Abstract
BackgroundNausea 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.MethodsObservational 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.ResultsAmong 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).ConclusionsSymptoms 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 registrationProspectively registered at ClinicalTrials.gov on Dec 17, 2009 (NCT01034254).
Highlights
Nausea and vomiting are experienced by a majority of pregnant women worldwide
The objective of this study was to investigate the effects of nausea, vomiting and poor appetite during pregnancy on birth outcomes using data collected in the rural plains of southern Nepal
The cumulative incidence of nausea, vomiting or poor appetite steadily decreased for every increase in month of pregnancy from beginning to end, with the exception of the first month of pregnancy, which had a frequency of symptoms that was slightly lower than the second month of pregnancy
Summary
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. The consequences of nausea and vomiting for pregnant women correlate with the severity of symptoms and range from reduced quality of life and depressive symptoms to preeclampsia, malnutrition, weight loss and dehydration [4, 6, 11,12,13,14]. Severe symptoms such as nausea accompanied with vomiting have been suggested to have greater negative impact on maternal wellbeing, pregnancy outcomes as well as birth outcomes [4, 6, 15, 16]. Factors associated with increased nausea and vomiting of pregnancy and hyperemesis gravidarum include lower education level, symptoms in a previous pregnancy, primigravity, obesity, younger age, family history of hyperemesis gravidarum, psychosocial morbidity and carrying a female fetus [4, 7, 12,13,14, 23]
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