Severity Of Nausea And Vomiting Of Pregnancy Research Articles

THE EFFECT OF PRENATAL EDUCATION ON NVP LEVELS

Background: Nausea and Vomiting of Pregnancy (NVP) can affect around 70-80% of pregnant women and has an impact on reducing quality of life. Various management efforts have been made to overcome NVP, including providing prenatal education. Objective: to determine the effect of prenatal education on the severity of NVP in Cirebon Regency. Method: quasi-experimental with one group pre-posttest design. The research population was pregnant women in the working area of the Plumbon Community Health Center, Cirebon Regency who experienced NVP. The number of research respondents was 30 people, determined using a purposive sampling technique. The research instruments were a knowledge questionnaire and PUQE-24 hour index scoring. Univariate and bivariate data analysis, using parametric analysis (paired t test). Results: the majority of respondents (76.7%) had the severity of NVP before prenatal education intervention in the moderate category. After being given the intervention, there was a decrease in the severity of NVP, the level of moderate responders became 50%, and the mild level increased from 23.3% to 50%. The results of statistical tests show that prenatal education for pregnant women has a significant effect on reducing the severity of NVP with α=0.030 <0.05. Conclusion: prenatal education has an effect on reducing the severity of NVP so that it can be considered as a complementary therapy in treating NVP.

Association of the 24-hour Pregnancy Unique Quantification of Emesis Index with Self-Rated Wellbeing Score: A Cross-Sectional Study

Introduction: Nausea and Vomiting of Pregnancy (NVP) are common symptoms of pregnancy. Often, treatment is guided by subjective symptoms, leading to hospitalisation of these patients and unnecessary health costs. The 24-hour Pregnancy-Unique Quantification of Emesis (PUQE) index helps objectively quantify these symptoms and guide the management of these patients. Aim: To assess the association of the 24-hour PUQE index with the self-rated well-being score in evaluating the severity of NVP. Materials and Methods: In this cross-sectional study, a total of 207 women at 5 to 12 weeks of singleton pregnancy were recruited after obtaining informed consent. They were interviewed regarding their symptoms of nausea and vomiting based on a 24-hour PUQE index questionnaire, and a score was assigned to them. They were stratified as mild, moderate, or severe based on the score. The association of these symptoms with a selfrated well-being score and subjective symptoms such as the ability to take multivitamins, sleep pattern, liquid intake, and the need for hospitalisation was assessed. They were followed-up after four weeks, and a repeat score was obtained. Chi-square test was performed to compare the severity of PUQE-24. Results: The mean well-being score at the first visit was 3.381±1.650, and at the follow-up visit, it was 7±1.763. At the first visit, 46 out of 207 had a mild 24-hour PUQE score, 140 out of 207 had a moderate score, and 21 out of 207 had a severe score. During the follow-up visit, 123 out of 207 had a mild score, 77 out of 207 had a moderate score, and seven out of 207 had a severe score. There was a significant association between the mean self-rated well-being score and the 24-hour PUQE score at the first and follow-up visits (p-value=0.0001). Among the patients hospitalised at the first visit (21 out of 28), 75% belonged to the severe PUQE category. The mean liquid intake at the first visit was 24.363±10.357 mL/kg/hr, and at the followup visit was 29.972±10.691, showing a significant association with the severity of the 24-hour PUQE score (p-value=0.0001). A significant association was observed between the 24-hour PUQE scores of the first and follow-up visits (p-value=0.002). Conclusion: In this study, there was a significant association between the 24-hour PUQE score and the well-being score at both visits. Stratifying the severity of NVP objectively will guide us to choose the appropriate treatment and reduce the need for hospitalisation.

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.

Usability of Pregnancy-Unique Quantification of Emesis questionnaire in women hospitalised for hyperemesis gravidarum: a prospective cohort study

ObjectivesPregnancy-Unique Quantification of Emesis (PUQE) questionnaire is mainly used in outpatient care to assess the severity of nausea and vomiting of pregnancy (NVP). Our aim was to evaluate the usability...

Lack of catch-up in weight gain may intermediate between pregnancies with hyperemesis gravidarum and reduced fetal growth: the Japan Environment and Children\u2019s Study

BackgroundWomen with nausea and vomiting of pregnancy (NVP) have higher birth weight infants, while those with hyperemesis gravidarum, a severe manifestation of NVP, have lower birth weight infants. We aimed to investigate the associations between maternal weight loss (a consequence of hyperemesis gravidarum), NVP, and infant birth weight.MethodsThis study was a secondary analysis of a nationwide birth cohort in Japan. Singleton pregnancies delivered at 28–41 weeks of gestation were included in the analysis. Women were categorized based on their weight change in the 1st trimester (as a proportion to their pre-pregnancy weight: > + 3%, > 0 to + 3%, > -3 to 0%, > -5 to -3%, ≤ -5%) and severity of NVP (no nausea, only nausea, vomiting but able to eat, vomiting and unable to eat). The effects of weight change and severity of NVP on infant birth weight and small for gestational age (SGA) were assessed using regression models. We further examined how these effects could be modified by maternal weight gain up to the 2nd trimester.ResultsAmong 91,313 women, 5,196 (5.7%) lost ≥ 5% of their pre-pregnancy weight and 9,983 (10.9%) experienced vomiting and were unable to eat in the 1st trimester. Women with weight loss ≥ 5% in the 1st trimester had infants 66 (95% CI: 53, 78) g lighter and higher odds of SGA (aOR: 1.29; 95% CI: 1.14, 1.47) than women who gained > 3% during the same period. However, when adjusting for weight gain up to the 2nd trimester, women with weight loss ≥ 5% in the 1st trimester had infants 150 (95% CI: 135, 165) g heavier and lower odds of SGA (aOR: 0.39; 95% CI: 0.33, 0.46) than those who gained > 3% during the same period. In contrast, women with more severe NVP tended to have infants with larger birth weight and lower odds of SGA compared to women without NVP. These trends were strengthened when adjusting for weight gain up to the 2nd trimester.ConclusionsOur study suggests the possibility that reduced fetal growth in pregnancies with hyperemesis gravidarum may be caused by the lack of catch-up in gestational weight gain up to the 2nd trimester.

The effects of Citrus aurantium and lavender aromas on nausea and vomiting of pregnancy in nulliparous pregnant women: A randomized clinical trial

Background: Nausea and vomiting of pregnancy (NVP) is common complaints in pregnant women. Objectives: This study aimed to compare the effects of Citrus aurantium (orange blossom [OB]) and lavender essential oils on the severity of NVP in nulliparous pregnant women. Methods: A single-blinded clinical trial was conducted in 165 nulliparous women with NVP. A demographic and pregnancy-related information form and the Rhodes index of nausea, vomiting, and retching (RINVR) were used to collect data. Participants were assigned into three groups of 55 to receive lavender oil, OB oil, or a placebo. The oils were inhaled by the participants for 4 days when they felt nauseous. The severity of NVP was measured at baseline and at the end of the study. Data analysis was performed using the Chi-square, paired t-test, analysis of variance, and Bonferroni post hoc test. Results: Mean RINVR scores (i.e., mean total vomiting, nausea, and retching scores) did not significantly differ in the three groups at baseline (P = 0.477). However, mean posttest RINVR scores decreased significantly in the OB and lavender aromatherapy groups (P < 0.001), whereas it did not change significantly in the placebo group (P = 0.989). Conclusion: Lavender and OB essential oils were effective in reducing NVP. Nurses and midwives may therefore recommend pregnant women to use either OB or lavender oil to alleviate their NVP.

Nausea and vomiting of pregnancy: associations with personal history of nausea and affected relatives

PurposeTo examine whether personal history of nausea or history of nausea and vomiting of pregnancy (NVP) in relatives are risk factors for a woman to suffer from NVP. Further, to evaluate if these factors are associated with the severity of NVP.MethodsCohort study of 2411 pregnant women recruited from maternity health care clinics. The severity of NVP was categorized according to Pregnancy-Unique Quantification of Emesis (PUQE) questionnaire into no/mild/moderate/severe NVP. History of nausea was assessed in connection with motion sickness, seasickness, migraine or other kinds of headache, after anesthesia, related to the use of contraceptives, and other kinds of nausea. History of NVP in relatives was categorized into first-degree (mother/sister) and second-degree relatives (more distant).ResultsIn multivariable analysis including previous personal history of nausea, motion sickness (OR 3.17, 95% CI 1.81–5.56, p < 0.0001) and nausea in migraine (OR 3.18, 95% CI 1.86–5.45, p < 0.0001) were associated with severe NVP. History of nausea in other kinds of headache was associated with moderate NVP (OR 1.91, 95% CI 1.34–2.72, p = 0.001). Women with affected first-degree relatives had higher odds for moderate (OR 3.84, 95% CI 2.72–5.40) and severe (OR 3.19, 95% CI 1.92–5.28) NVP (p < 0.0001). All these results remained significant after adjusting for parity, body mass index, smoking, employment and age.ConclusionWomen with personal history of nausea or family history of NVP have an increased susceptibility of NVP. This information is useful in pre-pregnancy counselling.

82: Additional risk variant in GDF15 and a stronger maternal genetic influence linked to Hyperemesis Gravidarum

Our recent genome-wide association (GWAS) and replication studies validated the placenta, appetite, and cachexia gene GDF15 and the GDF15 receptor, GFRAL, to be associated with Hyperemesis Gravidarum (HG). A second unlinked (r2< 0.01) SNP located in the 3’UTR of GDF15 (rs1054221) was also identified in the GWAS. Herein, we performed a replication study to validate the GWAS finding which linked rs1054221 to HG. Maternal versus paternal inheritance of nausea and vomiting of pregnancy (NVP) was also evaluated. DNA from 893 women with HG and 635 women with normal or no NVP were genotyped using a Taqman platform for rs1054221. Genotype rs1054221 and a previously identified risk allele in GDF15, rs16982345, were compared between cases requiring tube feeding and controls reporting no NVP using medcalc.org/calc/odds_ratio.php. Additionally, using an online survey from 2007 to 2017 of women with and without HG, severity of NVP was compared between participants’ sisters and sisters-in-law. Women with HG were significantly more likely to carry a T allele in rs1054221 compared to women who did not have HG (OR,1.44, P=0.001). Women with no NVP were 12 times more likely to have the genotype AA in rs16982345 or CC in rs1054221 than women with HG requiring tube feeding. 793 women with HG and 572 women with normal or no NVP self-reported on the NVP level of their sisters and sisters-in-law. Sisters of women with HG were significantly more likely to have HG themselves (OR, 5.91; P = .0001) compared to their sisters-in-law. Conversely, sisters of women with little to no NVP were significantly more likely to have little or no NVP (OR, 1.84; P = .0002), compared to their sisters-in-law. Evidence suggests abnormal levels of the hormone GDF15 are associated with HG. The validation of a second risk variant, rs1054221, provides further support for GDF15’s role in the etiology of HG. Additionally, maternal genes appear to play a more significant role than paternal DNA in contributing to the severity of NVP.

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.

Nausea and vomiting of pregnancy: Effects on quality of life and day-to-day function.

To investigate the effect of nausea and vomiting of pregnancy (NVP) on quality of life (QoL) and activities of daily living/socioeconomic function in a contemporary Australian setting. Observational, single centre prospective cohort study using validated survey instruments in pregnant women at 9-16weeks gestation at a tertiary metropolitan women's hospital in Sydney, Australia. QoL measured by the Short-Form Health Survey (SF-12) was compared between those with and without NVP. NVP severity scores were correlated with QoL scores, work patterns and medication use. Of 116 participants, 72% had NVP, with no baseline (including mental health) differences between women with or without NVP. As classified by modified Pregnancy-Unique-Quantified-Emesis (PUQE) survey, 42% had mild symptoms, 55% moderate and 1% severe. SF-12 Physical Component Summary (PCS) scores were significantly lower for those with NVP (P<0.001), but not Mental Component Summary (MCS) scores (P=0.11). Decreasing QoL was associated with increasing NVP severity (P<0.001), most markedly in the physical domain (P<0.001). Only 39% of women used any NVP treatment and 15% pharmacotherapy. Most used treatments were vitamin B6 , ginger, metoclopramide and natural remedies. Significantly more women with NVP required time off work (45% vs 16%, P=0.003). NVP is a physically morbid disease, affecting most pregnancies. NVP has a significant detrimental impact on QoL, especially physical QoL and work function. Despite this, we found low treatment utilisation, even in those with moderate/severe symptoms. Women should be encouraged to seek assistance for NVP and further education is required to improve practitioner awareness and management.

A comparison between the effects of ginger, pyridoxine (vitamin B6) and placebo for the treatment of the first trimester nausea and vomiting of pregnancy (NVP)

Introduction: Nausea and vomiting of pregnancy (NVP) are one of the most common complains of the early pregnancy period and are bothersome for pregnant women. Some prefer to use herbal medicine instead of chemical agents.Objective: The purpose of the present study was to compare the effects of ginger, pyridoxine (vitamin B6), and placebo for the treatment of NVP.Method: The study was performed as a triple blind clinical trial on pregnant women suffering mild to moderate NVP between 6 and 16 weeks of pregnancy. In these women ginger, 500 mg twice daily, vitamin B6 40 mg twice daily and placebo twice daily were administered for 4 d. Rhodes questionnaire was used for evaluation of the severity of symptoms. The severity of NVP was evaluated 24 h before entering the study and up to 4 d after using medications and results were compared among the three groups.Results: Seventy-seven women finished the study (28 in the Ginger group, 26 in the B6 group, and 23 in the placebo group). The women of the three groups did not have significant differences according to age, gestational age, parity, and severity of each symptom before treatment and educational status. Total score of Rhodes questionnaire for nausea was decreased significantly in three groups after treatment. (p < .001, p = .012, and p = .03 for ginger, vitamin B6, and placebo, respectively.) Also total score of Rhodes questionnaire for vomiting was decreased in three groups (p = .03 for ginger, p = .02 for B6, and p = .04 for placebo). Ginger and vitamin B6 could reduce the severity of all items of Rhodes questionnaire significantly; however, placebo was significantly effective only on the frequency of nausea, intensity of vomiting and frequency of retching. Ginger and vitamin B6 were more effective than placebo (p = .039 and p = .007, respectively); however, total score of Rhodes did not show significant difference between ginger and vitamin B6 (p = .128). Ginger was more effective for nausea (intensity and distress) and distress of vomit.Conclusion: Ginger is more effective than placebo for the treatment of mild to moderate NVP and is comparable with vitamin B6.Trial registration number and registry website: IRCT2015020320923N1

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.

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.

Determinants of Adherence to Delayed-Release Doxylamine and Pyridoxine in Patients With Nausea and Vomiting of Pregnancy

Women often hesitate to take medications in pregnancy due to fears of perceived potential fetal damage. The authors' objective is to identify the determinants of adherence to delayed-release doxylamine-pyridoxine (Diclectin) in patients with nausea and vomiting of pregnancy (NVP). The authors performed a prespecified secondary analysis of a multicenter double-blind randomized controlled trial of Diclectin versus placebo for the treatment of NVP. Data on adherence to study medication were collected in all patients. The primary outcome of this analysis was adherence to study medication, which was determined by pill counting and patient diaries. The treatment regimen in the original trial was not fixed and depended on patient's symptoms. There was no difference in the adherence rates between subjects in the Diclectin or placebo arms of the study, so the 2 arms were analyzed as one cohort. The degree of adherence was analyzed in the various subgroups. Subsequently, a multiple linear regression model was constructed to identify predictors to adherence. Two hundred fifty-eight women were included in this analysis. There were no differences in adherence rates according to ethnicity, race, or the presence of adverse events. Gravidity, average number of prescribed tablets per day, site of enrollment, and change in NVP severity measured by the pregnancy unique-quantification of emesis score were associated with adherence. In multivariable analysis, average number of tablets per day, change in pregnancy unique-quantification of emesis, number of treatment days, site of enrollment were significantly predictive of adherence, with the former being negatively correlated. Adherence to antinauseants for NVP is affected by number of tablets prescribed per day, and treatment duration and effectiveness.

Nausea and vomiting of pregnancy (NVP) and depression: cause or effect?

Both nausea and vomiting and depression are common conditions affecting women during pregnancy. Several studies have linked depression with nausea and vomiting of pregnancy (NVP); however, researchers were unable to determine whether depression was caused by NVP or by a pre-existing condition. To determine whether NVP is associated with depression in women with no history of depression prior to pregnancy. This was a prospective, observational, longitudinal study. Women with no diagnosis of depression who contacted The Motherisk Program prior to becoming pregnant or were at < 6 weeks gestation were enrolled in the study. Each woman was interviewed at 8, 11, 18, 30 weeks gestation and at 6-18 weeks post-partum. At each interview, we administered the EDPS, Wellbeing and PUQE questionnaires and analyzed the data for correlation between depression and NVP. Data were analyzed obtained from 57 women. There were five EPDS scores ≥13 (one at baseline and two each at weeks 8 and 11) considered indicative of depression and 11 cases with PUQE scores ≥7, indicative of moderate-high severity of NVP. We did not find an association between high PUQE scores and high EPDS scores and conversely, there was no relationship between high EPDS scores and high PUQE scores. No association between depressive symptoms and NVP was observed; however, our sample size was very small and further studies could be done with a larger population of pregnant women.

Long-term Neurodevelopment of Children Exposed to Maternal Nausea and Vomiting of Pregnancy and Diclectin

To determine the effects of nausea and vomiting of pregnancy (NVP) and its treatment with diclectin on child neurodevelopment. An observational cohort study of mother-child pairs ascertained via a pregnancy call-in center was conducted. Three groups of children were studied: 45 with NVP and diclectin, 47 with NVP no diclectin, and 29 with no NVP. Phone calls to mothers during pregnancy and 6 to 9 months after childbirth yielded information on pregnancy, birth, and early child development. Children aged 3 to 7 years received a comprehensive set of psychological tests. Mothers were assessed for IQ and socioeconomic status. All children scored in the normal range for IQ, with the NVP-exposed group scoring higher than the non-exposed group on Performance IQ (P < .02), NEPSY Verbal Fluency (P < .003) and Phonological Processing (P < .004), and McCarthy Numerical Memory (P < .004). Predictors of enhanced results were NVP severity and maternal IQ. NVP has an enhancing effect on later child outcome. Diclectin does not appear to adversely affect fetal brain development and can be used to control NVP when clinically indicated.

The Effect of Heartburn and Acid Reflux on the Severity of Nausea and Vomiting of Pregnancy

Heartburn (HB) and acid reflux (RF) in the nonpregnant population can cause nausea and vomiting; therefore, it is plausible that in women with nausea and vomiting of pregnancy (NVP), HB/RF may increase the severity of symptoms. To determine whether HB/RF during pregnancy contribute to increased severity of NVP. A prospectively collected cohort of women who were experiencing NVP and HB, RF or both (n=194) was studied. The Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scale and its Well-being scale was used to compare the severity of the study cohort's symptoms. This cohort was compared with a group of women experiencing NVP but no HB/RF (n=188). Multiple linear regression was used to control for the effects of confounding factors. Women with HB/RF reported higher PUQE scores (9.6+/-2.6) compared with controls (8.9+/-2.6) (P=0.02). Similarly, Well-being scores for women experiencing HB/RF were lower (4.3+/-2.1) compared with controls (4.9+/-2.0) (P=0.01). Multiple linear regression analysis demonstrated that increased PUQE scores (P=0.003) and decreased Well-being scores (P=0.005) were due to the presence of HB/RF as opposed to confounding factors such as pre-existing gastrointestinal conditions/symptoms, hyperemesis gravidarum in previous pregnancies and comorbidities. The present cohort study is the first to demonstrate that HB/RF are associated with increased severity of NVP. Managing HB/RF may improve the severity of NVP.

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.

Validity of a Modified Pregnancy–Unique Quantification of Emesis and Nausea (PUQE) Scoring Index to Assess Severity of Nausea and Vomiting of Pregnancy

Objective The only validated nausea and vomiting of pregnancy (NVP) severity index is the Motherisk Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) index that covers symptoms in the previous 12 hours. We sought to assess the validity of a modified-PUQE index that covers the entire first trimester of pregnancy by comparing NVP severity scores between the 12-hour PUQE index and our modified-PUQE index and by measuring the extent of the association between the modified-PUQE score and quality-of-life (QOL) score during the first trimester of pregnancy. Study Design A prospective study that included women who attended the Centre Hospitalier Universitaire Sainte-Justine or Rene-Laennec clinic for their prenatal visits was conducted from 2004-2006. Women were eligible if they were ≥18 years old and ≤16 weeks of gestation at the time of their first prenatal visit. Women who reported NVP were asked to fill out the 12-hour PUQE, the modified PUQE index, and the Short-Form Health Survey QOL index simultaneously. Intraclass correlation coefficients were calculated to determine concordance between the 2 scores. Linear regression models were built to measure the association between the modified-PUQE score and Short-Form Health Survey QOL scores. Results Among participants (n = 287), the mean NVP severity score was 5.7 vs 6.7 on the 12-hour PUQE and modified PUQE, respectively ( P Conclusion We are confident that, on the basis of the modified-PUQE, the relationship between QOL and severity of NVP justify the use of this new index.

Nausea and vomiting in early pregnancy: Relationship with anxiety and depression

Objective. To investigate the association between either depression or anxiety early in pregnancy, and nausea and vomiting, in a clinical sample.Methods. Anxiety and depression scores of 230 women were investigated by using the Hospital Anxiety and Depression Scale. Nausea and vomiting of pregnancy (NVP) were scored by using the Rhode's system. These scores and demographic data were compared and P < 0.05 was considered significant.Results. A significant correlation between Rhode's score and both anxiety (r = 0.388, P < 0.001) and depression score, (r = 0.351, P < 0.001) was found. Gestational age showed an inverse correlation with anxiety scores (P = 0.019). There was no significant correlation between demographic data and anxiety/depression scores, or Rhode's scores.Conclusion. There is an association between anxiety and depression early pregnancy and severity of NVP.