Nausea And Vomiting Of Pregnancy Symptoms Research Articles

Нудота та блювання під час вагітності: огляд сучасних можливостей

Nausea and vomiting of pregnancy (NVP) are the most frequent and characteristic symptoms of pregnancy for the first trimester that potentially may cause substantial negative consequences for the physical and emotional health of a woman. According to various studies, from 50 to 90% of women suffer from NVP. Usually, the symptoms of NVP begin at 5-6 weeks after the last menstrual period and disappear in most cases by the 16th-20th week of pregnancy, but sometimes they persist and may be observed until the third trimester, and in rare cases - even until childbirth. The doctor's main task in providing assistance to a pregnant woman with NVP is the timely application of an adequate treatment strategy, both effective and safe for a mother and a fetus, as well as ensuring the highest achievable life quality for a woman. The aim of this article is to analyze modern management opportunities for pregnant women with NVP, including an assessment of the advantages and disadvantages of different treatment strategies, for a comprehensive understanding of the NVP problem and the main principles and ways for solving it. This review is based on national guidelines (updated Royal College of Obstetricians and Gynecologists (RCOG) Green-top clinical guideline 2024, Society of Obstetricians and Gynecologists of Canada (SOGC) Guideline 2016), the results of various studies, and review articles (database of the Cochrane Library, UpToDate, EMBASE, MEDLINE). Conclusion: a combination of pyridoxine and doxylamine can be prescribed for the prevention of NVP since the diagnosis of pregnancy in a high-risk group of women. In case of already existing symptoms of NVP, the objective assessment of complaints, as well as a response to the prescribed therapy, are facilitated by the unified scales. In most cases, lifestyle modification and first-line drug therapy effectively reduce the severity of NVP symptoms and improve a woman's quality of life. In case of insufficient response, other drugs are added to the treatment regimen, including second and third-line drugs, with a consideration of possible drug interactions. Some patients might need admission, and in addition to antiemetic therapy, they might need intravenous rehydration, electrolyte balance restoration, and thromboprophylaxis. The authors declare that there is no conflict of interest.

Nausea and vomiting of pregnancy beyond the first trimester and the risk of preterm birth

Although most pregnant persons with nausea and vomiting of pregnancy (NVP) have symptoms that improve after the first trimester, approximately 20% experience NVP later in gestation. Little is known about pregnancy outcomes among these individuals. We aimed to investigate pregnancy outcomes among those with NVP after the first trimester. This is a secondary analysis of 9117 nulliparas from the NuMoM2b cohort who underwent NVP assessment with the Pregnancy-Unique Quantification of Emesis (PUQE) scale at three study visits; “V1” at 12.5±2.7 weeks, “V2” at 19.4±2.5 weeks, and “V3” at 28.0±3.2 weeks. Scores ranged 3-15 and were classified as having no NVP symptoms (PUQE score=3), mild (4-6) or moderate/severe (≥ 7) NVP at each visit. Chi-square analyses were used to compare the rate of adverse pregnancy outcomes (APO); small for gestational age, gestational hypertension, stillbirth, gestational diabetes, preterm birth (PTB) < 34 weeks, PTB < 37 weeks, across NVP categories at each study visit. Separate logistic regression models were used to estimate the association between degree of NVP at each visit and the odds of PTB < 37 weeks – adjusted for covariates (age, body mass index, race/ethnicity, smoking, gestational hypertension, depression). A separate sensitivity analysis was performed with additional adjustment for rate of gestational weight gain (GWG) per week. Degree of NVP at V1 and V3 was not associated with APO. There was a higher rate of PTB < 37 weeks in those with mild (10.1%) and moderate/severe NVP (13.3% ) versus having no NVP (8.2%) in V2 (χ2=13.8, p=0.001) (Table 1). On adjusted analysis, there was a marginally higher odds of PTB < 37 weeks among those with mild NVP at V2 (OR 1.21, 95% CI 1.00 to 1.47, p=0.050) and significantly higher odds with moderate/severe NVP at V2 (OR 1.60, 95% CI 1.09 to 2.36, p=0.017) versus having no NVP. This relationship was strengthened after adding GWG as a covariate (OR 1.85, 95% CI: 1.20 to 2.86, p=0.005). Moderate/severe NVP in mid-gestation may be associated with a higher risk of PTB.

Recalling the severity of nausea and vomiting of pregnancy – a study using Pregnancy-Unique Quantification of Emesis Questionnaire

The accuracy of the recall of the severity of nausea and vomiting of pregnancy (NVP) with Pregnancy-Unique Quantification of Emesis (PUQE) questionnaire has been questioned. We aimed to compare PUQE scores of women recalling the worst episode of NVP of their current pregnancy in different gestational weeks (gwks). Total of 2343 pregnant women (gwks 7–40) were recruited. Four groups were formed according to the gwks at reply: ≤16 gwks (n = 554), ≤20 gwks (n = 1209), >20 gwks (n = 1134) and ≥24 gwks (n = 495). PUQE scores were similar between the groups. Consequently, consistency of PUQE scores across the groups endorses the useability of the PUQE questionnaire in retrospective assessment of the overall severity of NVP in different gwks, regardless of passing of the peak NVP symptoms. Impact statement What is already known on this subject? Retrospective evaluation of the severity of nausea and vomiting of pregnancy (NVP) has been argued to be disposed to recall bias. Structured Pregnancy-Unique Quantification of Emesis (PUQE) questionnaire is a validated tool for assessing the severity of NVP. What do the results of this study add? When the women recalled the most severe NVP symptoms of their current pregnancy, no differences in the PUQE scores were found despite different gestational weeks at reply. Of distinct PUQE questions, women answering in early pregnancy reported longer duration of nausea than women answering in late pregnancy, but other questions were rated similarly. What the implications are of these findings for clinical practice and/or further research? Our aim was to compare the PUQE scores between the women who filled in the PUQE questionnaire in early or in late pregnancy, instructed to recall their worst symptoms in their current pregnancy. As there were no differences between the groups in total PUQE scores, our results support the application of PUQE questionnaire to assess the severity of NVP during pregnancy not only concurrent to the peak symptoms but also retrospectively.

Association between nausea and vomiting of pregnancy and postpartum depression: the Japan Environment and Children’s Study

Objective Postpartum depression (PPD) is a global emotional distress that affects women and their offspring regardless of their culture. The association between nausea and vomiting of pregnancy (NVP) and PPD has been widely described only for the severe form of NVP. We aimed to assess the relationship between PPD and NVP with regards to its severity. Methods Data from the Japan Environment and Children’s Study (JECS), a birth cohort study, were analyzed. PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS). Multiple logistic regression models were performed to assess the association between NVP and PPD. Results Out of the 80,396 women included in the study 14% had PPD. Among them 4,640 (42.1%) had mild NVP; 3,295 (29.9%) had moderate NVP whereas 1,481 (13.4%) had severe NVP. All forms of NVP were associated with PPD and the association gradually increased with the severity of NVP symptoms with odd ratio (OR): 1.26; 95% confidence interval (CI): 1.18–1.35 for mild, OR: 1.28; 95% CI: 1.19–1.38 for moderate and OR: 1.54; 95% CI: 1.42–1.68 for severe NVP. Conclusion Japanese women with NVP were more susceptible to develop PPD and the more severe the NVP symptoms were, the greater the risk of PPD. Thus, close monitoring of NVP-affected women is recommended.

Комплексний підхід до лікування раннього токсикозу у вагітних після застосування допоміжних репродуктивних технологій

Obstetricians-gynecologists do not always pay sufficient attention to nausea and vomiting of pregnancy (NVP), sometimes its severity is underestimated and adequate treatment is not prescribed. The objective: to investigate the efficacy and safety of the complex therapy of NVP in pregnant women after ART, including a preparation of ginger extract with pyridoxine and psychotherapy. Materials and methods. Sixty pregnant women were examined after applying VRT, with mild manifestations of NVP. The main group consisted of 30 women, with Emegest (ginger and pyridoxine extract) and psychotherapy used in NVP therapy, and a comparison group of 30 women who only adhered to recommendations on changes in diet and life. The presence of the syndrome of autonomic dysfunction was established using the A.M.Veyn questionnaire. For self-assessment of the level of reactive and personal anxiety, testing was carried out according to the method of Ch.D. Spilberger, Yu.L. Khanin. The quality of life was assessed using the SF-36 questionnaire. Results. The use of recommended NVP therapy in pregnant women after ART makes it possible to improve the condition of women already for 2–3 days, and in 2 weeks of treatment it is essential to reduce or even eliminate the symptoms of NVP. Complex therapy reduces the severity of the syndrome of autonomic dysfunction and the level of personal and situational anxiety, which, against the background of improving the overall condition, positively affects the quality of life. The applied therapy had no side effects or complications, positively influenced the further course of pregnancy and the condition of the fetus and the newborn, in particular, the frequency of preeclampsia is decreased by half and the birth asphyxia by 1.5. Conclusion. The safety and efficacy of Emegest in the complex therapy of nausea and vomiting of pregnancy allows us to recommend its use in pregnant women after ART. Key words: nausea and vomiting of pregnancy, Emegest, auxiliary reproductive technologies, psychotherapy.

Combining and Using the Utrecht Method and the Analytic Hierarchy Process to Facilitate Professional and Ethical Deliberation and Decision Making in Complementary and Alternative Medicine: A Case Study among a Panel of Stakeholders.

Background In daily practice, healthcare practitioners face many challenges in ethical and professional decision making. Currently, little is known on the ethical and professional deliberations and weighing benefits against risks in daily complementary and alternative medicine (CAM) practice. The aim of this study was to combine the Utrecht method and the Analytic Hierarchy Process (AHP) in deliberations, weighing benefits against risks of using ginger for a pregnant woman suffering nausea and vomiting of pregnancy (NVP) along with other comorbidities. Methods A hypothetical case was constructed using the twelve tips for constructing dilemma case-based assessment. Three CAM practitioners, two physicians, three pharmacists, and two patients were recruited, and the Utrecht and the AHP methods were combined and used to deliberate and weigh benefits against risks of using ginger for the presented case. Results Responses from the ten panelists were obtained. Priority ratings showed significantly higher scores (p-value < 0.001) for alleviating symptoms of NVP (30.7% ± 16.6%) compared to other potential benefits. Increasing the risk of bleeding was given significantly higher (p-value < 0.0001) weight scores (24.7% ± 13.5%) than other potential side effects. Potential risk of spontaneous abortion and risk of impairment of fetal development were given higher (p-value < 0.001) weight scores than risk of fetal hypoglycemia. When benefits were compared against side effects and risks to the fetus and pregnancy, potential benefits were given higher (p-value < 0.001) weight scores (72.3% ± 5.2%). Conclusions Considering the anticipated benefits and risks, a shared decision was made to use ginger in the case presented. The woman should also be informed of the potential side effects and risks of using ginger. The use of this combined method might promote openness and transparency in making shared decisions for healthcare providers and patients.

Treatment of nausea and vomiting during pregnancy-a cross-sectional study among 712 Norwegian women.

The purposes of this study were to investigate the treatments used for nausea and vomiting of pregnancy (NVP) according to NVP severity among Norwegian women and to assess whether maternal characteristics and attitudes were related to the use of pharmacological treatment of NVP. This is a cross-sectional Web-based study. Pregnant women and mothers with children ≤1 year of age were eligible to participate. Data were collected through an anonymous online questionnaire accessible from November 10th, 2014 to January 31st, 2015. In total, 712 women were included in the study, of which 62 (8.7 %), 439 (61.7 %) and 210 (29.5 %) had mild, moderate and severe NVP, respectively, according to the Pregnancy-Unique Quantification of Emesis (PUQE) classification. A total of 277 (38.9 %) women had used one or more antiemetics, of which meclizine, closely followed by metoclopramide, was the most commonly used. Different drug utilisation patterns were found between the groups of women with mild, moderate and severe NVP. Many with moderate or severe symptoms did not use any pharmacological treatment (70.2 and 32.9 %, respectively). Sick leave was given without initiating medical treatment in 266 (62.1 %) women. The women's beliefs about medicines had an important impact on their use of medicines for NVP. A large proportion of women suffered from moderate to severe symptoms of NVP, many of whom did not receive any pharmacological treatment. Many women, who had been on sick leave due to NVP, were not prescribed medicines.

The expression and adaptive significance of pregnancy-related nausea, vomiting, and aversions on Yasawa Island, Fiji

We report a study on nausea and vomiting of pregnancy (NVP) and pregnancy-related food aversions in a small-scale society from Yasawa Island, Fiji. Because NVP has rarely been studied quantitatively in small-scale populations, we begin with a detailed description of its expression among the women of Yasawa. We found that 66% of these women experience nausea and/or vomiting in tandem with the development of aversions to certain foods. This pattern of expression is similar to what has been documented for industrialized populations, and the prevalence of 66% is close to the industrialized mean prevalence of 69%. We then use the data from the women of Yasawa to evaluate the three main hypotheses that have been put forward to explain the evolution and ecological function of NVP. We show that food aversions of pregnancy focus preferentially on food types that are more likely to carry pathogens or contain chemical toxins. Such aversions do not focus on nutrient-dense foods or on frequently encountered foods. These findings are most consistent with the hypothesis that NVP, along with pregnancy-related aversions, evolved to motivate women to avoid exposure to diseases and other toxins when they are immune-compromised by pregnancy and during a critical period of embryo development. These findings contribute to a growing body of theoretical and empirical literature that suggests that NVP symptoms represent a series of adaptations rather than pathological responses to the physiological demands of pregnancy.

HPLC-DAD selective method for ginger root powder and extracts nauseastop as standarized not mutagenic ginger extract

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. Ginger is often advocated as beneficial for nausea and vomiting. The herb is increasingly used in western society because there is no FDA-approved medication for the treatment of NVP. The use of ginger in early pregnancy is recommended by the ACOG and the UK National Health Service but the use of standarized extract with well known actives concentration and description of the molecules contained is a must for effective results and proper dosing. For such purpose we describe a selective HPLC-DAD method for the analysis of ginger root powder and extracts for the separation and cuantification of all and every gingerols and shogaols, molecules responsables of the anti emetic activity. Moreover we compared the active content of the powder from roots and the botanical extract NAUSEASTOP. Furthermore for the first time, the Ames Test has been performed for testing the non mutagenic activity of NAUSEASTOP ginger extract and its suitability for the intake during pregnancy. Results reveals the safeness and efficacy of the extract.

The Impact of Nausea and Vomiting of Pregnancy on Quality of Life

Nearly all pregnant women experience nausea and vomiting of pregnancy (NVP) to some degree, yet its effects on quality of life (QOL) have not been studied extensively. The National Voice of Pregnancy survey was undertaken to increase understanding about the symptoms of NVP and their impact on QOL in women in the United States. In all, 621 currently or recently pregnant women completed an online survey about their NVP experiences. Their responses indicated that NVP can occur at any time of day or night and can have negative effects on eating, sleeping, and ability to handle domestic and occupational responsibilities. Relationships with spouse, family, friends, and coworkers can also be adversely affected. The effects of NVP are greater in women with moderate or severe symptoms, but women with mild NVP are also affected. These findings are consistent with previous studies conducted in various countries. Women sometimes fail to discuss NVP with their health care providers, and QOL issues rarely come up if it is discussed. Most women try dietary and other lifestyle modifications first to control their symptoms. Safe and effective medications are also available to help ease the symptoms of NVP and thereby improve QOL.

Characteristics of women with nausea and vomiting of pregnancy who chose to continue compassionate use of placebo after a randomised trial

The placebo effect has not been characterised in pregnant women suffering from nausea and vomiting of pregnancy (NVP). Our aim was to characterise determinants of the placebo effect in women treated with placebo for NVP. We analysed data from a multicentre, double blind randomised controlled trial of Diclectin® (delayed release doxylamine and pyridoxine) vs placebo for the treatment of NVP. A total of 127 women in the placebo arm and 130 in the active arm provided evaluable data for this analysis. Women who chose to continue placebo on a compassionate basis (n = 41) had significantly better improvement in symptoms of NVP and higher Wellbeing scores than those who did not ask to continue compassionate use. Results were similar in the active drug arm. The request to continue compassionate use of either placebo or active drug could be predicted by greater improvement in symptoms of NVP during the trial period.

The Leading Concerns of American Women with Nausea and Vomiting of Pregnancy Calling Motherisk NVP Helpline

Background. Nausea and vomiting of pregnancy (NVP) is the most common medical condition of pregnancy, affecting up to 85% of expecting mothers. In the USA, there is no FDA-approved medication for the treatment of NVP. Objective. To identify the primary concerns of American women leading them to contact the Motherisk NVP Helpline and to characterize the severity of their symptoms and therapy offered in order to develop improved and customized counseling for them. Methods. We reviewed the intake forms of the American women who called the NVP Helpline from 2008 to 2012. We extracted their state of residence, demographic data, severity of NVP symptoms, and other available clinical characteristics. Results. A total of 195 forms were reviewed. Of these, 86% called for information on management of NVP with/without questions about fetal drug safety, while 14% called solely about drug safety during pregnancy/breastfeeding. The majority of women were Caucasian, in their thirties, educated, employed, married and in their second pregnancy. Of them 95% were suffering from moderate-to-severe condition with 13% having hyperemesis gravidarum. Conclusion. American women need more information on the management of NVP and on a variety of its aspects in addition to the safety and effectiveness of antiemetic medications. Their leading concern was the use of doxylamine and vitamin B6 combination for NVP treatment followed by the use of ondansetron.

31: Preemptive Diclectin therapy for the management of nausea and vomiting of pregnancy and hyperemesis gravidarum

Our primary objective in this study was to determine whether the initiation of pre-emptive use of Diclectin (delayed release combination of 10 mg pyridoxine and 10 mg doxylamine) before symptoms of nausea and vomiting of pregnancy (NVP) began can mitigate symptoms as compared to starting Diclectin only at first sign of NVP symptoms, in patients with a high risk for recurrence of severe NVP or hyperemesis gravidarum (HG).

135: Maternal sub febrile temperature is associated with adverse obstetric and neonatal outcomes

with adverse obstetric and neonatal outcomes Liron Kogan, Uri Dior, Hagai Amsallem, Ayala Burger, Uri Elchalal, Yossef Ezra Hebrew University-Hadassah Medical Center, Department of Obstetrics and Gynecology, Jerusalem, Israel, Hebrew University-Hadassah Medical Center, Epidemiology Unit, Hebrew University School of Public Health, Jerusalem, Israel OBJECTIVE: To determine whether mild temperature elevation (37.137.9 Celsius degrees) developing during labor is a risk factor for adverse obstetric and neonatal outcome. STUDY DESIGN: A retrospective cohort analysis in a tertiary medical center between the years 2003-2010. Excluded: multiple pregnancies, elective cesarean deliveries, trial of labor after previous cesarean delivery, induction of labor using prostaglandins, fetal malformation, chromosomal abnormalities, stillbirths, and parturients suffering from intrapartum fever ( 38). A comparison was performed between women with maximal intrapartum temperature of 37 and two subgroups of women with maximal temperature of 37.1-37.4 and 37.537.9. Adjusted risk for adverse obstetric and neonatal outcome was calculated by using multiple logistic regression models to control for confounders. RESULTS: We studied 49,074 women with singleton pregnancies and spontaneous or induced labor. The frequency of intrapartum temperature of 37.1-37.4 and of 37.5-37.9 was 22.9% (n 11,259) and 2.9% (n 1,399), respectively. Mild elevation in maternal intrapartum temperature (37.1-37.4) was associated with higher rates of primary cesarean delivery and assisted vaginal delivery comparable to maternal temperature 37 (OR 1.5 and 1.2, 95% CI 1.4-1.6 and 1.1-1.3, P 0.001, respectively). A mildly elevated temperature (37.1-37.4) during labor in comparison with non-elevated temperature ( 37) was associated with greater risk for neonatal morbidity (asphyxia, convulsions, sepsis) and admission to neonatal intensive care unit (OR 2.2 and 1.8, 95% CI 1.7-2.8 and 1.6-2.1, P 0.001, respectively). Table 1 summarizes the associations of mildly elevated intrapartum fever with obstetrical and neonatal outcomes. CONCLUSION: Our data indicate that intrapartum sub febrile temperature is an important indicator of operative delivery and neonatal morbidity. 136 Rates of adverse pregnancy outcomes in women with nausea and vomiting of pregnancy Lorene Temming, Niki Istwan, Debbie Rhea, Cheryl Desch, Gary Stanziano, Saju Joy Carolinas Medical Center, Department of Obstetrics and Gynecology, Charlotte, NC, Alere Health, Department of Clinical Research, Atlanta, GA, Carolinas Medical Center, Maternal-Fetal Medicine, Charlotte, NC OBJECTIVE: To examine the influence of nausea and vomiting of pregnancy (NVP) on pregnancy outcomes. STUDY DESIGN: The study sample included primigravidas with current singleton gestation who voluntarily enrolled at 20 weeks gestation in a payor-provided maternity risk screening and education program with delivery at 20 weeks (n 81,486). Women with a history of diabetes were excluded. Patient-reported maternal characteristics and pregnancy outcomes were compared for women reporting NVP as a pregnancy complication vs. those without NVP using Pearson’s chisquare test statistic with 2-sided p-values 0.05 considered significant. RESULTS: Overall, 6.4% of women reported having mild to severe NVP symptoms complicating their pregnancy. Of those with NVP, 34.8% reported mild NVP requiring no hydration or pharmacologic intervention, while 65.2% reported moderate to severe symptoms with hydration or pharmacologic intervention required. Women reporting NVP were younger and more likely to be obese [pre-pregnancy body mass index (PPBMI) 30], single, and smoke; and less likely to have utilized artificial reproductive technology than those not reporting NVP. Pregnancy outcomes are compared for those with and without NVP in table, with several significant differences in outcomes. However, no significant differences in outcomes were observed for those women with mild (untreated) vs. moderate to severe (treated) NVP (all p 0.05). CONCLUSION: In this large study sample, primigravid women reporting mild to severe NVP as a pregnancy complication had higher rates of low pregnancy weight gain, preterm delivery, gestational hypertension/preeclampsia and small-for-gestational age infants than women that did not report having NVP. Poster Session I Clinical Obstetrics, Medical-Surgical-Disease, Neonatology, Physiology-Endocrinology www.AJOG.org

Treatment of Severe Nausea and Vomiting of Pregnancy with Subcutaneous Medications

We examined treatment outcomes in women with severe nausea and vomiting of pregnancy (NVP) receiving outpatient nursing support and either subcutaneous metoclopramide or subcutaneous ondansetron via a microinfusion pump. Among women receiving outpatient nursing services, we identified those diagnosed with severe NVP having a Pregnancy-Unique Quantification of Emesis (PUQE) score of greater than 12 at enrollment and prescribed either metoclopramide (N = 355) or ondansetron (N = 521) by their physician. Maternal characteristics, response to treatment, and start versus stop values were compared between the medication groups. Allocation to group was based on intention-to-treat protocol. Maternal characteristics were similar between the groups. Days to reduction in PUQE score levels were similar (median 2 days, metoclopramide; 3 days, ondansetron; P = 0.206). Alteration from metoclopramide to ondansetron (31.8%) was more frequent than alteration from ondansetron to metoclopramide (4.4%; P < 0.001). Improvement of NVP symptoms and reduced need for hospitalization was noted with both medications. Treatment with either metoclopramide or ondansetron resulted in significant improvement of NVP symptoms with half of women showing a reduction from severe symptoms to moderate or mild symptoms within 3 days of treatment initiation. Alteration in treatment was significantly greater in patients initially prescribed metoclopramide.

Optimal management of nausea and vomiting of pregnancy

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

Nausea and vomiting of pregnancy: what about quality of life?

The objective of this study was to determine the impact of nausea and vomiting of pregnancy (NVP) and other determinants on generic and NVP-specific health-related quality of life (QOL) in the first trimester of pregnancy. Prospective study. Centre Hospitalier Universitaire (CHU) Sainte-Justine or René-Laennec clinics, Montreal, Quebec, Canada. Pregnant women attending the clinics for their prenatal care from 2004 to 2006. Women were eligible if they were > or =18 years of age and < or =16 weeks of gestation at the time of their first prenatal visit. After their first prenatal visit, women were asked to fill out a questionnaire covering maternal characteristics, presence and severity of NVP, and health-related QOL. QOL was measured by the generic 12-item Short Form Health Survey v.1 (SF-12) and the NVP-specific Quality of Life for Nausea and Vomiting during Pregnancy. Of the 367 pregnant women included in the study, 78.5% of women reported NVP in the first trimester of pregnancy. Multivariable linear models showed that presence of NVP in the first trimester of pregnancy was significantly associated with a lower physical component summary scale (P < 0.0001) and mental component summary scale (P = 0.0066) of the SF-12 scores. More severe NVP (moderate versus mild: P = 0.0002; severe versus mild: P = 0.0177 as measured by the validated modified Pregnancy-Unique Quantification of Emesis and Nausea index), intensity of nausea symptoms reported on a visual analogue scale (P < 0.0001), and nonpharmacological methods used to ease NVP symptoms in the first trimester of pregnancy (P = 0.0059) were significantly associated with poorer NVP-specific QOL among women suffering from NVP. These findings show that presence and severity of NVP have a negative impact on health-related QOL, which emphasises the importance of an optimal management of NVP.

Prospective comparative study of the safety and effectiveness of ginger for the treatment of nausea and vomiting in pregnancy

Objectives The primary objective of our study was to examine the safety and the secondary objective was to examine the effectiveness of ginger for nausea and vomiting of pregnancy (NVP). Study design Pregnant women who called the Motherisk Program who were taking ginger during the first trimester of pregnancy were enrolled in the study. The women were compared with a group of women who were exposed to nonteratogenic drugs that were not antiemetic medications. The women were followed up to ascertain the outcome of the pregnancy and the health of their infants. They were also asked on a scale of 0 to10 how effective the ginger was for their symptoms of NVP. Results We were able to ascertain the outcome of 187 pregnancies. There were 181 live births, 2 stillbirths, 3 spontaneous abortions, and 1 therapeutic abortion. The mean birth weight was 3542±543 g, the mean gestational age was 39±2 weeks, and there were three major malformations. There were no statistical differences in the outcomes between the ginger group and the comparison group with the exception of more infants weighing less than 2500 g in the comparison group (12 vs 3, P ≤ .001). There were a total of 66 completed effectiveness scores with the mean score of 3.3±2.9 SD. Conclusion These results suggest that ginger does not appear to increase the rates of major malformations above the baseline rate of 1% to 3% and that it has a mild effect in the treatment of NVP.

Nausea and vomiting in pregnancy: results of a survey that identified interventions used by women to alleviate their symptoms

Nausea and vomiting of pregnancy (NVP) affects most pregnant women. There are safe and effective treatments available; however, most women choose to avoid pharmacological therapies and try lifestyle and dietary changes to treat their condition. To date, no attempt has been made to quantify women's experience with a variety of interventions. This study aims to identify factors commonly reported by women that alleviate their symptoms of NVP.Five hundred women with NVP, calling a pregnancy healthline between February 1996 and July 1999, completed a questionnaire where they were asked to rate which of 21 factors helped and to what extent each factor helped to improve their NVP symptoms. For each item, the ‘frequency’ (percentage of women who indicated that item as an improvement) and ‘mean importance’ (mean importance score of women who indicated that item as an improvement) were multiplied to give the ‘overall impact’ score.All 500 women reported that dietary and lifestyle changes helped to improve their NVP symptoms. However, most items were rated low and only 31% of women reported benefit from the use of pharmacological treatment In conclusion, this study has identified that NVP is a multifaceted condition. Lifestyle changes including validation, supportive counseling and dietary adjustments are important components, that can be used to counsel women with NVP, concomitantly with safe and effective treatment.

A novel method for the evaluation of the severity of nausea and vomiting of pregnancy

The symptomatology of nausea and vomiting of pregnancy (NVP) ranges from mild to very severe. The most advanced method to measure the burden of NVP, the Rhode’s scores, incorporates physical signs (length and number of episodes of nausea, number and volume of vomits, and number of retching) with measures of distress caused by these symptoms. However, this system has been validated only for symptoms that occurred in the past 12 h, thus obviating its wide clinical use, and particularly its retrospective use. Objective: To examine whether the severity of the physical symptoms of NVP correlate with the degree of stress caused by them, and to develop simple scores that can be used clinically. Methods and results: We prospectively scored 283 women with NVP using the Rhode’s system. There was excellent and highly significant correlation between the physical symptoms and their degrees of distress. Subsequently, we examined two simple scoring systems, one with three and one with five physical symptoms. Both yielded distribution of severity of NVP not different from the one found with the use of the full Rhode’s score. Conclusion: A scoring system based on all five physical symptoms, or only on three (length of nausea, number of episodes of nausea and number of vomits) yielded accurate estimates of severity and changes in severity of NVP. Unlike the Rhode’s score, this simple method can be used clinically to evaluate the severity and changes in NVP.