Functional
Nausea and Vomiting of Pregnancy

https://doi.org/10.1016/j.gtc.2011.03.009Get rights and content

Section snippets

Epidemiology

It is estimated that 70% to 80% of pregnant women experience NVP.1 In the United States and Canada this translates to approximately 4 million and 350,000 women who are affected each year, respectively.2

NVP is found more often in Western countries and urban populations, and is rare among Africans, Native Americans, Eskimos, and most Asian populations.3 Only a few studies have examined the racial distribution of NVP in a given population with conflicting results. One such study from Canada of 367

Metabolic and Hormonal Factors

Although the exact pathogenesis of NVP and HG are unknown, it is widely accepted that gestational vomiting results from various metabolic and endocrine factors, many of placental origin. The most implicated factor is human chorionic gonadotropin (hCG). This link between hCG and NVP is based largely on the temporal relationship between the peak of NVP and the peak of hCG production, both of which occur between 12 and 14 weeks’ gestation. In addition, nausea and vomiting are often worse in

History and Physical Examination

Despite popular use of the term “morning sickness,” NVP persists throughout the day in the majority of affected women and has been found to be limited to the morning in less than 2% of women.10 It often begins within weeks of missing menses and thus is caricatured across most cultures as the initial sign of pregnancy. Symptoms usually peak between 10 and 16 weeks’ gestation and usually resolve after 20 weeks. Up to 10% of women, however, continue to be symptomatic beyond 22 weeks.10

Whereas

Outcome

Most studies have found NVP to be associated with a favorable outcome for the fetus. A meta-analysis of 11 studies by Weigel and Weigel88 found a strong significant association between nausea and vomiting of pregnancy and decreased risk of miscarriage (common odds ratio = 0.36, 95% CI 0.32–0.42), and no consistent associations with perinatal mortality. Moreover, women without NVP have been found to deliver earlier than women with NVP.89

Adverse outcomes, however, have been reported in some

Hyperemesis gravidarum

HG is a condition of severe nausea and vomiting during pregnancy leading to fluid, electrolyte, and acid-base imbalance, nutritional deficiency, and weight loss.39 Some have defined it as the occurrence of greater than 3 episodes of vomiting per day accompanied by ketonuria and a weight loss of more than 3 kg or 5% of body weight.61 HG is the most common reason for hospitalization in early pregnancy and is second only to preterm labor throughout the whole of pregnancy.101 In the United States

Treatment

The goal of treatment is to improve symptoms while minimizing risks to mother and fetus. To attain this goal, a multimodal approach tailored to each individual is usually needed. Treatment modalities range from simple dietary modifications to drug therapy and total parenteral nutrition. Severity of symptoms and maternal weight loss are useful in determining the aggressiveness of treatment. The PUQE score and the Hyperemesis Impact of Symptoms (HIS) Questionnaire can be considered to assess the

Summary

NVP is an extremely common disorder in pregnancy that ranges in spectrum from mild to moderate nausea and vomiting to pathologic HG. Despite its prevalence, its pathogenesis is still largely unknown and consequently treatment is mainly symptomatic, ranging from dietary changes and oral pharmacologic treatment to hospitalization with intravenous fluid replacement and nutrition therapy.

Although most studies suggest that NVP is not harmful to the fetus, this condition is not benign in that it

First page preview

First page preview
Click to open first page preview

References (173)

  • K.D. Wenstrom et al.

    Elevated second-trimester human chorionic gonadotrophin levels in association with poor pregnancy outcome

    Am J Obstet Gynecol

    (1994)
  • T. Goodwin

    Nausea and vomiting of pregnancy; an obstetric syndrome

    Am J Obstet Gynecol

    (2002)
  • A. Borgeat et al.

    Hyperemesis gravidarum: is serotonin implicated?

    Am J Obstet Gynecol

    (1997)
  • C.A. Sullivan et al.

    A pilot study of intravenous ondansteron for hyperemesis gravidarum

    Am J Obstet Gynecol

    (1996)
  • B. Demir et al.

    Adjusted leptin level (ALL) is a predictor for hyperemesis gravidarum

    Eur J Obstet Gynecol Reprod Biol

    (2006)
  • N. Unsel et al.

    Leptin levels in women with hyperemesis gravidarum

    Int J Gynaecol Obstet

    (2004)
  • Y. Yoneyama et al.

    The T-helper 1/T-helper 2 balance in peripheral blood of women with hyperemesis gravidarum

    Am J Obstet Gynecol

    (2002)
  • P.B. Kaplan et al.

    Maternal serum cytokine levels in women with hyperemesis gravidarum in the first trimester of pregnancy

    Fertil Steril

    (2003)
  • Y. Yoneyama et al.

    Plasma adenosine concentrations increase in women with hyperemesis gravidarum

    Clin Chim Acta

    (2004)
  • P. Frigo et al.

    Hyperemesis gravidarum associated with Helicobacter pylori seropositivity

    Obstet Gynecol

    (1998)
  • T. Bagis et al.

    Endoscopy in hyperemesis gravidarum and Helicobacter pylori infection

    Int J Gynaecol Obstet

    (2002)
  • I. Kocak et al.

    Helicobacter pylori seropositivity in patients with hyperemesis gravidarum

    Int J Gynaecol Obstet

    (1999)
  • K.L. Koch et al.

    Nausea and vomiting during pregnancy

    Gastroenterol Clin North Am

    (2003)
  • A.G. Macfie et al.

    Gastric emptying in pregnancy

    Br J Anaesth

    (1991)
  • M. Lawson et al.

    Gastrointestinal transit time in human pregnancy: prolongation in the second and third trimesters followed by postpartum normalization

    Gastroenterol

    (1985)
  • S. Munch

    Chicken or the egg? The biological-psychological controversy surrounding hyperemesis gravidarum

    Soc Sci Med

    (2002)
  • W.L. Hasler et al.

    Mediation of hyperglycemia-evoked gastric slow waves dysrhythmias by endogenous prostaglandins

    Gastroenterol

    (1995)
  • F.D. Tierson et al.

    Nausea and vomiting of pregnancy and association with pregnancy outcome

    Am J Obstet Gynecol

    (1986)
  • T. Bayley et al.

    Food cravings and aversions during pregnancy: relationships with nausea and vomiting

    Appetite

    (2002)
  • R. Huxley

    Nausea and vomiting in early pregnancy; its role in placental development

    Obstet Gynecol

    (2000)
  • C. Attard et al.

    The burden of illness of severe nausea and vomiting of pregnancy in the United States

    Am J Obstet Gynecol

    (2002)
  • F. Miller

    Nausea and vomiting in pregnancy: the problem of perception—is it really a disease?

    Am J Obstet Gynecol

    (2002)
  • B. O’Brien et al.

    Variables related to nausea and vomiting during pregnancy

    Birth

    (1995)
  • J.P. Semmens

    Female sexuality and life situations: an etiologic psycho-socio-sexual profile of weight gain and nausea and vomiting of pregnancy

    Obstet Gynecol

    (1971)
  • A. Lacasse et al.

    Epidemiology of nausea and vomiting of pregnancy: prevalence, severity, determinants, and the importance of race/ethnicity

    BMC Pregnancy Childbirth

    (2009)
  • L. Dodds et al.

    Outcome of pregnancies complicated by hyperemesis gravidarum

    Obstet Gynecol

    (2006)
  • R. Blum

    Pregnancy, nausea, and vomiting: further explorations in theory

  • M.A. Klebanoff et al.

    Epidemiology of vomiting in early pregnancy

    Obstet Gynecol

    (1985)
  • J.M. Brandes

    First trimester nausea and vomiting as related to outcome of pregnancy

    Obstet Gynecol

    (1967)
  • R.M. Weigel et al.

    The association of reproductive history, demographic factors, and alcohol and tobacco consumption with the risk of developing nausea and vomiting in early pregnancy

    Am J Epidemiol

    (1988)
  • M. Davis

    Nausea and vomiting of pregnancy: an evidence-based review

    J Perinat Neonatal Nurs

    (2004)
  • L.A. Corey et al.

    The epidemiology of pregnancy complications and outcome in Norwegian twin population

    Obstet Gynecol

    (1992)
  • R. Gadsby et al.

    Pregnancy nausea related to women’s obstetric and personal histories

    Gynecol Obstet Invest

    (1997)
  • E. Furneaux et al.

    Nausea and vomiting of pregnancy; endocrine basis and contribution to pregnancy outcome

    Obstet Gynecol Surv

    (2001)
  • S. Whitehead et al.

    Maternal susceptibility to nausea and vomiting of pregnancy: is the vestibular system involved?

    Am J Obstet Gynecol

    (2002)
  • B. Kallen et al.

    Relationship between vitamin use, smoking, and nausea and vomiting of pregnancy

    Acta Obstet Gynecol Scand

    (2003)
  • G. Samisoe et al.

    Does position and size of corpus luteum have any effect on nausea and vomiting?

    Acta Obstet Gynecol Scand

    (1986)
  • J.M. Thorp et al.

    Effect of corpus luteum position on hyperemesis gravidarum. A case report

    J Reprod Med

    (1991)
  • L. Signorello et al.

    Saturated fat intake and the risk of severe morning sickness

    Epidemiology

    (1998)
  • D.B. Fell et al.

    Risk factors for hyperemesis gravidarum requiring hospital admission during pregnancy

    Obstet Gynecol

    (2006)
  • Cited by (0)

    View full text