [PMID: 33942705 DOI: 10.1080/01443615.2021.1871886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Nausea or vomiting in pregnancy (NVP) are among the commonest symptoms experienced in early pregnancy. We wanted to evaluate the association of dietary fibre intake, lifestyle characteristics and bowel function with NVP. One hundred and eighty-eight participants completed a self-administered questionnaire concerning bowel function, dietary fibre intake and lifestyle characteristics. Women suffering from NVP (n = 91) consumed significantly more fibre derived from cereal products (p=.026) and total fibre (p=.043) during pre-pregnancy period was compared to women without NVP (n = 97). In both groups, intake of total fibre and fibre derived from fruit and vegetables increased significantly during the first trimester. Dietary fibre intake did not protect from NVP. However, women suffering from NVP were able to maintain their fibre intake. Dietary fibre is tolerated well during NVP, and this finding can be used when giving diet counselling to women suffering from NVP.Impact statementWhat is already known on this subject? Nausea or vomiting in pregnancy (NVP) are among the commonest symptoms experienced in early pregnancy. The pathophysiology of NVP remains unknown, but it has been suggested to be multifactorial. Diet during pregnancy may have an impact on NVP. It is generally advised to avoid meat, poultry, fish, eggs and spicy and fatty foods during periods of NVP, but there is limited data on the effects of diet of NVP.What do the results of this study add? Women suffering from NVP have been shown to eat less meat (and thus protein) compared to women without NVP. Dietary fibre reduces constipation and heartburn and it also keeps blood glucose levels stable. Because of various beneficial effects of fibre on the digestive system, we hypothesised that a high fibre intake may alleviate the symptoms of NVP.What are the implications of these findings for clinical practice and/or further research? The aim of the present study was to investigate whether the amount or source of dietary fibre are associated with NVP. We wanted to investigate intake of fibre derived from cereal products (mostly representing insoluble fibre) and fibre derived from fruit and vegetables (containing mostly soluble fibre) separately in relationship to NVP, as the mechanisms of action of these fibre groups are different. There are no observational studies including also pre-pregnancy consumption of fibre when focussing on the association between fibre and NVP. The results of this study can be used when giving diet counselling to women suffering from NVP.
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Affiliation(s)
| | | | - Jukka Tapio Uotila
- Department of Obstetrics and Gynecology, Medical School Tampere University, Tampere University Hospital, Tampere, Finland
| | - Tarja Vihtamäki
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Tiina Hannele Luukkaala
- School of Health Sciences, Tampere Research and Innovation Center and University of Tampere, Tampere University Hospital, Tampere, Finland
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Minato-Inokawa S, Hayashi I, Nirengi S, Yamaguchi K, Takakura K, Sakane N, Nagai N. Association of Dietary Change during Pregnancy with Large-for-Gestational Age Births: A Prospective Observational Study. J Nutr Sci Vitaminol (Tokyo) 2021; 66:246-254. [PMID: 32612087 DOI: 10.3177/jnsv.66.246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Being born with large birthweight is considered as a risk of non-communicable diseases later in life. However, it is not fully understood what kind of maternal dietary intake during pregnancy affect large birthweight. Therefore, we examined the association of dietary intakes and its changes during pregnancy with large-for-gestational-age (LGA) births in Japanese pregnant women. In the prospective study, 245 pregnant women who visited Kyoto Medical Center were enrolled. Nutrition survey using brief-type self-administered diet history questionnaire (BDHQ) at all trimester was completed in 171 pregnant women. Based on birthweight and gestational age, participants were divided into three groups, such as small-for-gestational-age (<10th, SGA, n=17), appropriate-for-gestational-age (≥10th and <90th, AGA, n=144), and LGA (≥90th, n=10) groups. Compared with those without LGA births, mothers with LGA births showed: 1) greater weight gain during pregnancy (LGA: 14.0±3.2 kg, AGA: 9.9±3.9 kg, SGA: 8.4±3.1 kg, p<0.05); 2) higher energy intake throughout pregnancy (LGA: 310±368 kcal, AGA: 7±490 kcal, SGA: -97±293 kcal, ptrend<0.05); 3) larger changes in plant oil and sucrose consumptions from the 1st to 2nd trimester, probably due to the results of greater consumption of bread, Western confectionery, Japanese confectionery, and mayonnaise and dressing during the same period (ptrend<0.05, respectively). Our results suggest that higher energy intake throughout pregnancy, as well as greater consumption of plant oil and sucrose from the first to second trimester could be associated with LGA births.
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Affiliation(s)
- Satomi Minato-Inokawa
- Graduate School of Human Science and Environment, University of Hyogo.,Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center
| | - Ikuyo Hayashi
- Graduate School of Human Science and Environment, University of Hyogo.,Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center
| | - Shinsuke Nirengi
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center
| | - Ken Yamaguchi
- Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Center.,Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University Graduate School of Medicine
| | - Kenji Takakura
- Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Center
| | - Naoki Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center
| | - Narumi Nagai
- Graduate School of Human Science and Environment, University of Hyogo
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11
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What is known about the nutritional intake of women with Hyperemesis Gravidarum?: A scoping review. Eur J Obstet Gynecol Reprod Biol 2020; 257:76-83. [PMID: 33360613 DOI: 10.1016/j.ejogrb.2020.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/01/2020] [Accepted: 12/06/2020] [Indexed: 12/17/2022]
Abstract
Hyperemesis gravidarum (HG) is characterised by extreme nausea and vomiting of pregnancy, which can lead to dehydration, weight loss and electrolyte disturbances. Historically research has been challenging due to a lack of diagnostic criteria and objective outcome measures. Most studies in this population group have focused on medical management of symptoms, with little known about the effect of HG on nutritional intake and how this relates to perinatal outcomes. The aim of this study was to synthesise current knowledge of the dietary intake of women with HG. A systematic search of search engines was conducted in April 2020 using the following databases: MEDLINE, Embase, CINAHL, Cochrane database, Scopus, NHS Evidence, BNI, Emcare, ClinicalTrials.gov, PROSPERO, Ethos and Open Grey. Titles and abstracts were screened independently by two reviewers against predefined inclusion and exclusion criteria. Studies were included where the authors described severe pregnancy nausea and vomiting as HG, regardless of how HG was defined. After removal of duplicates, 4402 titles were identified, of which 3992 were initially excluded based on abstract and title. Following full text review, four of 10 articles were included. Three of the studies were hospital-based case control studies, one was an observational women's cohort study. Assessment of dietary intake was heterogeneous, with both retrospective and prospective self-report methods used, over different timeframes. In three of the studies, dietary intake was reported at one time point only. In total, across all four studies, data from only 314 women were included. Overall, despite data collected from four different countries, over 30 years, with various methods, women with HG had a significantly poorer dietary intake compared to non-affected pregnant women, consuming less than 50 % of recommended intakes for most nutrients. Nutritional intake worsened with increasing severity of symptoms. As this was a scoping review, study quality was not assessed. Overall, this review has identified a paucity of data about the dietary intake of women with HG; the limited available data indicates that women with HG are at risk of malnutrition. Future research quantifying nutritional intake in women with HG at several time points during pregnancy would provide valuable reference data, enabling nutritional status and outcomes to be monitored and interventions to be evaluated.
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12
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Regodón Wallin A, Tielsch JM, Khatry SK, Mullany LC, Englund JA, Chu H, LeClerq SC, Katz J. Nausea, vomiting and poor appetite during pregnancy and adverse birth outcomes in rural Nepal: an observational cohort study. BMC Pregnancy Childbirth 2020; 20:545. [PMID: 32943001 PMCID: PMC7499900 DOI: 10.1186/s12884-020-03141-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 07/28/2020] [Indexed: 01/17/2023] Open
Abstract
Background Nausea and vomiting are experienced by a majority of pregnant women worldwide. Previous studies have yielded conflicting results regarding their impact on birth outcomes and few studies have examined this relationship in settings with limited resources. We aimed to determine the effect of nausea, vomiting and poor appetite during pregnancy on birth outcomes in rural Nepal. Methods Observational cohort study using data collected in two randomized, community-based trials to assess the effect of influenza immunization during pregnancy on reproductive and respiratory outcomes among pregnant women and their offspring. Pregnant women in Sarlahi District, Nepal were recruited from 2011 to 2013. Exposure was defined as nausea, vomiting or poor appetite at any point during pregnancy and by trimester; symptoms were recorded monthly throughout pregnancy. Adverse outcomes were low birth weight (LBW), preterm birth and small for gestational age (SGA). Adjusted relative risks (aRR) with 95% CIs are reported from Poisson regressions with robust variance. Results Among 3,623 pregnant women, the cumulative incidence of nausea, vomiting or poor appetite was 49.5% (n = 1793) throughout pregnancy and 60.6% (n = 731) in the first trimester. Significantly higher aRRs of LBW and SGA were observed among women experiencing symptoms during pregnancy as compared to symptom free women (LBW: aRR 1.20; 95% CI 1.05 1.28; SGA: aRR 1.16; 95% CI 1.05 1.28). Symptoms in the first trimester were not significantly associated with any of the outcomes. In the second trimester, we observed significantly higher aRRs for LBW and SGA (LBW: aRR 1.17; 95% CI 1.01 1.36; SGA: aRR 1.16; 95% CI 1.05 1.29) and a significantly lower aRR for preterm birth (aRR 0.75; 95% CI 0.59 0.96). In the third trimester, we observed significantly higher aRRs for LBW and SGA (LBW: aRR 1.20; 95% CI 1.01 1.43; SGA: aRR 1.14; 95% CI 1.01 1.29). Conclusions Symptoms of nausea, vomiting or poor appetite during pregnancy are associated with LBW, SGA and preterm birth in a setting with limited resources, especially beyond the first trimester. Trial registration Prospectively registered at ClinicalTrials.gov on Dec 17, 2009 (NCT01034254).
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Affiliation(s)
- Amanda Regodón Wallin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room W5009, 21203-2105, Baltimore, MD, USA.
| | - James M Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | - Luke C Mullany
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Janet A Englund
- Seattle Children's Research Institute, University of Washington, Seattle, WA, USA
| | - Helen Chu
- Department of Medicine, University of Washington, WA, Seattle, USA
| | - Steven C LeClerq
- Nepal Nutrition Intervention Project, Sarlahi, Kathmandu, Nepal.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room W5009, 21203-2105, Baltimore, MD, USA
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13
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Dekkers GWF, Broeren MAC, Truijens SEM, Kop WJ, Pop VJM. Hormonal and psychological factors in nausea and vomiting during pregnancy. Psychol Med 2020; 50:229-236. [PMID: 30696502 DOI: 10.1017/s0033291718004105] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The aetiology of nausea and vomiting during pregnancy (NVP) is multifactorial, but the relative contribution of biological and psychological determinants is insufficiently understood. We examined the association of human chorionic gonadotropin (hCG), thyroid hormones (thyroid-stimulating hormone and thyroxin) and psychological factors with NVP. METHODS Blood chemistry and psychological measures were obtained in 1682 pregnant women participating in the Holistic Approach to Pregnancy and the first Postpartum Year (HAPPY) study between 12 and 14 weeks of gestation. The presence of NVP was measured using the Pregnancy-Unique Quantification of Emesis scale. Depressive symptoms were assessed using the Edinburgh Depression Scale. Multivariable logistic regression analyses were used to investigate the independent role of hCG, thyroid hormones and depression as related to NVP, adjusting for age, body mass index, education, parity, smoking status, unplanned pregnancy and history of depression. RESULTS Elevated levels of NVP were observed in 318 (18.9%) participants. High hCG levels [odds ratio (OR) = 1.47, 95% confidence interval (CI) = 1.11-1.95], elevated depressive symptoms in the first trimester (OR = 1.67, 95% CI = 1.15-2.43) and a history of depression (OR = 1.53, 95% CI = 1.11-2.11) were independently related to high NVP. Multiparity (OR = 1.47, 95% CI = 1.12-1.92) and younger age (OR = 0.91, 95% CI = 0.87-0.94) were also associated with high NVP, whereas (sub)clinical hyperthyroidism was not related to high NVP. CONCLUSIONS The current study is the first to demonstrate that a combination of hCG hormone and psychological factors are independently related to nausea and vomiting during early pregnancy.
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Affiliation(s)
- Guus W F Dekkers
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Maarten A C Broeren
- Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Sophie E M Truijens
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Willem J Kop
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Victor J M Pop
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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14
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Abstract
Nausea and vomiting of pregnancy (NVP) is a common condition that affects as many as 70% of pregnant women. Although no consensus definition is available for hyperemesis gravidarum (HG), it is typically viewed as the severe form of NVP and has been reported to occur in 0.3-10.8% of pregnant women. HG can be associated with poor maternal, fetal and child outcomes. The majority of women with NVP can be managed with dietary and lifestyle changes, but more than one-third of patients experience clinically relevant symptoms that may require fluid and vitamin supplementation and/or antiemetic therapy such as, for example, combined doxylamine/pyridoxine, which is not teratogenic and may be effective in treating NVP. Ondansetron is commonly used to treat HG, but studies are urgently needed to determine whether it is safer and more effective than using first-line antiemetics. Thiamine (vitamin B1) should be introduced following protocols to prevent refeeding syndrome and Wernicke encephalopathy. Recent advances in the genetic study of NVP and HG suggest a placental component to the aetiology by implicating common variants in genes encoding placental proteins (namely GDF15 and IGFBP7) and hormone receptors (namely GFRAL and PGR). New studies on aetiology, diagnosis, management and treatment are under way. In the next decade, progress in these areas may improve maternal quality of life and limit the adverse outcomes associated with HG.
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15
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McNamara K, Wood E. Food taboos, health beliefs, and gender: understanding household food choice and nutrition in rural Tajikistan. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2019; 38:17. [PMID: 31387643 PMCID: PMC6685270 DOI: 10.1186/s41043-019-0170-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 03/18/2019] [Indexed: 04/17/2023]
Abstract
Household nutrition is influenced by interactions between food security and local knowledge negotiated along multiple axes of power. Such processes are situated within political and economic systems from which structural inequalities are reproduced at local, national, and global scales. Health beliefs and food taboos are two manifestations that emerge within these processes that may contribute beneficial, benign, or detrimental health outcomes. This study explores the social dimensions of food taboos and health beliefs in rural Khatlon province, Tajikistan and their potential impact on household-level nutrition. Our analysis considers the current and historical and political context of Tajikistan, with particular attention directed towards evolving gender roles in the wake of mass out-migration of men from 1990 to the present. Considering the patrilieneal, patrilocal social system typical to Khatlon, focus group discussions were conducted with the primary decision-making groups of the household: in-married women, mothers-in-law, and men. During focus groups, participants discussed age- and gender-differentiated taboos that call for avoidance of several foods central to the Tajik diet during sensitive periods in the life cycle when micronutrient and energy requirements peak: infancy and early childhood (under 2 years of age), pregnancy, and lactation. Participants described dynamic and complex processes of knowledge sharing and food practices that challenge essentialist depictions of local knowledges. Our findings are useful for exploring entaglements of gender and health that play out across multiple spatial and temporal scales. While this study is situated in the context of nutrition and agriculture extension, we hope researchers and practitioners of diverse epistemologies will draw connections to diverse areas of inquiry and applications.
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Affiliation(s)
- Katharine McNamara
- Department of Environmental & Global Health College of Public Health and Health Professions, University of Florida, 1225 Center Drive, P.O. Box 100182, Gainesville, FL 32610-0182 USA
| | - Elizabeth Wood
- Department of Environmental & Global Health College of Public Health and Health Professions, University of Florida, 1225 Center Drive, P.O. Box 100182, Gainesville, FL 32610-0182 USA
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16
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Takei H, Shiraishi M, Matsuzaki M, Haruna M. Factors related to vegetable intake among pregnant Japanese women: A cross-sectional study. Appetite 2018; 132:175-181. [PMID: 30102942 DOI: 10.1016/j.appet.2018.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/31/2018] [Accepted: 08/07/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Vegetable intake (VI) is important for both fetal and maternal health. However, VI is insufficient among many pregnant Japanese women. This study aimed to identify the factors related to VI during pregnancy. METHODS A cross-sectional study was conducted in 2014, at a university hospital in Tokyo, Japan. Dietary intake was assessed using a brief-type self-administered diet history questionnaire. Demographic, physical, and psychological characteristics, dietary habits, and health-related behaviors were investigated using another questionnaire. Multiple linear regression analysis was used to identify factors related to VI. RESULTS Data of 273 healthy pregnant women was analyzed. The median value of energy-adjusted VI was 140.4 g/1000 kcal. Severe pregnancy-associated nausea (β = -0.148), a habit of eating out (β = -0.174), a habit of eating confectioneries (β = -0.158), and perceived barriers to obtaining vegetables (β = -0.149) were negatively associated with the energy-adjusted VI. In contrast, exercise habits (β = 0.193), knowledge of the recommended VI amounts for non-pregnant adults (β = 0.105), and the Vegetable Intake Self-Efficacy scale scores (β = 0.193) were positively associated with the energy-adjusted VI. CONCLUSIONS Pregnant women with severe pregnancy-associated nausea, or those who habitually eat out or eat confectioneries, may be a potential high-risk population for low VI. Enhancing knowledge and self-efficacy regarding VI would be effective in increasing VI during pregnancy.
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Affiliation(s)
- Haruka Takei
- Department of Midwifery and Women's Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mie Shiraishi
- Department of Midwifery and Women's Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Children and Women's Health, Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan.
| | - Masayo Matsuzaki
- Department of Midwifery and Women's Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Children and Women's Health, Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Megumi Haruna
- Department of Midwifery and Women's Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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17
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Savard C, Lemieux S, Lafrenière J, Laramée C, Robitaille J, Morisset AS. Validation of a self-administered web-based 24-hour dietary recall among pregnant women. BMC Pregnancy Childbirth 2018; 18:112. [PMID: 29685127 PMCID: PMC5913813 DOI: 10.1186/s12884-018-1741-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 04/12/2018] [Indexed: 01/11/2023] Open
Abstract
Background The use of valid dietary assessment methods is crucial to analyse adherence to dietary recommendations among pregnant women. This study aims to assess the relative validity of a self-administered Web-based 24-h dietary recall, the R24W, against a pen-paper 3-day food record (FR) among pregnant women. Methods Sixty (60) pregnant women recruited at 9.3 ± 0.7 weeks of pregnancy in Quebec City completed, at each trimester, 3 R24W and a 3-day FR. Mean energy and nutrient intakes reported by both tools were compared using paired Student T-Tests. Pearson correlations were used to analyze the association between both methods. Agreement between the two methods was evaluated using cross-classification analyses, weighted kappa coefficients and Bland-Altman analyses. Results Pearson correlation coefficients were all significant, except for vitamin B12 (r = 0.03; p = 0.83) and ranged from 0.27 to 0.76 (p < 0.05). Differences between mean intakes assessed by the R24W and the FR did not exceed 10% in 19 variables and were not significant for 16 out of 26 variables. In cross-classification analyses, the R24W ranked, on average, 79.1% of participants in the same or adjacent quartiles as the FR. Conclusions Compared to a 3-day FR, the R24W is a valid method to assess intakes of energy and most nutrients but may be less accurate in the evaluation of intakes of fat (as a proportion of energy intake), vitamin D, zinc and folic acid. During pregnancy, the R24W was a more accurate tool at a group-level than at an individual-level and should, therefore, be used in an epidemiological rather than a clinical setting. The R24W may be particularly valuable as a tool used in cohort studies to provide valid information on pregnant women’s dietary intakes and facilitate evaluation of associations between diet and adverse pregnancy outcomes. Electronic supplementary material The online version of this article (10.1186/s12884-018-1741-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claudia Savard
- École de nutrition de l'Université Laval, Pavillon Paul-Comtois, Université Laval, 2425, rue de l'Agriculture, local 2412, Québec, G1V 0A6, Canada.,Axe d'endocrinologie et de néphrologie du Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Institut sur la nutrition et les aliments fonctionnels, Université Laval, Québec, QC, Canada
| | - Simone Lemieux
- École de nutrition de l'Université Laval, Pavillon Paul-Comtois, Université Laval, 2425, rue de l'Agriculture, local 2412, Québec, G1V 0A6, Canada.,Institut sur la nutrition et les aliments fonctionnels, Université Laval, Québec, QC, Canada
| | - Jacynthe Lafrenière
- École de nutrition de l'Université Laval, Pavillon Paul-Comtois, Université Laval, 2425, rue de l'Agriculture, local 2412, Québec, G1V 0A6, Canada.,Institut sur la nutrition et les aliments fonctionnels, Université Laval, Québec, QC, Canada
| | - Catherine Laramée
- Institut sur la nutrition et les aliments fonctionnels, Université Laval, Québec, QC, Canada
| | - Julie Robitaille
- École de nutrition de l'Université Laval, Pavillon Paul-Comtois, Université Laval, 2425, rue de l'Agriculture, local 2412, Québec, G1V 0A6, Canada.,Axe d'endocrinologie et de néphrologie du Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Institut sur la nutrition et les aliments fonctionnels, Université Laval, Québec, QC, Canada
| | - Anne-Sophie Morisset
- École de nutrition de l'Université Laval, Pavillon Paul-Comtois, Université Laval, 2425, rue de l'Agriculture, local 2412, Québec, G1V 0A6, Canada. .,Axe d'endocrinologie et de néphrologie du Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada. .,Institut sur la nutrition et les aliments fonctionnels, Université Laval, Québec, QC, Canada.
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18
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Jara-Palacios MÁ, Cornejo AC, Narváez-Caicedo C, Moreano G, Vásquez KP, Moreno-Izquierdo C, Romero-Sandoval N. Plasma zinc levels in Ecuadorian mothers of infants with nonsyndromic cleft lip with or without cleft palate: A case series. Birth Defects Res 2018; 110:495-501. [PMID: 29316356 DOI: 10.1002/bdr2.1188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/12/2017] [Accepted: 11/28/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Previous studies have reported an association between maternal zinc deficiency and increased risk of nonsyndromic cleft lip with or without cleft palate (NSCL/P) in offspring. A high prevalence of zinc deficiency and a high prevalence of NSCL/P have been reported in Ecuador. We postulated that mothers of infants with NSCL/P may have lower serum zinc levels than women from the general population. METHODS A case series study was conducted from November 2013 to July 2016. Thirty-five healthy mothers of infants with NSCL/P were selected during surgical missions conducted by Operación Sonrisa Ecuador. A single blood sample along with pertinent medical history was collected during personal interviews after 3.6 months postpartum. The prevalence of plasma zinc concentration (PZn) deficiency among the participants was determined and analyzed along with the prevalence of PZn deficiency in Ecuadorian women of reproductive age from the general population. RESULTS The mean PZn was 11.47 µmol/dm3 . The prevalence of PZn deficiency among the participants was 31.4% (95% CI: 17.1-48.6) and differed significantly from the prevalence of zinc deficiency observed among women from the general population (G2 = 8.66; p < .05). CONCLUSIONS The results showed that the prevalence of PZn deficiency is lower in a cohort of healthy mothers of infants with NSCL/P than in women from the general population in Ecuador. More studies are required to confirm these findings and evaluate other factors related to NSCL/P pathophysiology in the Ecuadorian population.
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Affiliation(s)
- Miguel Ángel Jara-Palacios
- Escuela de Medicina, Facultad de Ciencias Médicas, de la Salud y de la Vida, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Angélica Carolina Cornejo
- Escuela de Medicina, Facultad de Ciencias Médicas, de la Salud y de la Vida, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Camila Narváez-Caicedo
- Escuela de Medicina, Facultad de Ciencias Médicas, de la Salud y de la Vida, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Gabriela Moreano
- Escuela de Medicina, Facultad de Ciencias Médicas, de la Salud y de la Vida, Universidad Internacional del Ecuador, Quito, Ecuador
| | | | - Cristina Moreno-Izquierdo
- Escuela de Medicina, Facultad de Ciencias Médicas, de la Salud y de la Vida, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Natalia Romero-Sandoval
- Escuela de Medicina, Facultad de Ciencias Médicas, de la Salud y de la Vida, Universidad Internacional del Ecuador, Quito, Ecuador.,Grups de Recerca d'Amèrica i Àfrica Llatines- GRAAL, Barcelona, España
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19
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Adu-Afarwuah S, Lartey A, Dewey KG. Meeting nutritional needs in the first 1000 days: a place for small-quantity lipid-based nutrient supplements. Ann N Y Acad Sci 2017; 1392:18-29. [PMID: 28319655 DOI: 10.1111/nyas.13328] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/28/2017] [Accepted: 02/06/2017] [Indexed: 02/06/2023]
Abstract
The first 1000 days of life is marked by intense metabolic activity and tissue deposition. The increased nutritional needs during this period, and the challenges to meeting them, are often not understood or appreciated. Here, we describe the nutritional needs during the first 1000 days, highlight the challenges to meeting these needs in developing countries, outline intervention strategies, and examine the consumption of small-quantity lipid-based nutrient supplements (SQ-LNS) as a promising strategy. In low-income settings, the challenge to meeting nutritional needs during the first 1000 days is worsened by overreliance on cereal-based diets of low nutrient density and high prevalence of infections and infestations. Dietary diversification is the ideal long-term solution to nutritional deficiencies, but difficulties with obtaining adequate amounts of iron, zinc, and certain vitamins may still remain. Several other interventions are available, but applying them is often fraught with challenges, including cost and contextual factors limiting efficacy. Evidence suggests that SQ-LNS supplementation may help reduce inadequate gestational weight gain and promote fetal and child growth and development in some populations. More research is needed to evaluate the effectiveness of SQ-LNS and other fortified products in different contexts and within integrated programs that address other determinants of maternal and child undernutrition.
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Affiliation(s)
- Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Anna Lartey
- Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Kathryn G Dewey
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, California
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20
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Abstract
Supplemental Digital Content is available in the text. Background: The relationship between arsenic and birth weight is not well understood. The objective was to evaluate the causal relationship between prenatal arsenic exposure and birth weight considering the potential mediation effects of gestational age and maternal weight gain during pregnancy using structural equation models. Methods: A prospectively enrolled cohort of pregnant women was recruited in Bangladesh from 2008 to 2011. Arsenic was measured in personal drinking water at the time of enrollment (gestational age <16 weeks, N = 1,140) and in toenails collected ≤1 month postpartum (N = 624) using inductively coupled plasma mass spectrometry. Structural equation models estimated the direct and indirect effects of arsenic on birth weight with gestational age and maternal weight gain considered as mediating variables. Results: Every unit increase in natural log water arsenic was indirectly associated with decreased birth weight (β = −19.17 g, 95% confidence interval [CI]: −24.64, −13.69) after adjusting for other risk factors. This association was mediated entirely through gestational age (β = −17.37 g, 95% CI: −22.77, −11.98) and maternal weight gain during pregnancy (β = −1.80 g, 95% CI: −3.72, 0.13). When exposure was modeled using toenail arsenic concentrations, similar results were observed. Every increase in natural log toenail arsenic was indirectly associated with decreased birth weight (β = −15.72 g, 95% CI: −24.52, −6.91) which was mediated through gestational age (β = −13.59 g, 95% CI: −22.10, −5.07) and maternal weight gain during pregnancy (β = −2.13 g, 95% CI: −5.24, 0.96). Conclusion: Arsenic exposure during pregnancy was associated with lower birth weight. The effect of arsenic on birth weight appears to be mediated mainly through decreasing gestational age and to a lesser extent by lower maternal weight gain during pregnancy.
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21
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Crozier SR, Inskip HM, Godfrey KM, Cooper C, Robinson SM. Nausea and vomiting in early pregnancy: Effects on food intake and diet quality. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 27896913 PMCID: PMC5400073 DOI: 10.1111/mcn.12389] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 09/07/2016] [Accepted: 09/12/2016] [Indexed: 11/30/2022]
Abstract
Experiences of nausea and/or vomiting in pregnancy (NVP) vary greatly, but the paucity of studies with pre-pregnancy dietary data mean that little is known about the effects of NVP on diet. Using an administered food frequency questionnaire, diet was assessed before pregnancy and at 11 and 34 weeks' gestation in 2270 participants in a UK birth cohort study (Southampton Women's Survey). Experience of NVP in early pregnancy was graded as none, mild, moderate, or severe. Participants reported their level of food consumption as more, the same, or less than before pregnancy. "Prudent" diet scores (derived using principal component analysis) were used to describe participants' diet quality before, in early and late pregnancy. In early pregnancy, 89% of women were nauseous, although most commonly, the NVP experienced was mild (48%) or moderate (30%); 11% had severe NVP. A total of 39% of women reported an increase in their level of food intake in early pregnancy; 34% reported a reduction. Increasing severity of nausea was associated with changes in intake of a range of foods, most notably reduced consumption of vegetables, tea/coffee, rice/pasta, breakfast cereals, beans/pulses and citrus fruits/fruit juices and increased consumption of white bread, and soft drinks. Increasing severity of nausea was also associated with decreasing prudent diet score from before to early pregnancy, such that women with severe nausea had prudent diet scores 0.29 SDs lower than those with no nausea (P < 0.001). However, this was transient as NVP was not related to change in diet quality from before to late pregnancy.
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Affiliation(s)
- Sarah R Crozier
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Hazel M Inskip
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Sian M Robinson
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
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- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
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Validation of a food-frequency questionnaire for assessing vitamin intake of Japanese women in early and late pregnancy with and without nausea and vomiting. J Nutr Sci 2016; 5:e27. [PMID: 27547390 PMCID: PMC4976112 DOI: 10.1017/jns.2016.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/21/2016] [Indexed: 12/03/2022] Open
Abstract
Maternal vitamin intake during pregnancy is crucial for pregnancy outcomes and the child's subsequent health. However, there are few valid instruments for assessing vitamin intake that address the effects of nausea and vomiting during pregnancy (NVP). This study aimed to investigate the validity of a FFQ concerning vitamin intake during early and late pregnancy with and without NVP. The participants comprised 200 Japanese pregnant women who completed the FFQ and from whom blood samples were taken in early and late pregnancy. Energy-adjusted dietary vitamin intakes (vitamin C, folate, vitamin B6, vitamin B12, vitamin A, vitamin E and vitamin D) from FFQ were compared with their blood concentrations. A subgroup of women with NVP was investigated. In early pregnancy, significant correlations between FFQ and biomarkers were observed for vitamin C (r 0·27), folate (r 0·18) and vitamin D (r 0·26) in women with NVP and for vitamin A (r 0·18), vitamin B12 (r 0·24) and vitamin D (r 0·23) in women without NVP. No significant correlations were observed in either group for vitamins B6 or E. In late pregnancy, similar significant associations were observed for vitamin C (r 0·27), folate (r 0·22), vitamin B6 (r 0·18), vitamin B12 (r 0·27) and vitamin A (r 0·15); coefficients were higher among women without NVP. Our study demonstrates that the FFQ is a useful tool for assessing intake of several important vitamins in early and late pregnancy regardless of NVP status.
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Abstract
Implantation failure and pregnancy loss are estimated to affect up to 75% of fertilized ova; however as of yet there is limited empirical evidence, particularly at the population level, for understanding the environmental determinants of these losses. The purpose of this review is to summarize the current knowledge on prepregnancy nutrition and early pregnancy outcomes with particular focus on the outcome of spontaneous abortion among pregnancies conceived naturally and early pregnancy end points among pregnancies conceived through in vitro fertilization. To date, there is limited evidence to support associations of prepregnancy vitamin D and caffeine intake with pregnancy loss. There is suggestive data supporting a link between a healthy diet and lower risk of pregnancy loss. High folate and minimal to no alcohol intake prior to conception have the most consistent evidence supporting an association with lower risk of pregnancy loss.
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Birkeland E, Stokke G, Tangvik RJ, Torkildsen EA, Boateng J, Wollen AL, Albrechtsen S, Flaatten H, Trovik J. Norwegian PUQE (Pregnancy-Unique Quantification of Emesis and nausea) identifies patients with hyperemesis gravidarum and poor nutritional intake: a prospective cohort validation study. PLoS One 2015; 10:e0119962. [PMID: 25830549 PMCID: PMC4382206 DOI: 10.1371/journal.pone.0119962] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 01/18/2015] [Indexed: 11/21/2022] Open
Abstract
Objective The English questionnaire Pregnancy-Unique Quantification of Emesis and nausea (PUQE) identifies women with severe Hyperemesis Gravidarum. Our aim was to investigate whether scores from the translated Norwegian version; SUKK (SvangerskapsUtløst Kvalme Kvantifisering) was associated with severity of hyperemesis and nutritional intake. Design A prospective cohort validation study. Setting Hospital cohort of Hyperemesis Gravidarum (HG) patients from western Norway and healthy pregnant women from Bergen, Norway. Sample 38 women hospitalized due to HG and 31 healthy pregnant controls attending routine antenatal check-up at health centers. Methods Data were collected May 2013-January 2014. The study participants answered the Norwegian PUQE-questionnaire (scores ranging from 3 to15) and registered prospectively 24-hours nutritional intake by a food list form. Main outcome measures Differences of PUQE-scores, QOL-score and nutritional intake between hyperemesis patients and controls. Results Hyperemesis patients had shorter gestational age compared to controls (median 9.7 weeks; 95% CI 8.6-10.6 versus 11.9; 95% CI 10.1-12.9, p=0.004), and larger weight-change from pre-pregnant weight (loss of median 3 kg; 95% CI 3-4 versus gain of 2 kg; 95% CI 0.5-2, p<0.001) otherwise groups were similar regarding pre-pregnant BMI, age, gravidity, and inclusion weight. Compared to controls, hyperemesis patients had significant higher PUQE-score (median 13; 95% CI 11-14 vs. 7; 95% CI 4-8), lower QOL (median score 3; 95% CI 2-4 vs. 6; 95% CI 4.5-8) and lower nutritional intake (energy intake median 990 kcal/24 hours; 95% CI 709-1233 vs. 1652; 95% CI 1558-1880 all p<0.001). PUQE-score was inversely correlated to nutritional intake (-0.5, p<0.001). At discharge PUQE-score had fallen to median 6 (95% CI 5-8) and QOL score risen to 7 (95% CI 6-8) in the HG group, (both p<0.001 compared to admission values). Conclusion PUQE-scoring has been validated as a robust indicator of severe hyperemesis gravidarum and insufficient nutritional intake in a Norwegian setting.
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Affiliation(s)
| | - Guro Stokke
- Dpt. Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Randi J Tangvik
- Dpt. Research and Development, Haukeland University Hospital, Bergen, Norway
| | - Erik A Torkildsen
- Dpt. Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - Jane Boateng
- Dpt. Obstetrics and Gynecology, Helse-Foerde, Foerde, Norway
| | | | - Susanne Albrechtsen
- Dpt. Clinical Science, University of Bergen, Bergen, Norway; Dpt. Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Hans Flaatten
- Dpt. Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway; Dpt. Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jone Trovik
- Dpt. Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
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The expression and adaptive significance of pregnancy-related nausea, vomiting, and aversions on Yasawa Island, Fiji. EVOL HUM BEHAV 2015. [DOI: 10.1016/j.evolhumbehav.2014.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Gaskins AJ, Rich-Edwards JW, Hauser R, Williams PL, Gillman MW, Penzias A, Missmer SA, Chavarro JE. Prepregnancy dietary patterns and risk of pregnancy loss. Am J Clin Nutr 2014; 100:1166-72. [PMID: 25240079 PMCID: PMC4163795 DOI: 10.3945/ajcn.114.083634] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Two previous case-control studies observed associations between specific food groups and risk of miscarriage; however, to our knowledge, no previous studies have investigated dietary patterns and risk of pregnancy loss. OBJECTIVE We aimed to assess prepregnancy adherence to the alternate Healthy Eating Index 2010 (aHEI-2010), alternate Mediterranean diet (aMED), and Fertility Diet (FD) and risk of pregnancy loss. DESIGN Our prospective cohort study included 15,950 pregnancies reported by 11,072 women in the Nurses' Health Study II between 1992 and 2009. Diet was assessed every 4 y starting in 1991 by using a validated food-frequency questionnaire. Prepregnancy dietary pattern scores were computed as the sum of a woman's score on each pattern's predefined components. Multivariable log-binomial regression models with generalized estimating equations were used to estimate RRs and 95% CIs. RESULTS Incident spontaneous abortions and stillbirths were reported in 2756 (17.3%) and 120 (0.8%) pregnancies, respectively. None of the 3 dietary patterns were associated with risk of pregnancy loss. In the multivariable model, RR of pregnancy loss for a 1-SD increase in score was 1.02 (95% CI: 0.98, 1.05) for the aMED pattern, 1.01 (95% CI: 0.98, 1.05) for the aHEI-2010 pattern, and 0.98 (95% CI: 0.95, 1.01) for the FD pattern. Results were consistent when pregnancy loss was classified as either a spontaneous abortion (loss at <20 wk) or a stillbirth (loss at ≥20 wk). CONCLUSION Prepregnancy adherence to several dietary patterns was not associated with risk of pregnancy loss.
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Affiliation(s)
- Audrey J Gaskins
- From the Departments of Nutrition (AJG, MWG, and JEC), Epidemiology (AJG, JWR-E, RH, PLW, SAM, and JEC), Environmental Health (RH), and Biostatistics (PLW), Harvard School of Public Health, Boston, MA; the Channing Division of Network Medicine (JWR-E, SAM, and JEC) and Connors Center for Women's Health and Gender Biology (JWR-E), Department of Medicine, and the Department of Obstetrics, Gynecology, and Reproductive Biology (SAM), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; the Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (MWG); the Department of Obstetrics, Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (AP); and Boston In Vitro Fertilization, Waltham, MA (AP)
| | - Janet W Rich-Edwards
- From the Departments of Nutrition (AJG, MWG, and JEC), Epidemiology (AJG, JWR-E, RH, PLW, SAM, and JEC), Environmental Health (RH), and Biostatistics (PLW), Harvard School of Public Health, Boston, MA; the Channing Division of Network Medicine (JWR-E, SAM, and JEC) and Connors Center for Women's Health and Gender Biology (JWR-E), Department of Medicine, and the Department of Obstetrics, Gynecology, and Reproductive Biology (SAM), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; the Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (MWG); the Department of Obstetrics, Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (AP); and Boston In Vitro Fertilization, Waltham, MA (AP)
| | - Russ Hauser
- From the Departments of Nutrition (AJG, MWG, and JEC), Epidemiology (AJG, JWR-E, RH, PLW, SAM, and JEC), Environmental Health (RH), and Biostatistics (PLW), Harvard School of Public Health, Boston, MA; the Channing Division of Network Medicine (JWR-E, SAM, and JEC) and Connors Center for Women's Health and Gender Biology (JWR-E), Department of Medicine, and the Department of Obstetrics, Gynecology, and Reproductive Biology (SAM), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; the Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (MWG); the Department of Obstetrics, Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (AP); and Boston In Vitro Fertilization, Waltham, MA (AP)
| | - Paige L Williams
- From the Departments of Nutrition (AJG, MWG, and JEC), Epidemiology (AJG, JWR-E, RH, PLW, SAM, and JEC), Environmental Health (RH), and Biostatistics (PLW), Harvard School of Public Health, Boston, MA; the Channing Division of Network Medicine (JWR-E, SAM, and JEC) and Connors Center for Women's Health and Gender Biology (JWR-E), Department of Medicine, and the Department of Obstetrics, Gynecology, and Reproductive Biology (SAM), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; the Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (MWG); the Department of Obstetrics, Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (AP); and Boston In Vitro Fertilization, Waltham, MA (AP)
| | - Matthew W Gillman
- From the Departments of Nutrition (AJG, MWG, and JEC), Epidemiology (AJG, JWR-E, RH, PLW, SAM, and JEC), Environmental Health (RH), and Biostatistics (PLW), Harvard School of Public Health, Boston, MA; the Channing Division of Network Medicine (JWR-E, SAM, and JEC) and Connors Center for Women's Health and Gender Biology (JWR-E), Department of Medicine, and the Department of Obstetrics, Gynecology, and Reproductive Biology (SAM), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; the Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (MWG); the Department of Obstetrics, Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (AP); and Boston In Vitro Fertilization, Waltham, MA (AP)
| | - Alan Penzias
- From the Departments of Nutrition (AJG, MWG, and JEC), Epidemiology (AJG, JWR-E, RH, PLW, SAM, and JEC), Environmental Health (RH), and Biostatistics (PLW), Harvard School of Public Health, Boston, MA; the Channing Division of Network Medicine (JWR-E, SAM, and JEC) and Connors Center for Women's Health and Gender Biology (JWR-E), Department of Medicine, and the Department of Obstetrics, Gynecology, and Reproductive Biology (SAM), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; the Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (MWG); the Department of Obstetrics, Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (AP); and Boston In Vitro Fertilization, Waltham, MA (AP)
| | - Stacey A Missmer
- From the Departments of Nutrition (AJG, MWG, and JEC), Epidemiology (AJG, JWR-E, RH, PLW, SAM, and JEC), Environmental Health (RH), and Biostatistics (PLW), Harvard School of Public Health, Boston, MA; the Channing Division of Network Medicine (JWR-E, SAM, and JEC) and Connors Center for Women's Health and Gender Biology (JWR-E), Department of Medicine, and the Department of Obstetrics, Gynecology, and Reproductive Biology (SAM), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; the Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (MWG); the Department of Obstetrics, Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (AP); and Boston In Vitro Fertilization, Waltham, MA (AP)
| | - Jorge E Chavarro
- From the Departments of Nutrition (AJG, MWG, and JEC), Epidemiology (AJG, JWR-E, RH, PLW, SAM, and JEC), Environmental Health (RH), and Biostatistics (PLW), Harvard School of Public Health, Boston, MA; the Channing Division of Network Medicine (JWR-E, SAM, and JEC) and Connors Center for Women's Health and Gender Biology (JWR-E), Department of Medicine, and the Department of Obstetrics, Gynecology, and Reproductive Biology (SAM), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; the Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA (MWG); the Department of Obstetrics, Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (AP); and Boston In Vitro Fertilization, Waltham, MA (AP)
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Li Q, Xiong R, Wang L, Cui J, Shi L, Liu Y, Luo B. Associations of dietary habits, physical activity and cognitive views with gestational diabetes mellitus among Chinese women. Public Health Nutr 2014; 17:1850-7. [PMID: 23920137 PMCID: PMC10282208 DOI: 10.1017/s1368980013001882] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 06/02/2013] [Accepted: 06/12/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the relationship between dietary habits, physical activity and cognitive views and the risk of gestational diabetes mellitus (GDM) in Chinese women. DESIGN A cross-sectional study to explore the potential risk factors of GMD through the International Physical Activity Questionnaire, an FFQ and a self-designed structured questionnaire, respectively. SETTING Guangzhou, Guangdong Province, China. SUBJECTS Chinese pregnant women (n 571) who underwent a 75-g oral glucose tolerance test at their 24th to 28th gestational week. RESULTS Thirteen per cent of the investigated women were identified as having GDM, and an increased intake of local featured foods and lower physical activity were observed in the GDM-positive group v. the GDM-negative group. Women who regarded early-pregnancy morning sickness as relevant to fetal abnormalities and those with unlimited dietary intake after the ending of morning sickness both had an increased risk for GDM (P = 0·018 and P = 0·038, respectively). After multiple logistic regression analysis, cognitive views for unlimited food intake subsequent to morning sickness, increased consumption of energy-dense snack foods and high-glycaemic-index fruits were strongly associated with the risk of GDM (OR = 1·911, P = 0·032; OR = 1·050, P = 0·001; and OR = 1·002, P = 0·017, respectively). CONCLUSIONS Local featured foods and incorrect cognitive views on pregnancy-related health were closely related to the risk of GDM in Chinese women. Intensive health education about pregnancy physiology and reasonable dietary and physical exercise behaviours should be strengthened for the control of GDM.
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Affiliation(s)
- Qing Li
- Department of Dietetics, Nanfang Hospital, Southern Medical University, 1838 N. Guangzhou DaDao, Guangzhou 510515, People's Republic of China
- School of Public Health and Tropical Medicine, Southern Medical University, 1023 S. Shatai Road, Guangzhou 510515, People's Republic of China
| | - Ribo Xiong
- School of Public Health and Tropical Medicine, Southern Medical University, 1023 S. Shatai Road, Guangzhou 510515, People's Republic of China
| | - Liang Wang
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Junying Cui
- School of Public Health and Tropical Medicine, Southern Medical University, 1023 S. Shatai Road, Guangzhou 510515, People's Republic of China
| | - Linna Shi
- Department of Dietetics, Nanfang Hospital, Southern Medical University, 1838 N. Guangzhou DaDao, Guangzhou 510515, People's Republic of China
| | - Yungang Liu
- School of Public Health and Tropical Medicine, Southern Medical University, 1023 S. Shatai Road, Guangzhou 510515, People's Republic of China
| | - Bingde Luo
- School of Public Health and Tropical Medicine, Southern Medical University, 1023 S. Shatai Road, Guangzhou 510515, People's Republic of China
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Correia-Branco A, Keating E, Martel F. Maternal undernutrition and fetal developmental programming of obesity: the glucocorticoid connection. Reprod Sci 2014; 22:138-45. [PMID: 25001018 DOI: 10.1177/1933719114542012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
An adequate maternal nutrition during pregnancy is crucial for the health outcome of offspring in adulthood. Maternal undernutrition during critical periods of fetal development can program the fetus for metabolic syndrome (MetS) later in life, especially when postnatally challenged with a hypernutritive diet. Adipogenesis, which begins in utero and accelerates in neonatal life, is a major candidate for developmental programming. During fetal development, the hypothalamic-pituitary-adrenal (HPA) axis is extremely susceptible to programming, and the HPA tone is increased throughout life in undernourished conditions. As a consequence, an alteration in the expression and function of glucocorticoid (GC) receptors and of the major GC regulatory enzymes (11β-hydroxysteroid dehydrogenase 1 and -2) occurs. In this review, we will give insights into the role of maternoplacental adverse interactions under the specific context of maternal undernutrition, for later-in-life MetS development, with a special emphasis on the role of GCs.
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Affiliation(s)
- Ana Correia-Branco
- Department of Biochemistry, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Elisa Keating
- Department of Biochemistry, Faculty of Medicine, University of Porto, Porto, Portugal Center for Biotechnology and Fine Chemistry, School of Biotechnology, Portuguese Catholic University, Porto, Portugal
| | - Fátima Martel
- Department of Biochemistry, Faculty of Medicine, University of Porto, Porto, Portugal
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Catallozzi M, Williams CY, Zimet GD, Hargreaves KM, Gelber SE, Ratner AJ, Stanberry LR, Rosenthal SL. Attitudes towards microbicide use for bacterial vaginosis in pregnancy. Sex Health 2014; 11:305-12. [PMID: 25140927 DOI: 10.1071/sh14011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 05/27/2014] [Indexed: 01/11/2023]
Abstract
UNLABELLED Background Bacterial vaginosis (BV) is the most common reproductive tract infection (RTI) and is a significant risk factor for preterm birth. Microbicides could be an option for the prevention and treatment of BV in pregnancy, and understanding use of the product will be crucial. The present study explored attitudes of women in the third trimester of pregnancy regarding topical microbicide use for the prevention and treatment of BV. METHODS Twenty-six women in their third trimester were interviewed regarding their knowledge and beliefs about RTIs during pregnancy and attitudes concerning the use of topical microbicides for prevention and treatment of BV. RESULTS Participants had a mean age of 24.9 years, were largely under-represented minorities and the majority had had past pregnancies. Participants had knowledge and experience with RTIs but not BV. They were open to the use of microbicides for prevention or treatment of BV, but believed that women requiring treatment would be more motivated. Rationales for acceptability were most commonly related to the baby's health. Practical issues that may interfere with use were often, but not always, related to pregnancy. There was a range of attitudes about partner involvement in decision-making and the practicalities of product use. CONCLUSION Pregnant women are knowledgeable about RTIs but not necessarily BV. The women in this study found microbicide use acceptable, particularly for treatment. To improve acceptability and use, education would be needed about BV and possible complications, how to overcome practical problems and the value of involving partners in the decision.
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Affiliation(s)
- Marina Catallozzi
- Department of Pediatrics, Columbia University College of Physicians & Surgeons-Morgan Stanley Children's Hospital of New York Presbyterian Hospital, 622 West 168th Street, New York, NY 10032, USA
| | - Camille Y Williams
- Department of Pediatrics, Columbia University College of Physicians & Surgeons-Morgan Stanley Children's Hospital of New York Presbyterian Hospital, 622 West 168th Street, New York, NY 10032, USA
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, 410 West 10th Street, Indianapolis, IN 46202, USA
| | - Katharine M Hargreaves
- Department of Pediatrics, Columbia University College of Physicians & Surgeons-Morgan Stanley Children's Hospital of New York Presbyterian Hospital, 622 West 168th Street, New York, NY 10032, USA
| | - Shari E Gelber
- Weill Cornell Medical College, 525 East 168th Street, New York, NY 10065, USA
| | - Adam J Ratner
- Department of Pediatrics, Columbia University College of Physicians & Surgeons-Morgan Stanley Children's Hospital of New York Presbyterian Hospital, 622 West 168th Street, New York, NY 10032, USA
| | - Lawrence R Stanberry
- Department of Pediatrics, Columbia University College of Physicians & Surgeons-Morgan Stanley Children's Hospital of New York Presbyterian Hospital, 622 West 168th Street, New York, NY 10032, USA
| | - Susan L Rosenthal
- Department of Pediatrics, Columbia University College of Physicians & Surgeons-Morgan Stanley Children's Hospital of New York Presbyterian Hospital, 622 West 168th Street, New York, NY 10032, USA
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İsbir GG, Mete S. Experiences with Nausea and Vomiting During Pregnancy in Turkish Women Based on Roy Adaptation Model: A Content Analysis. Asian Nurs Res (Korean Soc Nurs Sci) 2013; 7:175-81. [DOI: 10.1016/j.anr.2013.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 07/18/2013] [Accepted: 08/12/2013] [Indexed: 11/28/2022] Open
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Graham JE, Mayan M, McCargar LJ, Bell RC. Making compromises: a qualitative study of sugar consumption behaviors during pregnancy. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2013; 45:578-585. [PMID: 23877052 DOI: 10.1016/j.jneb.2013.03.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 03/11/2013] [Accepted: 03/16/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To explore influences on women's sugar consumption behaviors during pregnancy. DESIGN Focused ethnography guided this qualitative study. Contrasting experiences between women with varying sugar intakes were investigated using semi-structured interviews. SETTING Metropolitan area, Canada. PARTICIPANTS Fifteen women with varying intakes of added sugar, who were in the third trimester of their first pregnancy, participated in this study. PHENOMENON OF INTEREST Sugar consumption behaviors during pregnancy. ANALYSIS Interviews were audio-recorded, transcribed, and analyzed using qualitative content analysis to inductively derive themes. RESULTS Pregnant women increased their intake of sugars in an effort to achieve a compromise between meeting nutrition recommendations, lifestyle adjustments, physical symptoms, and cultural norms. Physical symptoms, lack of nutritional guidance, and social pressures were identified as barriers to achieving a diet low in sugars, whereas implementing dietary strategies guided by nutritional knowledge was a facilitator. CONCLUSIONS AND IMPLICATIONS This research provides insights that may be used to design effective interventions to improve maternal health. Strategies to help pregnant women achieve a healthy diet and limit sugar intake should be guided by nutritional knowledge, dietary awareness, and internal motivations to engage in healthy dietary changes.
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Affiliation(s)
- Jocelyn E Graham
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
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Chortatos A, Haugen M, Iversen PO, Vikanes Å, Magnus P, Veierød MB. Nausea and vomiting in pregnancy: associations with maternal gestational diet and lifestyle factors in the Norwegian Mother and Child Cohort Study. BJOG 2013; 120:1642-53. [PMID: 23962347 DOI: 10.1111/1471-0528.12406] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2013] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate primarily the dietary intake, as well as demographics and selected lifestyle factors, of women experiencing nausea and vomiting in pregnancy, nausea only, or women who are symptom free. DESIGN Prospective cohort study. SETTING The Norwegian Mother and Child Cohort Study, a population-based pregnancy cohort. SAMPLE Analyses were based on 51 675 Norwegian pregnancies. METHODS Dietary intake was assessed by a self-reported food frequency questionnaire answered in the first trimester of pregnancy, as were data regarding nausea and vomiting. Chi-squared tests, one-way analysis of variance, and multiple linear regression were used. MAIN OUTCOME MEASURES Nausea and vomiting in pregnancy (NVP), gestational weight gain (GWG), and dietary intake. RESULTS We found that 17 070 (33%) women experienced NVP, 20 371 (39%) experienced only nausea, and 14 234 (28%) were symptom free. Women with NVP were younger and heavier at pregnancy onset, with the lowest GWG and highest energy intake during pregnancy, primarily from carbohydrates and added sugars, compared with the other groups (P < 0.001). In multiple linear regression analysis of GWG and group adjusted for body mass index (BMI), gestational length, smoking during pregnancy, and energy intake, a significant interaction was found between BMI and group (P < 0.001). A significant effect of group (P < 0.001) was found in all BMI strata, except among underweight women (P = 0.65). CONCLUSIONS Our study suggests that women with NVP are characterised by high intakes of carbohydrates and added sugar, primarily from sugar-containing soft drinks. Whether higher intakes of carbohydrates are a response aimed to alleviate symptoms, or are actually provoking the condition, is not known.
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Affiliation(s)
- A Chortatos
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Blindern, Oslo, Norway; Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Blindern, Oslo, Norway
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Louie JCY, Markovic TP, Ross GP, Foote D, Brand-Miller JC. Higher glycemic load diet is associated with poorer nutrient intake in women with gestational diabetes mellitus. Nutr Res 2013; 33:259-65. [DOI: 10.1016/j.nutres.2013.02.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 02/11/2013] [Accepted: 02/19/2013] [Indexed: 01/17/2023]
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Shiraishi M, Haruna M, Matsuzaki M, Murayama R, Sasaki S. Validity of a diet history questionnaire estimating β-carotene, vitamin C and α-tocopherol intakes in Japanese pregnant women. Int J Food Sci Nutr 2013; 64:694-9. [PMID: 23506338 DOI: 10.3109/09637486.2013.775225] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We investigated the validity and reproducibility of a self-administered diet history questionnaire (DHQ) that estimates the intakes of β-carotene, vitamin C and α-tocopherol. Ninety-five healthy women with singleton pregnancies in the second trimester were examined at a university hospital in Tokyo. The intakes of β-carotene, vitamin C and α-tocopherol assessed by the DHQ were compared to the corresponding serum concentrations. To assess the reproducibility, 58 pregnant women completed it in two sessions within a 4-5 week interval. We found significantly positive correlations between the energy-adjusted intakes and serum concentrations of β-carotene and vitamin C (r = 0.254 and r = 0.323, respectively). However, α-tocopherol intake was not associated with the corresponding serum concentration. The intraclass correlation coefficients of the two-time DHQ were 0.743 (β-carotene), 0.665 (vitamin C) and 0.718 (α-tocopherol). DHQ has acceptable validity and reproducibility for β-carotene and vitamin C intakes in Japanese pregnant women.
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Affiliation(s)
- Mie Shiraishi
- Midwifery and Women's Health, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan.
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Young AG, Pike IL. A biocultural framework for examining maternal cravings and aversions among pastoral women in east Africa. Ecol Food Nutr 2012; 51:444-62. [PMID: 22881360 DOI: 10.1080/03670244.2012.696013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Food preferences during pregnancy result from a complex set of biocultural interactions with important implications for maternal and child health. This article explores the social context of maternal food choice in marginal environments of East Africa. Biocultural data collected among Turkana and Datoga women living in Kenya and Tanzania indicate there is a significant social context to food choice that influences the types of food that women report craving and the food that is consumed. Our framework argues for a deeper understanding of how culture shapes food preferences and how marginalization can constrain access to favored and healthy foods.
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Affiliation(s)
- Alyson G Young
- Department of Anthropology, University of Florida, Gainesville, Florida 32611, USA.
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Patil CL, Abrams ET, Steinmetz AR, Young SL. Appetite Sensations and Nausea and Vomiting in Pregnancy: An Overview of the Explanations. Ecol Food Nutr 2012; 51:394-417. [DOI: 10.1080/03670244.2012.696010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Shiraishi M, Haruna M, Matsuzaki M, Murayama R, Sasaki S, Murashima S. Validity and reproducibility of folate and vitamin B(12) intakes estimated from a self-administered diet history questionnaire in Japanese pregnant women. Nutr J 2012; 11:15. [PMID: 22420377 PMCID: PMC3324379 DOI: 10.1186/1475-2891-11-15] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 03/15/2012] [Indexed: 11/10/2022] Open
Abstract
Background No validated dietary questionnaire for assessing folate and vitamin B12 intakes during pregnancy is available in Japan. We evaluated the validity and reproducibility of intakes of folate and vitamin B12 estimated from a self-administered diet history questionnaire (DHQ) in Japanese pregnant women. Methods A sample of 167 healthy subjects with singleton pregnancies in the second trimester was recruited at a private obstetric hospital in metropolitan Tokyo from June to October 2008 (n = 76), and at a university hospital in Tokyo from June 2010 to June 2011 (n = 91). The dietary intakes of folate and vitamin B12 were assessed using the DHQ. The serum concentrations of folate and vitamin B12 were measured as reference values in the validation study. To assess the reproducibility of the results, 58 pregnant women completed the DHQ twice within 4-5 week interval. Results Significantly positive correlations were found between energy-adjusted intakes and serum concentrations of folate and vitamin B12 (r = 0.286, p < 0.001 and r = 0.222, p = 0.004, respectively). After excluding the participants with nausea (n = 121), the correlation coefficient for vitamin B12 increased to 0.313 (p = 0.001). When participants were classified into quintiles based on intakes and serum concentrations of folate and vitamin B12 , approximately 60% were classified in the same or adjacent quintile. The intraclass correlation coefficients of the two-time DHQ were 0.725 for folate and 0.512 for vitamin B12 . Conclusion The present study indicated that the DHQ had acceptable validity and reproducibility for assessing folate and vitamin B12 intakes in Japanese pregnant women.
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Affiliation(s)
- Mie Shiraishi
- Department of Midwifery and Women's Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
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Weigel MM, Coe K, Castro NP, Caiza ME, Tello N, Reyes M. Food aversions and cravings during early pregnancy: association with nausea and vomiting. Ecol Food Nutr 2011; 50:197-214. [PMID: 21888579 DOI: 10.1080/03670244.2011.568906] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The prospective cohort study examined whether Ecuadorian women with early pregnancy nausea and vomiting (NVP) are more likely to develop food aversions and cravings, and if so, whether the specific foods identified as aversive or craved are the same as those predicted by the popular maternal-embryo protection hypothesis (MEPH). Consistent with MEPH predictions, women with NVP were more likely to report increased odor sensitivity and aversions for some predicted "toxic" foods and more likely to crave fruits. However, other hypothesis predictions were not supported. The relationship of food aversions and cravings with NVP appears more complicated than that explained by the MEPH.
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Affiliation(s)
- M Margaret Weigel
- Human Nutrition and Immunology Research Laboratory, Department of Public Health Sciences, College of Health Sciences, University of Texas at El Paso, El Paso, Texas, USA.
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Abstract
PURPOSE OF REVIEW Nausea and vomiting of pregnancy (NVP) affects 90% of pregnant women and its impact is often underappreciated. Hyperemesis gravidarum, the most severe end of the spectrum, affects 0.5-2% of pregnancies. The pathogenesis of this condition remains obscure and its management has largely been empirical. This review aims to provide an update on advances in pregnancy hyperemesis focusing on papers published within the past 2 years. RECENT FINDINGS The cause of hyperemesis is continuing to be elaborated. Recent data attest to the effectiveness of the oral doxylamine-pyridoxine in NVP. Follow-up data of children exposed in early pregnancy to doxylamine-pyridoxine for NVP are reassuring. Evidence is increasing for ginger as an effective herbal remedy for NVP. Metoclopramide is effective in NVP and hyperemesis gravidarum, with a good balance of efficacy and tolerability. A recent large-scale study on first trimester exposure to metoclopramide is reassuring of its safety. Evidence is emerging for the treatment of acid reflux to ameliorate NVP. The role of corticosteroids for hyperemesis gravidarum remains controversial. Transpyloric feeding may be warranted for persistent weight loss, despite optimal antiemetic therapy. SUMMARY Women with significant NVP should be identified so that they can be safely and effectively treated.
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Affiliation(s)
- Peng C Tan
- Department of Obstetrics and Gynecology, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia.
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Current world literature. Curr Opin Obstet Gynecol 2011; 23:135-41. [PMID: 21386682 DOI: 10.1097/gco.0b013e32834506b7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
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.
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Affiliation(s)
- Neda Ebrahimi
- Pharmaceutical Sciences, University of Toronto, Toronto, Ontario, Canada.
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