A comparison of different severities of nausea and vomiting during pregnancy relative to stress, social support, and maternal adaptation

A cross-sectional and comparative research design with convenience sampling was used to recruit pregnant women from prenatal clinics in southern Taiwan between 2002 and 2003 to examine the differences in perceived stress, social support, and maternal psychosocial adaptation among women with different severities (mild or less than mild, moderate, and severe) of nausea and vomiting during pregnancy. A total of 150 pregnant women participated in this study. One-way analysis of variance indicated that perceived stress was significantly different among the 3 groups. The least significant difference post-hoc test revealed that pregnant women with mild nausea and vomiting had significantly lower stress than did pregnant women with severe nausea and vomiting. The severity of nausea and vomiting was significantly associated with the Prenatal Self Evaluation Questionnaire subscales for "acceptance of pregnancy" and "fear of helplessness and loss of control in labor." Social support and maternal psychosocial adaptation were not significantly different among these three groups. The degree of perceived stress and maternal psychosocial adaptation may be related to the severity of nausea and vomiting during pregnancy.     

The impact of nausea and vomiting on women: a burden of early pregnancy

Nausea and vomiting are troublesome symptoms occurring in the first trimester of pregnancy. The aim of this study was to describe the impact these symptoms have on women in early pregnancy by interviewing, using a structured questionnaire, 593 pregnant women presenting with nausea and vomiting in the first trimester of pregnancy. The women were asked to complete the Rhodes index of nausea and vomiting and the MOS 36 Short Form Health Survey (SF-36). Symptoms of nausea and vomiting started early in pregnancy. Nausea was the most troublesome symptom experienced by women, both in its duration and intensity. Low scores for the SF-36 were found for all items, particularly physical functioning, energy and social functioning. The women described substantial effects on working, household duties and parenting activities. Findings from this study suggest nausea and vomiting in early pregnancy has a profound impact on women's general sense of well-being and day to day life activities.     

Severity of Nausea and Vomiting During Pregnancy: What Does It Predict?

Background: Relationships between the severity of nausea and vomiting during pregnancy and selected demographic (employment status, parity, age, smoking) and pregnancy outcome (birthweight, gender) variables are described. Methods: Women who volunteered for a community-based clinical trial were eligible for inclusion in this study. On three occasions, 12 hours apart, during early pregnancy using a continuous measure of nausea, vomiting, and retching, women assessed the amount, duration, and severity of symptoms as they occurred. After the birth of their infants, they provided information about the duration of nausea, vomiting, and retching as well pregnancy outcome information by responding to a mailed questionnaire. Multivariate methods were used to analyze data. Results: More severe vomiting in early pregnancy was likely to continue for a longer period of time and was related to decreased infant birthweight. Gestational age, parity status, and severity of vomiting were predictors of infant birthweight and together explained 22 percent of the variance in birthweight. A significant relationship between fetal gender and severity of nausea and vomiting was not found. Conclusions: It may be possible to identify women at risk for third trimester vomiting and to provide appropriate nutritional support and counseling so that their risk of having a low-birthweight infant is reduced. A larger sample would be required to assess the relationship between fetal gender and severity of nausea, vomiting, and retching.     

Survey of medicinal cannabis use among childbearing women: patterns of its use in pregnancy and retroactive self-assessment of its efficacy against 'morning sickness'

A majority of women experience some nausea and/or vomiting during pregnancy. This condition can range from mild nausea to extreme nausea and vomiting, with 1-2% of women suffering from the life-threatening condition hyperemesis gravidarum. Cannabis (Cannabis sativa) may be used therapeutically to mitigate pregnancy-induced nausea and vomiting. This paper presents the results of a survey of 84 female users of medicinal cannabis, recruited through two compassion societies in British Columbia, Canada. Of the seventy-nine respondents who had experienced pregnancy, 51 (65%) reported using cannabis during their pregnancies. While 59 (77%) of the respondents who had been pregnant had experienced nausea and/or vomiting of pregnancy, 40 (68%) had used cannabis to treat the condition, and of these respondents, 37 (over 92%) rated cannabis as 'extremely effective' or 'effective.' Our findings support the need for further investigations into cannabis therapy for severe nausea and vomiting during pregnancy.     

Non-steroid hormones and tissue polypeptide antigen (TPA) in emetic and non-emetic pregnancy

In order to investigate further the endocrine and metabolic features of the common condition emesis gravidarum, serum concentrations of some non-steroid hormones and tissue polypeptide antigen (TPA) were determined in 102 healthy pregnant women. 62 complained of nausea and vomiting in early pregnancy. Significantly higher and lower levels of human chorionic gonadotropin were noted in early and late pregnancy, respectively, in women with emesis gravidarum. A significant rise in serum prolactin and TPA was found throughout pregnancy in all subjects, no differences between emetic and non-emetic pregnancies being registered. Serum concentrations of growth hormone (hGH) showed a significant decline as pregnancy advanced. Emetic women demonstrated higher hGH levels in late pregnancy than did asymptomatic subjects. Free T4 concentrations remained stable when comparing early with late pregnancy, no dissimilarities being found between women with and without nausea and vomiting in pregnancy. These data do not support the hypothesis of major metabolic disturbances as an etiologic factor for nausea and vomiting in pregnancy. However, as overt differences between emetic and non-emetic pregnancy were found, hormonal factors may be involved in the pathogenesis of this condition.     

Reprint of: Survey of medicinal cannabis use among childbearing women: Patterns of its use in pregnancy and retroactive self-assessment of its efficacy against ‘morning sickness’

A majority of women experience some nausea and/or vomiting during pregnancy. This condition can range from mild nausea to extreme nausea and vomiting, with 1–2% of women suffering from the life-threatening condition hyperemesis gravidarum. Cannabis (Cannabis sativa) may be used therapeutically to mitigate pregnancy-induced nausea and vomiting. This paper presents the results of a survey of 84 female users of medicinal cannabis, recruited through two compassion societies in British Columbia, Canada. Of the seventy-nine respondents who had experienced pregnancy, 51 (65%) reported using cannabis during their pregnancies. While 59 (77%) of the respondents who had been pregnant had experienced nausea and/or vomiting of pregnancy, 40 (68%) had used cannabis to treat the condition, and of these respondents, 37 (over 92%) rated cannabis as ‘extremely effective’ or ‘effective.’ Our findings support the need for further investigations into cannabis therapy for severe nausea and vomiting during pregnancy.     

Nausea and Vomiting in Pregnancy Is Not Always Nausea and Vomiting of Pregnancy

The majority of pregnant women experience nausea and vomiting during pregnancy. However, nausea and vomiting in pregnancy is not always nausea and vomiting of pregnancy (NVP). The differential diagnosis of nausea and vomiting in pregnancy can be extensive and the underlying cause can sometimes be difficult to diagnose. However, the timing or onset of the symptoms is important in differentiating NVP from other causes. A thorough history and physical examination, with appropriate investigations, should be carried out in symptomatic women.     

Recall bias of the symptoms of nausea and vomiting of pregnancy

OBJECTIVE: Nausea and vomiting of pregnancy is the most common medical condition in pregnancy. Relatively little research has been conducted on this condition, and much of it is based on women's reports. Determinants that affect women's reports of their nausea and vomiting of pregnancy symptoms have not been elucidated. The purpose of this study was to assess the accuracy of recall by women of their symptoms of nausea and vomiting of pregnancy. STUDY DESIGN: Two hundred women who called the Motherisk nausea and vomiting of pregnancy counseling line in Toronto were asked about the severity of their nausea and vomiting of pregnancy symptoms with the use of the pregnancy unique quantification of emesis and nausea system (PUQE). The patients were asked the same questions again during a follow-up call, which took place up to 16 weeks later. RESULTS: There was a recall (or reporting) bias for nausea and vomiting, with women reporting significantly more severe symptoms during their follow-up call than they had reported originally. Multivariate analysis revealed that the severity of the symptoms affected the accuracy of recall positively, whereas the time that has elapsed affected it negatively. CONCLUSION: Retrospective evaluation of nausea and vomiting of pregnancy symptoms may produce a recall bias, which may distort the evaluation of the therapeutic effectiveness of antiemetics.     

Acupuncture To Treat Nausea and Vomiting in Early Pregnancy: A Randomized Controlled Trial

Background: Nausea and vomiting in early pregnancy are troublesome symptoms for some women. We undertook a single blind randomized controlled trial to determine whether acupuncture reduced nausea, dry retching, and vomiting, and improved the health status of women in pregnancy. Methods: The trial was undertaken at a maternity teaching hospital in Adelaide, Australia, where 593 women less than 14 weeks' pregnant with symptoms of nausea or vomiting were randomized into 4 groups: traditional acupuncture, pericardium 6 (p6) acupuncture, sham acupuncture, or no acupuncture (control). Treatment was administered weekly for 4 weeks. The primary outcomes were nausea, dry retching, vomiting, and health status. Comparisons were made between groups over 4 consecutive weeks. Results: Women receiving traditional acupuncture reported less nausea (p < 0.01) throughout the trial and less dry retching (p < 0.01) from the second week compared with women in the no acupuncture control group. Women who received p6 acupuncture (p < 0.05) reported less nausea from the second week of the trial, and less dry retching (p < 0.001) from the third week compared with women in the no acupuncture control group. Women in the sham acupuncture group (p < 0.01) reported less nausea and dry retching (p < 0.001) from the third week compared with women in the no acupuncture group. No differences in vomiting were found among the groups at any time. Conclusion: Acupuncture is an effective treatment for women who experience nausea and dry retching in early pregnancy. A time‐related placebo effect was found for some women. (BIRTH 29:1 March 2002)     

Nausea and vomiting of early pregnancy and pregnancy outcome. An epidemiological study

The association of nausea and vomiting in pregnancy with the outcome of pregnancy was investigated in a historical cohort of 903 women in Los Angeles, California, USA. Multivariable statistical methods were employed to control for the potential confounding effects of age, ethnicity, occupation, and anti-emetic use on pregnancy outcome. The analyses indicated that vomiting was associated with decreased risk of miscarriage (adjusted odds ratio 0.18, 95% CI 0.06 to 0.53); women with nausea but no vomiting had a miscarriage risk equal to that in the sample overall. Among the subsample of women with signs of threatened miscarriage, those who had experienced vomiting had a decreased risk of miscarriage (10.3% vs 31.7% in the subsample). No statistically significant association was observed between nausea and vomiting of pregnancy and other pregnancy outcomes (perinatal mortality, fetal anomalies, neonatal anthropometric measures).     

Variables Related to Nausea and Vomiting During Pregnancy

ABSTRACT: Seventy to 90 percent of all pregnant women experience nausea, and 50 percent have at least one episode of vomiting or retching. A continuous measure was used to quantify symptoms of nausea with or without vomiting or retching during pregnancy in 126 women. Relationships between symptoms and selected variables were evaluated. Nausea with or without vomiting or retching was associated with maternal age, occupation, parity, cigarette smoking, infant gender and the personality trait of independence. Significant associations were entered into multiple regression equations. Fourteen percent of the variation in symptoms overall, 25.1 percent of the variation in nausea symptoms, and 16.6 percent of the variation in vomiting or retching symptoms were explained by a combination of these selected independent variables. Although this study found associations, independent variables contributed little to predicting or explaining the presence and severity of nausea and vomiting during pregnancy. More sensitive measures and evaluation are required to understand and treat this perplexing phenomenon.     

Women's responses to nausea and vomiting in pregnancy

OBJECTIVE: To explore women's experiences of nausea and vomiting in pregnancy. DESIGN: secondary (thematic) analysis of data collected by narrative interviews for two wider studies about antenatal screening and about pregnancy for the DIPEx website (www.dipex.org). PARTICIPANTS AND SETTING: A maximum variation sample was recruited throughout the UK. Data from the 73 women interviewed have been analysed. Interviews took place between October 2003 and December 2004, mostly in the home. FINDINGS: sickness is considered a typical and almost inevitable feature of pregnancy. Against this backdrop, a new framework for understanding women's responses to nausea and vomiting in pregnancy, and the meanings they attach to it, is suggested: nausea and vomiting as something to be expected, survived, resisted, resented, and acknowledged by others. KEY CONCLUSIONS: The concepts of loss of self and biographical disruption from the field of chronic illness seem to resonate with the women's experiences, and may perhaps be extended to transient as well as chronic health conditions. People's experiences of their bodies in health as well as illness need to be more widely studied. IMPLICATIONS FOR PRACTICE: Many women would appreciate greater acknowledgement of the distress nausea and vomiting in pregnancy causes them, information about remedies and strategies other women have found helpful, and reassurance. Expressions of empathy by health-care professionals are frequently lacking and particularly desired.     

Helicobacter pylori and severe nausea and vomiting during pregnancy

Helicobacter pylori is a bacterial infection of the stomach, which may aggravate nausea and vomiting in pregnancy. Studies have found conflicting evidence of the role of H. pylori in severe nausea and vomiting in pregnancy and hyperemesis gravidarum. Several women suffering from weight loss and experiencing continued nausea and vomiting were tested for H. pylori antibody during their pregnancy. This article reviews the outcomes of women with both positive and negative H. pylori tests, the treatment of H. pylori, and its controversial role in managing severe nausea and vomiting in pregnancy.     

Psychosocial morbidity among women with nausea and vomiting of pregnancy: prevalence and association with anti-emetic therapy

Unlike severe nausea and vomiting of pregnancy (NVP), it is not known whether milder forms of NVP have been associated with psychosocial morbidity. We undertook the study to explore the prevalence of psychosocial morbidity by severity of NVP, and determine whether, after correction for severity of nausea/vomiting, there is a relationship between psychosocial morbidity and women's decisions to take anti-emetics as a reflection of their distress due to NVP. From 1996-97, an NVP Healthline was advertised. Callers underwent semi-structured interviews about both their NVP and associated psychosocial morbidity in a previous pregnancy. Most of the 3201 callers resided in Canada, worked outside the home, reported on planned pregnancy (a median of) 4 years before, and described severe (> 5 episodes/day of) nausea and vomiting. More severe nausea/vomiting was associated with more frequent feelings of depression, consideration of termination of pregnancy, adverse effects on women's relationships with their partners or their partners' everyday lives, and the perceived likelihood that NVP would harm their baby (p < 0.0001). However, all psychosocial factors were reported by a clinically important proportion of women with mild nausea/vomiting (0-1 episodes/day). The severity of vomiting was most closely related to women's decisions to take anti-emetics, but other psychosocial factors were also independently associated with anti-emetic therapy. We conclude that psychosocial morbidity is evident across the spectrum of severity of nausea and vomiting among women with NVP. The severity of nausea or vomiting does not appear adequately to reflect the distress caused by NVP, as reflected by women's decisions to take anti-emetic therapy.     

Effect of acupressure by Sea-Bands on nausea and vomiting of pregnancy

OBJECTIVE: To determine the effect of continuous acupressure at P6 applied by Sea-Bands with acupressure buttons on the frequency and severity of nausea and vomiting of pregnancy during the 1 st trimester. DESIGN: A two-group, quasi-experimental, posttest-only and posttest-repeated measure. SETTING: Seventeen medical clinics or offices in southern Michigan. PARTICIPANTS: Convenience sample of English-speaking, healthy pregnant women in their 1 st trimester, who had at least one episode of nausea, vomiting, or both before their prenatal clinic/office visit where they were recruited. After being accepted for the study, the women were randomly assigned to treatment or placebo groups. INTERVENTION: Treatment group 1 applied SeaBands with acupressure buttons to both wrists for 4 days and removed the Sea-Bands for 3 subsequent days. Placebo group 2 applied the Sea-Bands without acupressure buttons to both wrists on the same time schedule as group 1. MAIN OUTCOME MEASURE: Self-report daily diaries of the number of times per day that participants experienced nausea, the severity of nausea, the number of vomiting episodes per day, and the severity of vomiting. RESULTS: Mann-Whitney U procedures revealed that the treatment group had significantly less frequency and severity of nausea and vomiting of pregnancy while wearing the Sea-Bands than did the placebo group. The treatment group also had significantly less frequency and severity of nausea and vomiting of pregnancy while wearing the SeaBands than when not wearing the Sea-Bands. CONCLUSIONS: Sea-Bands with acupressure buttons are a noninvasive, inexpensive, safe, and effective treatment for the nausea and vomiting of pregnancy.     

Nausea and Vomiting During Pregnancy: Effects on the Quality of Women's Lives

ABSTRACT: More than 70 percent of all pregnant women experience nausea and vomiting during pregnancy, and 28 percent report that symptoms cause them to change their usual activities. We investigated the magnitude of problems that nausea and vomiting impose on the lifestyle of pregnant women and their families. Twenty-seven women who were experiencing different degrees of nausea and vomiting were selected from 147 pregnant women and asked to participate in semistructured telephone interviews. All participants reported changes in family, social, or occupational functioning as a result of these symptoms. Nausea and vomiting can impose substantial lifestyle limitations on pregnant women that can have short- and long-term consequences for them and their families. Both the duration and severity of symptoms were greater for many participants than is generally believed. All participants reported that recumbent rest or dietary alterations provided relief. Caregivers should recognize and validate the need for pregnant women to make changes in lifestyle that will enable them to achieve comfort.     

Nausea and vomiting associate with increasing maternal androgen levels in otherwise uncomplicated pregnancies

BACKGROUND: The objective of the present study was to investigate the hypothesis that maternal androgen levels associate with nausea and vomiting in otherwise uncomplicated pregnancies. METHODS: One hundred and twenty-nine women with uncomplicated pregnancies, reported nausea and vomiting in weeks 17, 25, 33, 37, and when admitted for delivery. Maternal levels of androstenedione, dehydroepiandrosterone sulfate (DHEAS), testosterone, and sex hormone binding globulin (SHBG) were measured and the free testosterone index calculated in weeks 17 and 33 of pregnancy. RESULTS: Maternal levels of androstenedione and DHEAS associated positively with nausea and vomiting in week 17. In week 33, testosterone and DHEAS associated positively with nausea and vomiting, as well as androstenedione. A calculated emesis score associated positively with increasing average levels of both androstenedione and testosterone during pregnancy, as well as the free testosterone index. CONCLUSIONS: Nausea and vomiting associate with increasing maternal androgen levels during otherwise uncomplicated pregnancies. Whether androgens are causally related to emesis gravidarum remains unknown.     

Psychosocial morbidity among women with nausea and vomiting of pregnancy: Prevalence and association with anti-emetic therapy

Unlike severe nausea and vomiting of pregnancy (NVP), it is not known whether milder forms of NVP have been associated with psychosocial morbidity. We undertook the study to explore the prevalence of psychosocial morbidity by severity of NVP, and determine whether, after correction for severity of nausea/ vomiting, there is a relationship between psychosocial morbidity and women's decisions to take anti-emetics as a reflection of their distress due to NVP. From 1996–97, an NVP Healthline was advertised. Callers underwent semi-structured interviews about both their NVP and associated psychosocial morbidity in a previous pregnancy. Most of the 3201 callers resided in Canada, worked outside the home, reported on planned pregnancy (a median of) 4 years before, and described severe (> 5 episodes/day of) nausea and vomiting. More severe nausea/vomiting was associated with more frequent feelings of depression, consideration of termination of pregnancy, adverse effects on women's relationships with their partners or their partners' everyday lives, and the perceived likelihood that NVP would harm their baby (p < 0.0001). However, all psychosocial factors were reported by a clinically important proportion of women with mild nausea/vomiting (0–1 episodes/day). The severity of vomiting was most closely related to women's decisions to take anti-emetics, but other psychosocial factors were also independently associated with anti-emetic therapy.

We conclude that psychosocial morbidity is evident across the spectrum of severity of nausea and vomiting among women with NVP. The severity of nausea or vomiting does not appear adequately to reflect the distress caused by NVP, as reflected by women's decisions to take anti-emetic therapy.