Sleep quality in women with nausea and vomiting of pregnancy: a cross-sectional study.

BACKGROUND: Nausea and vomiting of pregnancy (NVP) deteriorates many aspects of daily lives of women. However, little is known about associations between NVP and sleep quality. METHODS: Women attending to routine mid-pregnancy visits in maternity health care clinics in Turku city area and surrounding municipalities, Finland, during 2011-2014, were invited to participate. A cohort of 1203 volunteers (mean age 30 years, mean gestational week 16.6, mean BMI 24.4 kg/m2, nulliparous 46%) was recruited. The severity of NVP in the worst 12-h period of current pregnancy was assessed with Pregnancy Unique Quantification of Emesis Questionnaire (PUQE) and categorized accordingly into no/mild/moderate and severe NVP. Sleep disturbances during the past 3 months were assessed with selected questions (difficulty falling asleep, night awakenings, too early morning awakenings and sleepiness during the day) from Basic Nordic Sleep Questionnaire (BNSQ). In addition, general sleep quality, as well as physical and mental quality of life (QoL) were rated with three visual analog scales (VAS). Associations between PUQE categories (severity of NVP) and sleep disturbances, general sleep quality, physical QoL and mental QoL were evaluated with multinomial regression analysis. RESULTS: According to PUQE, NVP was most frequently moderate (n = 629, 52.3%), followed by mild (n = 361, 30.0%) and severe (n = 77, 6.4%). Only 11.3% had no NVP (n = 136). The most frequent sleep disturbance was night awakenings (69.9%, n = 837), followed by sleepiness during the day (35.7%, n = 427), too early morning awakenings (12.0%, n = 143) and difficulty falling asleep (7.1%, n = 81). In adjusted analysis (age, parity, body mass index, smoking, employment), more severe NVP was associated with night awakenings (AOR 3.9, 95% CI 1.79-8.47, P < 0.0001) and sleepiness during the day (AOR 4.7, 95% CI 2.20-9.94, P < 0.0001). In VAS, women with more severe NVP rated worse general sleep quality and worse physical and mental QoL. However, in multivariable analysis, the association between the severity of NVP and physical and mental QoL was stronger than that of sleep . CONCLUSIONS: More severe NVP is associated with sleep disturbances and in close relation to lower physical and mental QoL. Thus, in comprehensive care of women with NVP, also sleep quality should be evaluated.

Women's Perceived Reasons for Their Excessive Postpartum Weight Retention: A Qualitative Interview Study.

INTRODUCTION: Obesity in Sweden has doubled to 14% over the last 20 years. New strategies for treatment and prevention are needed. Excessive gestational weight gain has been found to contribute substantially to obesity, and there is a consistent association between postpartum weight retention and obesity later in life. We aimed to explore what factors women perceive as reasons for having substantial postpartum weight retention, to identify areas for new and improved interventions. METHODS: Qualitative interview study (semi-structured) using an emergent design. Fifteen women, with a postpartum weight retention ≥ 10 kg, were interviewed by a trained cognitive therapist. Eight women had pre-pregnancy BMI below 30 kg/m2. Interviews were transcribed verbatim and data analysed using inductive manifest content analysis. Salient text passages were extracted, shortened, coded and clustered into categories. RESULTS: Participants reported no knowledge of current gestational weight gain recommendations or of risks for adverse pregnancy outcomes with excessive weight gain or postpartum weight retention. Excessive eating emerged as a common strategy to provide relief of psychological, emotional and physical discomfort, such as depression and morning sickness. Women perceived medical staff as being unconcerned about weight, and postpartum weight loss support was scarce or absent. Some women reported eating more due to a belief that breastfeeding would automatically lead to weight loss. CONCLUSION: There is a need to raise awareness about risks with unhealthy gestational weight development and postpartum weight retention in women of childbearing age. The common strategy to cope with psychological, emotional or physical discomfort by eating is an important factor to target with intervention. The postpartum year is a neglected period where additional follow-up on weight and weight loss support is strongly indicated.

Abdomen agudo durante la gestación y el puerperio / Acute abdomen during pregnancy and the puerperium

El abdomen agudo en la gestación y el puerperio constituye un diagnóstico complejo y un reto terapéutico. Nuestro objetivo es realizar una revisión bibliográfica de esta patología a propósito de un caso de peritonitis secundaria a absceso tubárico con apendicitis por helmintos concomitante. Principalmente, su sintomatología se resume en el dolor y la distensión abdominal, las náuseas y/o los vómitos. Estos síntomas se encuentran presentes en el embarazo normal, dificultando el diagnóstico diferencial. El abdomen agudo es relativamente infrecuente durante la gestación y el puerperio, siendo la apendicitis aguda la principal causa de origen no obstétrico. Asocia una elevada morbimortalidad materno-fetal, que aumenta a medida que la gestación avanza, requiriendo un manejo multidisciplinar para alcanzar un diagnóstico precoz y un tratamiento efectivo. Fundamentalmente, el abordaje terapéutico es quirúrgico debido, en gran medida, al diagnóstico tardío con frecuente asociación de complicaciones. Un manejo temprano será primordial para minimizar riesgos para la madre y el feto

Acute abdomen in pregnancy and the postpartum period is a complex diagnostic and therapeutic challenge. We review the literature on this topic and report a case of peritonitis secondary to tubal abscess with concomitant helminth appendicitis. The main symptoms of this entity are pain and bloating, nausea and/or vomiting. These symptoms are present in normal pregnancy, which hampers the differential diagnosis. Acute abdomen is relatively uncommon during pregnancy and the postpartum, and the main obstetric cause is acute appendicitis. Maternal and fetal morbidity and mortality are high and increase as the pregnancy progresses, requiring multidisciplinary management to achieve early diagnosis and effective treatment. The therapeutic approach is mainly surgical, largely due to late diagnosis and associated complications. Early management is essential to minimize the risks to the mother and fetus

Comparison of antiemetics for nausea and vomiting of pregnancy in an emergency department setting.

OBJECTIVE: To compare time from medication administration to disposition from the Emergency Department (ED) between women treated for nausea and vomiting of pregnancy with different antiemetic agents. DESIGN: We performed a retrospective cohort study of women 13 weeks gestation or less treated in our Women and Infants Hospital ED for nausea and vomiting of pregnancy between 2009 and 2011. Data was collected on patient demographics, antiemetics used, and time to disposition. We analyzed time of administration of the antiemetic used first line (ondansetron versus metoclopramide versus promethazine or prochlorperazine) to time the discharge order was placed. RESULTS: We analyzed data from 439 women treated in the ED for nausea and vomiting of pregnancy. Forty-four percent received ondansetron alone, 47% received any other antiemetic alone, and 9% received more than one agent first line. Antiemetic agent selected did not differ by patient age, parity, current treatment for nausea and vomiting in pregnancy, orthostatics, ketonuria or disposition. We found no difference in time from medication administration to disposition between women who received ondansetron and women who received any other antiemetic (metoclopramide, prochlorperazine or promethazine). Adjusting for potential confounders, compared to patients who received any other first line therapy, patients who received ondansetron had 2.09 times the odds of having a time to disposition at or above the 75th percentile (95% CI 1.31-3.34). CONCLUSIONS: The use of ondansetron in the ED for nausea and vomiting of pregnancy was associated with similar mean time from administration to disposition as other antiemetics.

Resident obstetricians' awareness of the oral health component in management of nausea and vomiting in pregnancy.

BACKGROUND: Nausea and vomiting are common in early pregnancy in 50-90% of pregnant women and resolves in all but 10% of these women. Many obstetricians encounter this problem and should be familiar with the probable outcomes, current treatment options and oral health component of its management. This study assessed the awareness of obstetrics residents of the oral health component of management of nausea and vomiting in pregnancy. METHODS: This study was carried out among resident doctors in Obstetrics and Gynaecology in Nigeria. A pre-tested, self-administered questionnaire was used for the data collection. The data collected were analyzed using the Statistical Package for Social Science (SPSS) version 17.0. Non parametric analysis in the form of chi square was carried out to test for statistical significance with P value <0.05 considered statistically significant. RESULTS: A total of 200 questionnaires were administered while 186 were filled and returned, giving a response rate of 93%, comprising 21.5% senior residents and 78.5% junior residents. Most of the respondents agreed that oral health is important in pregnancy. A majority (58%) also thought that oral health complaints in pregnancy were not normal. Fifty-seven percent of the respondents neither assessed teeth and gums of pregnant women for problems during ante-natal care nor educated them on care that would improve their oral health. Majority (95.7%) of the respondents assisted pregnant women with dealing with nausea and vomiting but were not aware of the oral health component of its management. CONCLUSION: Oral health component in the management of nausea and vomiting in pregnancy has been largely neglected in obstetric care. It is pertinent that ante-natal health care providers receive adequate education on perinatal oral health care.

The outpatient management and special considerations of nausea and vomiting in pregnancy.

With 50-90% of pregnant women experiencing nausea and vomiting of pregnancy (NVP), the burden of illness can become quite significant if symptoms are under-treated and/or under-diagnosed, thus allowing for progression of the disease. The majority of these women will necessitate at least one visit with a provider to specifically address NVP, and up to 10% or greater will require pharmacotherapy after failure of conservative measures to adequately control symptoms. As a result, initiation of prompt and effective treatment in the outpatient setting is ideal. Once NVP is diagnosed and treatment is started, it is crucial to track symptoms in order to assess for a decrease in or resolution of symptoms as well as an escalation in symptoms requiring additional therapy. Of note, co-existing gastroesophageal reflux disease (GERD), Helicobacter pylori infection, and psychosocial factors may have a negative impact on the management of NVP. Ultimately, every woman has her own perception of disease severity and desire for treatment. It is critical that both the provider and patient be proactive in the diagnosis and management of NVP.

Prevalence and persistence of nausea and vomiting along the pregnancy / Prevalencia y persistencia de náuseas y vómitos durante el embarazo

Background/aims: Nausea and vomiting of pregnancy (NVP) impact in the pregnant woman’s quality of life, especially when are persistent or severe. The objective is to estimate the prevalence and factors associated with the persistence of NVP in each trimester of pregnancy. Methods: We studied a cohort of 263 pregnant women with gestational age < 12 weeks. Data were collected using the Gastro- Esophageal Reflux Questionnaire validated for use in the Spanish population. Data were collected through telephone interviews at the end of each trimester of pregnancy. The main variable was the presence of NVP in each trimester and their persistence along the pregnancy. Results: The prevalence of nausea in the each trimester was 63.5 %, 33.8 %, 26.2 %, and vomiting was 29.3 %, 22.1 %, 14.1 %, respectively. Factors associated with nausea in the first trimester were Latin-American origin (OR: 3.60, 95 %IC 1.61- 80.5) and primary education (OR: 0.31; 0.13-0.73); vomiting was associated with Latin-American origin (OR: 13.80, 1.82-104.4) and was inversely associated with weight gain (OR: 0.58, 0.35- 0.97). Persistence of NVP were only associated with suffering the symptom in the previous trimester (p < 0.01), and did not find other predictor factors. Conclusions: NVP’s prevalence declines along pregnancy, is associated with race and inversely with weight gain, and its persistence over time cannot be predicted (AU)

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Síndrome Hellp: estudio de revisión para la atención de enfermería / Síndrome Hellp: estudo de revisão para o cuidado de enfermagem

Revisión narrativa de enfoque cualitativo que analiza el síndrome HELLP como una de las principales complicaciones de la hipertensión arterial en el embarazo. HELLP significa: H: hemolisis, EL = enzimas hepáticas elevadas y LP: disminución del número de plaquetas circulantes. Cuando una mujer embarazada en estado de pre-eclampsia presenta alteraciones clínicas o de laboratorio compatibles con hemolisis, se puede considerar la posibilidad de síndrome de HELLP. Cuando el cuadro materno es estable es posible seguir el embarazo con la utilización de corticoides en la inducción de la maduración del pulmón fetal, con reducción de las complicaciones maternas y neonatales, dado que en el síndrome HELLP la interrupción del embarazo es el único tratamiento capaz de disminuir el síndrome. Este estudio destaca la importancia de la propedéutica investigadora para el diagnóstico del síndrome HELLP cuando embarazadas hipertensas con pre-eclampsia son asistidas por la enfermera en las consultas de prenatal (AU)

Narrative review of a qualitative approach that examines HELLP Syndrome as a major complication of hypertension among pregnant women. It is a set of signs and symptoms that can occur in the pre-eclampsia. HELLP means: H: hemolysis (involves the destruction of red blood cells), EL: elevated liver enzymes and LP: decreased number of platelets (cells that help clotting) circulating. When a pregnant woman in a state of pre-eclampsia presents clinical or laboratory abnormality consistent with hemolysis one can consider the possibility of HELLP Syndrome. In the situation where a pregnant woman is stable it is possible to make the pregnancy viable with the use of steroids in the induction of fetal lung maturation, reducing the birth complications for the mother and the newborn; because in HELLP syndrome the birth is the only treatment capable of stopping it. This study highlights the importance of investigation process for the diagnosis of HELLP syndrome in a pregnant hypertensive, with pre-eclampsia is assisted by a nurse, to prevent the impairment of the vitality and maternal mortality in severe cases (AU)

Revisão Narrativa de abordagem qualitativa que analisa a Síndrome HELLP como uma das principais complicações da hipertensão arterial na gravidez. A palavra HELLP significa: H: hemólise; EL: enzimas hepáticas elevadas e LP: diminuição do número de plaquetas circulantes. Quando uma gestante em estado de pré-eclampsia apresenta alterações laboratoriais ou clínicas compatíveis com hemólise, pode-se considerar a possibilidade da Síndrome HELLP. Quando o quadro materno apresenta-se estável é possível viabilizar a gestação a partir do uso de corticóides na indução da maturação pulmonar fetal, com redução das complicações maternas e neonatais; até porque na Síndrome HELLP o término da gestação é o único tratamento capaz de frear a Síndrome. Este estudo destaca a importância da propedêutica investigante para o diagnostico da Síndrome HELLP sempre que uma gestante hipertensa, portadora de pré-eclampsia é assistida pela Enfermeira nas consultas de Pré-natal (AU)

Appetite sensations in pregnancy among agropastoral women in rural Tanzania.

Women all over the globe report physical and appetite sensations in early pregnancy, and this study contributes to this growing literature by reporting on the appetite sensations experienced by pregnant women from rural Tanzania. Appetite changes associated with 545 pregnancies were compiled from surveys conducted to report on the prevalence of appetite loss, nausea, vomiting, dizziness, joint pain, cravings, aversions, and pica experienced by agropastoral women from rural north-central Tanzania. In addition to these symptoms, specific craved and aversive food groups are described. Statistical associations among appetite sensations, NVP, and birthweight are tested. The only symptom associated with a lower average birth weight for newborns was vomiting. In addition to investigating micronutrient content and chemical properties of specific food and non-food items, future research should include assessing relationships among various appetite sensations and short- and long-term health outcomes for both the mother and child.

Síntomas y signos digestivos durante la gestación: náuseas y vómitos/hiperemesis gravídica / Gastrointestinal signs and symptoms during pregnacy: nausea and vomiting / hyperemesis gravidarum

Entre los simples vómitos gestacionales y la HG existe una multitud de cuadros con grados de intensidad intermedios, sin que se observen claras diferencias etiopatogénicas. Las náuseas y vómitos de la gestación (NVG) son una situación fisiológica frecuente en la embarazada. Suelen ser esporádicos, preferentemente matutinos, con capacidad de alterar la calidad de vida de la gestante pero sin repercusión en su estado metabólico. Cuando el cuadro se agrava presentando vómitos continuos e intensos que imposibilitan la correcta alimentación de la gestante nos encontramos ante una hiperemesis gravídica (HG), que puede llevar a un cuadro de deshidratación, deficiencias nutricionales y alteración metabólica, requiriendo en muchas ocasiones tratamiento hospitalario para corregir las alteraciones hidroelectrolíticas presentes y múltiples complicaciones tanto digestivas como neurológicas(AU)

Nausea and vomiting in pregnancy is a common physiological condition in pregnant women. It is usually sporadic, often in the morning, which can affect the quality of life of the pregnant woman without any change in her metabolic state. When the condition is aggravated, with continuous and intense vomiting which makes it impossible to follow a correct diet, we are faced with a hyperemesis gravidarum (HG) which can lead to dehydration, nutritional deficiencies and metabolic changes. On many occasions this may require hospital treatment to correct the water and electrolyte changes and the multiple digestive tract and neurological complications. There is a multitude of conditions between simple gestational vomiting and HG with intermediate levels of intensity, without any clear differences in pathological origin(AU)

Treatment of heartburn and acid reflux associated with nausea and vomiting during pregnancy.

QUESTION: In addition to suffering from nausea and vomiting of pregnancy, which is being treated with antiemetics, some of my pregnant patients complain of heartburn and acid reflux. Should these symptoms also be treated and, if so, which acid-reducing medications are safe for use during pregnancy? ANSWER: Increased severity of nausea and vomiting of pregnancy is associated with the presence of heartburn and acid reflux. Antacids, histamine-2 receptor antagonists, and proton pump inhibitors can be used safely during pregnancy, as large studies have been published with no evidence of adverse fetal effects.