Pregnancy-Unique Quantification Of Emesis And Nausea Research Articles

The impact of using acupressure wristband on PC 6 point to reduce nausea and vomiting during pregnancy

Background: Pregnancy is a physiological process, during pregnancy physiological and psychological changes or adaptations occur in pregnant women. These changes can cause discomfort, such as nausea and vomiting. Nausea and vomiting usually occur in the first trimester of pregnancy (0-12 weeks of gestation) with a prevalence of almost 80%. Pregnant women with symptoms of nausea and vomiting can experience hyperemesis gravidarum so that their nutritional intake is disrupted. One way to anticipate and treat nausea and vomiting is through acupuncture therapy, but this therapy is often feared because it requires inserting needles. So acupressure therapy is used, which is a complementary therapy that can be applied to pregnant women by applying pressure to acupuncture points to stimulate the central nervous system through the hypothalamus and limbic system thereby balancing hormones. Purpose: To determine the effect of using an acupressure wristband at pericardium point 6 in reducing nausea and vomiting in pregnant women. Method: The type of research used was a pre-post-test experimental design using PC 6 acupuncture points on pregnant women between 6-14 weeks of gestation who experienced nausea and vomiting as many as 30 participants. Research data was collected using the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scoring system, which measures the severity of nausea and vomiting in pregnancy within 12 hours. Results: There is a difference in the PUQE scale before and after using the acupressure wristband at point PC 6. Where before the intervention some participants experienced nausea and vomiting in the moderate NVP category (7-12), namely 15 (50.0%) and severe NVP ≥13.13 (43 .3%). However, after intervention for the intensity of nausea and vomiting, the majority of participants were in the mild NVP category ≤6, 14 (46.7%). This shows that using the PC 6 acupuncture wristband can relieve nausea and vomiting experienced by pregnant women. Conclusion: Acupressure wristband are effective in preventing nausea and vomiting experienced by pregnant women.

Effects of foot-massage in pregnant women with hyperemesis gravidarum on severity of nausea-vomiting and anxiety

ABSTRACT Objective This study was conducted to determine the effects of foot massage performed on pregnant women with hyperemesis gravidarum on the severity of nausea and vomiting and pregnancy-related anxiety. Material and method This randomised controlled study was conducted between February and November 2020 with 104 pregnant women hospitalised in the pregnant women follow-up service ward of a public hospital in eastern Turkey with the diagnosis of hyperemesis gravidarum. Data were obtained from the pregnant women who were given a ‘Personal Information Form’ and before and after each application by using the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) Test and the Pregnancy-Related Anxiety Scale-Revision 2 (PRAQ-R2). Results Before foot massage, the pre-test mean PUQE total, PRAQR-2 total, and PRAQR2 fear of childbirth and concerns about physical appearance dimension scores of the participants in the experimental and control groups were similar (p > 0.05), It was determined that the PRAQR2 fear of having a disabled child control group had significantly higher pre-test scores compared to the massage group (p < 0.05). After foot massage, the severity of nausea and vomiting was significantly lower in the participants in the experimental group compared to those in the control group (p < 0.001). Additionally, the mean PRAQR2 total and dimension scores of the participants in the experimental group were significantly lower than those in the control group (p < 0.05). Conclusion These findings support the use of the foot massage is an effective intervention in reducing the severity of nausea and vomiting and pregnancy-related anxiety.

Ffect Peppermint Aromatherapy Inhalation Reducing Nausea And Vomiting In First Trimester Of Pregnancy

The Nausea and vomiting in pregnant women in the first trimester was physiologically due to an increase in the Human Chorionic Gonadotrophin (HCG) hormone which affects the digestive system, causing complaints of nausea and vomiting. One of them was handling nausea and vomiting by administering peppermint aromatherapy inhalation. Peppermint had a sharp menthol aroma, a distinctive cold refreshing smell, and the smell of menthol which had properties against contractions by inhibiting muscle contact caused by serotonin hormone so that it could successfully overcome nausea and vomiting in pregnant women. This study aims to determine the differences in nausea and vomiting before and after administration of peppermint aromatherapy inhalation dose, 0,1-0,2 ml for 1-10 minutes to pregnant women in their first This type of research was quasi-experimental, one-group pre-and post-test design. The number of samples was 48 respondents intervention and treatments, with the sampling method "purposive sampling" type of non-probability sampling. The data collection tool was a Pregnancy Unique Quantification of Emesis and Nausea (PUQE) questionnaire. Data analysis techniques used univariate and bivariate analysis. The results of data analysis used the Wilcoxon test and obtained a p-value of 0. 000 p 0. 05. This means that there were differences in nausea and vomiting before and after giving peppermint aromatherapy inhalation to pregnant women in their first trimester. It is expected that pregnant women use peppermint aromatherapy inhalation to treat nausea and vomiting because it does not have a toxic effect on the health of the mother and fetus.

Effectiveness of Acupressure on Emesis Gravidarum in the First Trimester Pregnant Women

Emesis gravidarum is nausea and vomiting that can cause dehydration and drastic weight loss that occurs in the first trimester of pregnancy. Acupressure on PC point 6 serves to control the function of the cerebral cortex through the nervous system that inhibits or reduces the nausea vomiting response. Objective: This study was to determine the effectiveness of acupressure on vomiting in first trimester pregnant women at the Karanggan Medika Clinic Gungung Putri Bogor in 2023. Research Methods: This study used a quasi-experiment design with pre test and post test design with control group. Sampling using purposive sampling technique with 28 respondents. The instrument used was Pregnancy-Unique Quantification of Emesis and Nausea (PUQE)-24 assessing the level of emesis gravidarum with scores ≤6 to ≥13. Results: Based on the results of non-parametric statistical analysis, namely by using the Mann Whitney test, the P-value is 0,001 (0,05) which means that there is a significant difference in first trimester pregnant women who are given the intervention with those who are not given the intervention. And the results of the Wilcoxon test P-value 0,001 (0,05), namely there is an effect of giving acupressure to emesis gravidarum in first trimester pregnant women at the Karanggan Medika Clinic Gunung Putri Bogor in 2023. Suggestion: It is expected for first trimester pregnant women who experience emesis gravidarum to apply acupressure as a therapy that can overcome nausea and vomiting during first trimester pregnancy.

The effect of dayak ginger (&lt;i&gt;Zingiber Officinale Roscoe&lt;/i&gt;) extraction in ginger cookies in reducing emesis gravidarum severity among pregnant women

One of the discomforts during pregnancy is nausea and vomiting, known as emesis gravidarum. Ginger cookies, as a Complementary Alternative Medicine (CAM), are often consumed by pregnant women to alleviate nausea. The purpose of this study was to investigate the effect of ginger cookies on pregnant women experiencing emesis gravidarum. This research was conducted as a Randomized Control Trial (RCT), following the CONSORT Guidelines. The study involved 59 pregnant women with a gestational age ranging from 6 to 16 weeks who were experiencing nausea and vomiting. The subjects were selected using random sampling. The intervention involved providing ginger cookies for a duration of 3 weeks. The severity of emesis gravidarum was assessed using the Pregnancy Unique Quantification of Emesis and Nausea (PUQE) questionnaire. Data analysis was carried out using an Independent Sample t-test. The results revealed a significant difference in the average severity of hyperemesis between the treatment and control groups (p &lt; 0.001), indicating a significant difference in emesis gravidarum severity between the intervention and control groups. In conclusion, ginger cookies have been shown to reduce the severity of emesis gravidarum. They can be considered as an adjunct in providing behavioral education to pregnant women to prevent emesis gravidarum.

The effectiveness of the application of self-hypnosis and prenatal gentle yoga on emesis gravidarum in the first-trimester pregnant women

Background: Emesis gravidarum is an inconvenience that often occurs in the first trimester of pregnancy. Continuous emission of gravidarum can be bad for the health of pregnant women and the fetus is conceived, so it must be overcome as early as possible, one of which can use non-pharmacological therapy, namely applying self-hypnosis and prenatal gentle yoga to reduce emissions of gravidarum can make pregnant women relax. This study aimed to analyze the application of self-hypnosis with Prenatal Gentle Yoga on emissions of gravidarum in first-trimester pregnant women. Methods: The design of this study used a Quasi experimental design with a Two group pretest-posttest design without control using purposive sampling. This research was conducted on first-trimester pregnant women who experienced the emission of gravidarum in the PMB Nanik Sidoarjo of ​​32 pregnant women in the first trimester. The self-hypnosis was carried out every day for approximately 15-30 minutes for 1 week, while prenatal yoga was carried out 3 times a week for 30 minutes. Data collection on the intensity of nausea and vomiting used the Pregnancy Unique Quantification of Emesis and Nausea (PUQE)-24 scoring system questionnaire. Data analysis used an independent T-Test test. Results: The results of the analysis of this study indicate that the mean difference in the Self Hypnosis treatment group is greater (1.77) than in the Prenatal Gentle Yoga group (1.25), which means that Self Hypnosis is more effective in reducing the intensity of nausea and vomiting in emesis gravidarum versus Prenatal Gentle Yoga. Conclusion: Therapy Self Hypnosis and Prenatal Gentle Yoga can reduce the emission level of gravidarum in first-trimester pregnant women so that it can be used as an alternative therapy that is easy to apply and has minimal side effects by pregnant women who experience gravidarum emissions.

Clinical features and frequency of area postrema syndrome in neuromyelitis optica spectrum disorder: A single-center study in Mexico

Area postrema syndrome (APS) is a group of conditions associated with attacks of nausea/vomiting, intractable hiccups, and narcolepsy that emerge during neuromyelitis optic spectrum disorder (NMOSD). The appearance of these symptoms is used as a diagnostic criterion for neuromyelitis optica in clinic. Frequency and clinical features of APS is poorly reported and even unknown in Latin America. We aimed to exhaustively describe APS in NMOSD patients from a tertiary medical center in Mexico City. A survey-based, cross-sectional, single-center study was performed from October 2020 to October 2021. Validated pregnancy-unique quantification of emesis and nausea (PUQE) scoring system and Epworth sleepiness scale were used for identifying nausea/vomiting and narcolepsy symptoms, respectively. Also, a simple two-option questionnaire was applied for determining hiccups frequency. Further clinical data was extracted from medical record. Fifty outpatients met inclusion criteria for NMOSD and were included in the study. Mean age was 45.5 (± SD 14.34) years old. At diagnosis, this population had a mean age of 39.7 (± SD 13.15) years. Women were more prone to develop some of theses conditions (64.0%). The frequency of isolated APS symptoms at onset was 36.0% for nausea/vomiting, 14.0% for narcolepsy, and 22.0% for intractable hiccups. Combination of nausea/vomiting and hiccups was more frequent (10%) than other combined symptoms. APS is a core clinical manifestation in Mexican NMOSD patients with a higher incidence in women.

Pengaruh Permen Jahe dalam Mengatasi Keluhan Mual dan Muntah pada Ibu Hamil

Pregnancy is a natural process that causes physical and psychological changes due to hormonal changes. Often pregnancy enters a critical period if it is not passed comfortably by pregnant women. Pregnant women must be able to adapt psychologically and physiologically to pregnancy hormones. The effect of hormonal changes is nausea and vomiting in early pregnancy, especially in the morning. Nausea and vomiting can be reduced by using herbal ingredients. The method used in this study was a literature study on the benefits of ginger, then ginger was processed into ginger candies with added sugar and water. The ginger candy was then given to women who were pregnant for 4 days in the first trimester of pregnant women. Nausea and vomiting were measured before and after being given the ginger candy using the Pregnancy Unique Quantification of Emesis and Nausea (PUQE) instrument. The data were processed statistically to determine the effect of extra ginger candy on nausea and vomiting of pregnant women. After measuring the pretest and posttest giving ginger candy, it was concluded that there was an effect of ginger candy on reducing nausea and vomiting.

Evaluation of nausea and vomiting in the first trimester on the risk of adverse birth outcomes and the contribution of genetic polymorphisms: a pilot prospective study.

To evaluate the impact of Nausea and Vomiting in Pregnancy (NVP) on the risk of Preterm Birth (PTB) and Low Birth Weight (LBW), and explore the effect of geneticpolymorphisms on the severity of NVP. A prospective study was conducted. Participants' experience of NVP prior to 12 gestational weeks were evaluated by a Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scale. 11 Single Nucleotide Polymorphisms (SNPs) loci located in growth differentiation factor 15 (GDF15) and leucine-rich repeat containing 25 (LRRC25) gene of chr19p13.11 and intergenic region of chr4q12 were genotyped, which were implicated as genetic risk factors for NVP. Logistic regression models were applied to determine the effect of NVP in the first trimesteron the risk of PTB and LBW, and genetic polymorphisms on the risk of NVP. Among 413 pregnant women, the incidence of nausea and vomiting was 85.5% (n = 353) in the first trimester, including 38.7% (n = 160) mild vomiting, 42.6% (n = 176) moderate vomiting and 4.1% (n = 17) severe vomiting.33 were PTB, 20 were LBW. Compared with pregnant women without NVP, women with mild, moderate or severe NVP in the first trimester were not associated with the risk of PTB and LBW. Besides, the polymorphisms of 11 SNPs loci were not associated with the risk of NVP. Our study indicated that symptoms of nausea and vomitingin the first trimester were not significantly associated with PTB and LBW, and there were also no associations between GDF15 and LRRC25 polymorphisms and NVP.

Comparison of the prevalence and severity of nausea and vomiting in the first trimester between singleton pregnancies conceived from stimulated in vitro fertilization and frozen embryo transfer cycles

ObjectiveThe objective of this prospective study is to compare the prevalence and severity of nausea and vomiting in the first trimester between singleton pregnancies conceived from stimulated in vitro fertilization (IVF) and frozen embryo transfer cycles (FET).MethodsAll women were recruited at 6 weeks gestation and filled in the modified Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) to document whether they had any experience of nausea and vomiting weekly till 12 weeks gestation. The primary outcome was the prevalence of nausea and vomiting and the secondary outcomes included severity of nausea and vomiting and pregnancy outcomes.ResultsA total of 360 pregnant women were recruited and 171 were in the stimulated IVF group and 189 in the FET group. The overall return rate was 82.2% (81.8% in the stimulated IVF group and 82.5% in the FET group). Nausea and vomiting were worse in the FET group compared with the IVF group. There were significantly more women who felt nauseated or sick in the FET group (p value = 0.032 for week 11 and p value = 0.046 for week 12); significantly more women with a longer duration of nausea in the FET group (p value = 0.044 for week 7 and p value = 0.030 for week 8); significantly more women with more vomiting in a day in the FET group (p value = 0.042) and significantly more women with retching or dry heaves in the FET group (p value = 0.030 for week 8 and p value = 0.028 for week 11).ConclusionNausea and vomiting were significantly more prevalent and severe in the FET group when compared with the stimulated IVF group.

Nausea and vomiting during pregnancy: a possible correlation with obsessive compulsive disorder and alexithymia

The possible correlation between nausea and vomiting during pregnancy (NVP) with obsessive-compulsive disorder (OCD) and alexithymia were examined in this cross-sectional study. A cohort of pregnant women at the first trimester of pregnancy experiencing NVP were divided into three groups, according to severity (mild, moderate and severe) with the Pregnancy Unique Quantification of Emesis and Nausea (PUQE) test. The Maudsley Obsessive Compulsive Disorder Scale (MOCQ) and the Toronto Alexithymia Scale (TAS-20) were applied. Scores of scales were compared in all three groups, and the relationship between NVP severity and OCD and alexithymia was evaluated. On the 110 enrolled pregnant women, 42 had mild, 36 had moderate and 32 had severe NVP. Pregnant women with mild NVP had lower MOCQ scores than those with severe NVP (p = .010). Total scores of TAS-20 were higher among subjects with greater NVP severity (p < .001). PUQE scores were demonstrated significant correlations with MOCQ and total and subsection scores of the TAS-20, regardless of NVP groups. Study results showed that women with more pronounced OCD and/or alexithymia can experience somatic complaints, such as NVP, particularly intense in their first trimester of pregnancies. For this reason, psychotherapy in addition to medical treatments could be recommended to pregnant women with severe NVP. Impact statement What is already known on this subject? NVP is a condition experienced by most women, particularly in the first trimester of pregnancy, which can be affected by the psychosomatic condition of the pregnant woman. What do the results of this study add? The severity of nausea and vomiting according to PUQE test were significantly associated with OCD and alexithymia presence in pregnant women during their first trimester period. What are the implications of these findings for clinical practice and/or further research? These findings might demonstrate the symptoms of NVP are correlated to OCD, as well as alexithymia. Longitudinal studies are required to demonstrate the clear causal relationship between NVP and psychiatric symptoms as in OCD and in alexithymia.

THE EFFECT OF CONSUME GINGER AND HONEY BISCUITS ON THE FRECUENCY OF NAUSEA AND VOMITING IN TEENAGE PREGNANCY

The risk of complication that occur during pregnancy at a young age increasing maternal and infant mortality. Nausea and vomiting occur commonly during pregnancy but it will risk becoming more severe in teenage pregnancy, so it need to be prevented. Nonpharmacological therapy with ginger honey biscuits was used in this quantitative study to relieve nausea and vomiting in teenage pregnancy. Quasi-experiment design was used in this study with pre and post test of 32 respondents in control group and 32 respondents in intervention group. The respondent is teenage pregnancy 12-19 years old and experience nausea, vomiting. Pregnancy Unique Quantification of Emesis and Nausea (PUQE) Questionnaire used in this study to show the nausea and vomiting scores experienced by teenage pregnancy pre and post intervention ginger honey biscuits. This study conducted to identify the effect of consuming ginger biscuits and honey on the frequency of nausea and vomiting in teenage pregnancy. The results showed that there was a difference in the frequency of nausea and vomiting of teenage pregnancy before and after consume ginger honey biscuits. The recommendation of this research is the using of ginger honey biscuits as nursing intervention to relieve nausea and vomiting in teenage pregnancy.Keywords: ginger honey biscuits; nausea and vomiting; teenage pregnancy.

The Effect of Giving Mint Decoction of Mint Leaves on the Reduction Of Nausea And Vomiting In First Trimester Pregnant Women at The Puskesmas Cipondoh Of Tangerang

The first trimester of pregnancy is the formation that starts from the conception of the ovum with a sperm cell. Pregnancy is the process of conception that is complete with gestational age at 1 week to 12 weeks during pregnancy. In the first trimester of pregnancy a woman experiences complaints of nausea, vomiting. Pregnant women who experience nausea and vomiting can consume decoction of mint leaves because mint leaves contain essential oils which can help relieve nausea and vomiting. The purpose of this study was to determine the effect of mint leaf decoction on the reduction of nausea and vomiting in first trimester pregnant women at Puskesmas Cipondoh of Tangerang. This study used quantitative research with quasi-experimental research methods with one group pretest-posttest design. The sample in this study amounted to 10 respondents, selected through purposive sampling. Data retrieval was done using the Pregnancy Unique Quantification of Emesis And Nausea (PUQE) questionnaire to measure nausea and vomiting. Data analysis used the Wilcoxon statistical test with a confidence level of 95%. The results of this study found that there was an effect of giving decoction of mint leaves to a decrease in nausea and vomiting in first trimester pregnant women in Puskesmas Cipondoh Kota Tangerang with p value= 0.008 (p &lt; 0.05). The conclusion of this study is that giving mint leaves boiled for three days can reduce nausea and vomiting in pregnant women. This research can be recommended to add the number of samples so that they can be made into two intervention groups and control groups so that they can be used as comparative materials. Researchers expect health workers to be able to implement therapy to reduce nausea and vomiting by using mint leaves. Keywords: Mint leaves, Pregnancy, Nausea vomiting

Area postrema syndrome: Frequency, criteria, and severity in AQP4-IgG-positive NMOSD.

ObjectiveTo define the frequency, duration, and severity of intractable nausea, vomiting, or hiccups in aquaporin-4–immunoglobulin G (AQP4-IgG)-positive neuromyelitis optica spectrum disorder (NMOSD) and propose diagnostic criteria and a severity scale for area postrema syndrome (APS).MethodsAn International NMOSD database was interrogated for frequency of APS. Patients with AQP4-IgG–positive NMOSD completed an APS symptom questionnaire. Nausea and vomiting severity was derived from the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) score. The diagnostic criteria, severity scale, and immunotherapy response was applied to a prospective validation cohort of patients from multiple centers.ResultsAnalysis of an international database for AQP4-IgG–seropositive NMOSD (n = 430) revealed a high prevalence of isolated APS attacks (onset 7.1%–10.3%; subsequent 9.4%–14.5%) across continents. For 100 patients with 157 episodes of APS, nausea (n = 127, 81%) lasted for a median of 14 days (range 2–365), vomiting (113, 72%) with a median of 5 episodes/d (2–40) lasted 1–20 minutes, and hiccups (102, 65%) lasted a median of 14 days (2–365). Symptoms consistently and completely resolved following immunotherapy. Data were used to propose APS diagnostic criteria and repurpose PUQE score (hiccups severity grade based on symptom duration). The clinical utility was demonstrated in a prospective validation cohort.ConclusionIsolated APS attacks are frequently encountered both at onset and during the NMOSD course. The diagnostic criteria proposed here will assist clinicians in recognizing APS. Diagnosis of an APS attack earlier than 48 hours is possible if a dorsal medulla lesion is detected. Accurate diagnosis and evaluation of APS attack severity will assist in outcome measurement in NMOSD clinical trials.

Evaluation of nausea and vomiting in pregnancy using the Pregnancy-Unique Quantification of Emesis and Nausea scale in Korea.

ObjectiveSeverity of nausea and vomiting of pregnancy (NVP) is associated with adverse pregnancy outcomes and poorer quality of life (QOL). The aim of this study was to evaluate the severity of NVP and maternal well-being status using the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scale in a Korean population.MethodsA total of 527 pregnant women who were receiving prenatal care at 4 hospitals were asked to participate in the study between January 2015 and June 2015. The severity of NVP was evaluated by the PUQE scale and maternal well-being status was evaluated using the visual analogue scale (VAS). Statistical analyses were performed to determine the risk factors associated with NVP and the associations between the severity of NVP and QOL.ResultsAmong the 472 eligible pregnant women, 381 (80.7%) were suffering from NVP during pregnancy. No significant differences (P>0.05) were observed in any of the variables between the 2 study groups, with the exception of smoking, alcohol consumption, and history of NVP. NVP history was found to be the most powerful risk factor (adjusted odds ratio, 11.6; 95% confidence interval, 4.7–28.7). The correlation coefficient (r) between the VAS scores of maternal well-being status and PUQE severity was −0.25 (r2=0.062; P<0.001).ConclusionIn this study, an explicit decline in maternal well-being status was observed according to severity of NVP. The PUQE scale may be of help to clinicians, healthcare providers, and researchers because of its simplicity and usefulness as a tool for NVP evaluation.

A randomized crossover trial on the effect of compression stockings on nausea and vomiting in early pregnancy.

IntroductionThis study aimed to assess the impact of wearing compression stockings on women’s quality of life (QoL) associated with nausea and vomiting in early pregnancy (NVP).MethodsIn this randomized, open, single-center, crossover study, 74 women were assigned 1:1 to 2 weeks with compression stockings followed by 2 weeks without or vice versa. The main outcomes were NVP-associated QoL, leg-related QoL, and dizziness, as assessed by the Nausea and Vomiting in Pregnancy Quality of Life (NVPQOL) questionnaire, Chronic Venous Disease Quality of Life (CIVIQ) questionnaire, and questions on dizziness at baseline and after each 2-week period, respectively. Daily NVP was assessed using the modified Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) questionnaire. Data were analyzed using Pearson’s chi-square and independent t-tests.ResultsFifty-eight women completed the study. QoL scores improved with compression treatment; changes in mean total scores were as follows: NVPQOL, −36.7 with compression vs −21.7 without (P<0.0001); and CIVIQ, −4.5 with compression vs +1.4 without (P=0.001). Mean dizziness scores were −3.2 with compression vs −0.4 without (P<0.0001). PUQE mean total score (standard deviation) was 4.9 (2.3) with compression vs 5.5 (2.2) without (P=0.042).DiscussionWearing of compression stockings in early pregnancy may improve nausea and vomiting-associated symptoms in addition to improving QoL factors.

Validation of specific questionnaires to assess nausea and vomiting of pregnancy in a French population

ObjectiveTo validate the modified Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) score and the Health-Related Quality of Life for Nausea and Vomiting of Pregnancy (NVP-QOL) score in a French population. MethodsA retrospective study was conducted of data for women who delivered at a tertiary care hospital in La Roche sur Yon, France, between November 1, 2012, and April 1, 2013. Only women who reported nausea and vomiting of pregnancy (NVP) in the first trimester were invited to respond to the two questionnaires. ResultsOverall, complete questionnaires were available from 399 women, 238 (59.6%) of whom reported NVP in the first trimester. The modified-PUQE score was associated with the self-reported symptom severity (P<0.001). A relationship was also noted when either the NVP-QOL score or the modified-PUQE score was compared with the symptom intensity (P<0.001 for both comparisons). Furthermore, a high NVP-QOL score was associated with a high modified-PUQE score (P<0.001). ConclusionThe modified-PUQE and NVP-QOL scores provided valid indices for assessing NVP severity and alterations in quality of life. Owing to its simplicity, the modified-PUQE score might be used routinely among women experiencing NVP in the first trimester of pregnancy.

Pharmacodynamics of transdermal granisetron in women with nausea and vomiting of pregnancy

Limited options exist for women with nausea and vomiting of pregnancy (NVP) who cannot tolerate oral intake. Transdermal delivery of granisetron, a 5-hydroxytryptamine-3 receptor antagonist, provides an effective alternative for such patients. The objective of this study was to evaluate the pharmacodynamics of granisetron administered intravenously (IV) and as a sustained release transdermal patch in women with NVP. We recruited 16 women with singleton gestation between 12 0/7-18 6/7 weeks who were receiving treatment for NVP and had a Pregnancy Unique Quantification of Emesis and Nausea (PUQE) score of ≥6. All consenting subjects received 1 mg of granisetron as an IV infusion over 5 minutes and blood was obtained prior to the infusion and at 10, 20, 30, and 60 minutes and at 2, 4, 6, 8, 12, and 24 hours after the start of the infusion. After a minimum washout of 48 hours after initiation of IV granisetron, a 52-cm(2) granisetron patch (34.3 mg) was placed on the upper arm of all subjects for 7 days. Blood was drawn prior to patch placement and daily thereafter for 9 days. The subjects were evaluated daily. The PUQE score was obtained from these subjects prior to the IV infusion and daily for 2 days after and again prior to and daily for 9 days after patch placement. Complete data were available in 15 women after IV administration and 13 women after patch placement. One woman stopped participation during the IV infusion while data were not available in 2 additional women after patch placement due to noncompliance. Peak plasma granisetron concentrations after IV and transdermal administration were similar (∼10 ng/mL). Prior to IV administration of granisetron, the PUQE score was 8.6 ± 1.8 (mean ± SD). The PUQE scores were significantly reduced for the ensuing 2 days (P < .01). The PUQE score prior to patch placement was 7.6 ± 2.4. Scores were significantly (P < .001) reduced within 1 day of patch placement and stayed significantly reduced during the ensuing 6 days of patch placement. The patch was removed on the seventh day and PUQE scores increased significantly on the third day after patch removal. No serious side effects were reported either during IV administration or patch placement. Granisetron significantly improved symptoms of nausea and vomiting as gauged by the PUQE score. After IV infusion the reduction in PUQE score was observed within 1 day. When granisetron wasadministered as a patch, benefit likewise was seen within 1 day suggesting rapid absorption of the medication transdermally. The beneficial effect of transdermal granisetron on the PUQE score persisted for the entire 7 days during which the patch was in place. In this small cohort, the granisetron patch appeared to be efficacious in reducing the symptoms of nausea and vomiting. The patch provides another option for treating this disorder and may be particularly useful in women who cannot tolerate oral medications.

Norwegian PUQE (Pregnancy-Unique Quantification of Emesis and nausea) identifies patients with hyperemesis gravidarum and poor nutritional intake: a prospective cohort validation study.

ObjectiveThe 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.DesignA prospective cohort validation study.SettingHospital cohort of Hyperemesis Gravidarum (HG) patients from western Norway and healthy pregnant women from Bergen, Norway.Sample38 women hospitalized due to HG and 31 healthy pregnant controls attending routine antenatal check-up at health centers.MethodsData 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 measuresDifferences of PUQE-scores, QOL-score and nutritional intake between hyperemesis patients and controls.ResultsHyperemesis 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).ConclusionPUQE-scoring has been validated as a robust indicator of severe hyperemesis gravidarum and insufficient nutritional intake in a Norwegian setting.

Vitamin B6 supplementation in pregnant women with nausea and vomiting

ObjectiveTo determine whether supplementation with vitamin B6 improves nausea and/or vomiting in pregnancy. MethodsThis experimental study was conducted with 60 pregnant women experiencing nausea and/or vomiting prior to the 12th gestational week. Of these women, 30 were treated daily with 10mg and the remaining 30 with 1.28mg of pyridoxine hydrochloride for 2weeks. The primary outcome was the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) score in each group at the end of treatment. ResultsThe women experiencing nausea and/or vomiting in pregnancy had significantly lower levels of circulating vitamin B6 (P=0.007) compared with those without this symptom. Vitamin B6 supplementation significantly increased plasma vitamin B6 concentration (P<0.05 in both groups). There were no significant differences in PUQE score or in plasma concentration levels of protein, dopamine, serotonin, unconjugated estriol, and ghrelin after supplementation between the 2 groups at baseline, but there was a significantly lesser decrease in PUQE score and a greater increase in vitamin B6 level and vitamin B6 concentration to plasma protein concentration ratios in group 1 than in group 2 after supplementation (P<0.05 for all). ConclusionAlthough the high-supplementation group had a greater decrease in PUQE score in comparison to the low-supplementation group, the difference is unlikely to affect the severity of symptoms.