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.

The health and quality of life of Thalidomide survivors as they age - Evidence from a UK survey.

BACKGROUND: In the late 1950s and early 1960s the drug Thalidomide was marketed across the world as a non-addictive tranquilizer. Despite being given to pregnant women as a safe treatment for morning sickness, Thalidomide caused serious damage to the unborn child. Much has been written about the drug and the birth defects it caused but evidence about the health of Thalidomide survivors as they age is limited. AIM: The aim of this study was to: explore the health and wellbeing UK Thalidomide survivors; document the health problems experienced by them as they reach their mid-50s; and examine the impacts on their health-related quality of life and employment. METHODS: A health and wellbeing survey of 351 UK Thalidomide survivors, which gathered information about home and employment circumstances, recent health problems, and health related quality of life (using SF12 Health Survey). Overall analysis focused on descriptive statistics; the association between respondents' health related quality of life and original impairment was examined using Pearson Correlation; and a three step Hierarchical Regression was used to explore the influence of five factors which narrative responses suggested might be important. RESULTS: As Thalidomide survivors reach their mid-50's they are experiencing a wide range of secondary health problems, in particular musculoskeletal problems, and depression and anxiety, with multimorbidity a growing issue. These health problems are having a negative impact on their employment (two fifths are unable to work) and their physical health related quality of life, which is significantly poorer than the general population. DISCUSSION: Having lived relatively independent lives, many Thalidomide survivors are now having to adjust to growing disability. The study provides further evidence of the accumulative impact of disability over peoples' lifetimes and highlights the value of a life course perspective in understanding the complex experience of growing older with a disability.

The burden of nausea and vomiting during pregnancy: severe impacts on quality of life, daily life functioning and willingness to become pregnant again - results from a cross-sectional study.

BACKGROUND: Though nausea and vomiting is very common during pregnancy, no studies have investigated the impact of this condition on the women's daily lives in a Scandinavian population. The aim of this study was to describe the burden of nausea and vomiting during pregnancy (NVP) on global quality of life, daily life functioning and willingness to become pregnant again according to the severity of NVP symptoms. METHODS: This study is a cross-sectional population-based study conducted in Norway. Pregnant women and mothers with children <1 year of age with current or prior NVP were eligible to participate. Data were collected through an anonymous on-line questionnaire accessible from November 10th, 2014 to January 31st, 2015. Severity of NVP was measured using the 24-h Pregnancy Unique Quantification of Emesis Scale (PUQE). Associations between severity of NVP, daily life functioning and willingness to become pregnant again were tested using chi-square tests. Associations with global quality of life measured in terms of the Quality of Life Scale (QOLS) were estimated using generalized linear models and reported as unstandardized regression coefficients (ß) with 95% confidence intervals (CI). RESULTS: 712 women with NVP were included in the study. NVP was significantly associated with several characteristics, including daily life functioning, quality of life and willingness to become pregnant again. The negative impact was greater the more severe the symptoms were, although considerable adverse effects were also seen among women with mild and moderate NVP symptoms. Over one fourth of the women with severe NVP considered terminating the pregnancy due to NVP, and three in four considered not to get pregnant again. Severity of NVP remained significantly associated with reduced global quality of life when adjusting for maternal characteristics and illnesses with ß (95% CI) = -10.9 (-16.9, -4.9) for severe versus mild NVP. CONCLUSIONS: NVP as measured by PUQE had a major impact on various aspects of the women's lives, including global quality of life and willingness to become pregnant again.

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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Pregnancy sickness and parent-offspring conflict over thyroid function.

Pregnancy sickness is widespread in human mothers but its etiology, somewhat surprisingly, remains unclear. Human chorionic gonadotropin (hCG) has long been considered a prime hormonal suspect, but the correlation between pregnancy sickness and hCG levels is imperfect resulting in uncertainty about its causal role. As others have noted part of this uncertainty likely stems from the structural and functional diversity of hCG. One enigmatic role of hCG is its action as a thyroid stimulator during early gestation. Native hCG is weakly thyrotropic but is produced in prodigious quantities and suppresses the production of thyroid stimulating hormone (TSH) but not curiously when TSH levels are in the higher deciles. Higher levels of hCG induce higher maternal production of thyroxine (T4). hCG thus appears to augment and sometimes even supplant TSH in the regulation of thyroid hormone in early gestation. This has lead to the suggestion that hCG serves as a backup system, albeit incomplete, for the production of essential thyroid hormone during pregnancy. Another interpretation, however, is that hCG, produced by the embryo, serves as a second control circuit for the thyroid during pregnancy. If so, it serves embryonic interests that are at odds with maternal interests (maternal-embryo conflict) under conditions of iodine deficiency. Iodine is an essential micronutrient for neurodevelopment and thyroid function, and has been in short supply for most humans over most of our evolutionary history. Iodine deficiency during gestation has severe impacts on embryo neuromotor development, but also induces thyroid disease in mothers, impairing her future reproductive prospects. Under this view, embryos use hCG to push mothers to release more thyroid hormone. hCG, however, is produced outside the normal maternal thyroid control circuit and thus is not subject to a normal negative feedback. hCG also serves multiple functions simultaneously therefore its production is likely not fine-tuned for thyroid function per se. hCG levels may remain high even when thyroid hormone production is more than sufficient to meet the needs of mother and embryo. Instead, the system appears to be regulated at the back end by clearing surplus hormone using placental Type II (D2) and Type III (D3) deiodinases. As maternal thyroid hormone levels rise, placental D3 is upregulated, shunting more T4 and T3 into a deactivating pathway. The metabolites that result, particularly the inert metabolite of T4, reverse T3, are correlates of surplus thyroid hormone production and thus are strong candidates for the proximate triggers of pregnancy sickness. Nausea and vomiting of early pregnancy thus arises as a by-product of an antagonistic pleiotropy between mother and embryo over the allocation of iodine: when dietary iodine is scarce, a benefit accrues to the embryo at a cost to mother; when iodine is plentiful, pregnancy sickness ranging from frequently mild to occasionally severe, is a sequelae of undiminished embryonic demands. If pregnancy sickness serves as a marker of thyroid function, an absence of first trimester nausea and vomiting sickness may indicate a higher priority for testing of thyroid function to avert the inimical effects of hypothyroidism during gestation.

Standing body sway in women with and without morning sickness in pregnancy.

Morning sickness typically is attributed to hormonal changes in pregnancy. We asked whether morning sickness is associated with changes in standing postural equilibrium, as occurs in research on visually induced motion sickness. Twenty-one pregnant women (mean age=30 years, mean height=163cm; mean weight=63kg) were tested during the first trimester. Laboratory-based balance measures were collected, along with perceived postural stability, the presence of morning sickness, and the severity of subjective symptoms. We varied the distance between the feet and the visual task performed during stance. Participants were classified as either experiencing (Sick, n=12) or not experiencing (Well, n=9) morning sickness. Perceived balance stability was lower for Sick than for Well women. The positional variability of sway was reduced for the Sick group, relative to the Well group. Positional variability decreased with wider stance width, and was reduced during performance of a more demanding visual task. Stance width and visual task also influenced the temporal dynamics of sway. Effects of stance width and visual task on postural sway were similar to effects in non-pregnant adults, suggesting that sensitive tuning of posture is maintained during the first trimester. The findings suggest that women with morning sickness may attempt to stabilize their bodies by reducing overall body sway. It may be useful to recommend that women adopt wider stance early in pregnancy.

Oral healthcare considerations for the pregnant woman.

UNLABELLED: Pregnancy is a period of both joy and anxiety in a woman's life and is characterized by various physiological changes in her body brought about by the circulating female sex hormones. The oral cavity is also the seat of changes and these physiologic changes of pregnancy need to be addressed while managing the pregnant woman in the dental clinic. The main goal is to minimize the occurrence of any complications that might harm the mother-to-be and/or the unborn child. Preventive, emergency, and routine dental procedures are all deemed suitable during various phases of pregnancy, with some treatment modifications and initial planning. CLINICAL RELEVANCE: The dentist should be in a position to manage pregnant women in clinical practice effectively.

Nursing care of nausea and vomiting in pregnancy: Roy adaptation model.

Nursing theories and conceptual models need to be developed and used in practice for accumulation of nursing knowledge. The authors in this article explain the concepts and nursing process of the Roy adaptation model in light of an example with the nausea and vomiting of pregnancy. It is expected that the article will provide guidance for nurses who want to use the model while offering nursing care and conducting research.

Dietary and clinical impacts of nausea and vomiting during pregnancy.

BACKGROUND: Nutrition during pregnancy is important for the health of both mother and infant. Nausea and vomiting in pregnancy (NVP) may alter food intake but the dietary and clinical consequences of NVP are poorly understood. The present study aimed to identify the differences in dietary intakes and clinical characteristics of women with NVP compared with those without. METHODS: Women with (n = 134) or without (n = 53) NVP were studied in each trimester of pregnancy. The babies were studied at birth, and at 1 and 6 months. The presence of nausea and vomiting was established by interviews using standard questions. Daily intakes of foods and nutrients were assessed from 3-day food diaries. Weight gain during pregnancy and weights and lengths of the infants at birth and at 1 and 6 months of age were recorded. RESULTS: In the first trimester, intake of meat products and thus protein in women with NVP was lower both quantitatively (P = 0.007) and as a proportion of energy (16.4E% [interquartile range (IQR) 14.9-18.4]) compared to non-NVP [18.3E% (IQR 16.3-19.8), P = 0.003]. The proportional intakes of carbohydrates were higher in NVP subjects [50.1E% (IQR 46.7-53.6)] than in non-NVP [46.8E% (IQR 43.6-51.9), P = 0.008]. Dietary and total intakes of vitamin B(12), total intake of magnesium and dietary intake of zinc were lower in women with NVP. Changes in diet remained throughout pregnancy. Women with NVP had shorter pregnancies [39.9 (95% CI 39.6-40.1)] compared with those without [40.4 (95% CI 40.1-40.8) weeks, P = 0.018], but neither pregnancy weight gain nor infants' weight and length differed. CONCLUSIONS: Nausea and vomiting in pregnancy modified dietary intake and has potential clinical impacts as suggested by the altered pregnancy duration. In view of the programming effect of early nutrition, these alterations may carry long-term health consequences.

Nausea and vomiting of pregnancy: a tailored approach to treatment.

Nausea and vomiting of pregnancy is a multifactorial condition with significant adverse effects on quality of life and health of mother and fetus that warrants recognition, investigation, and treatment. Safe therapies are available and should be offered readily to all women suffering from this condition.

Treatment options for nausea and vomiting during pregnancy.

Nausea and vomiting, common symptoms during pregnancy, often are regarded as an unpleasant but normal part of pregnancy during the first and early second trimesters. Nausea and vomiting of pregnancy (NVP) occurs in approximately 75-80% of pregnant women. The exact etiology and pathogenesis of NVP are poorly understood and are most likely multifactorial. Some theories for the etiology of NVP are psychological predisposition, evolutionary adaptation, hormonal stimuli, and Helicobacter pylori infection. Treatment ranges from dietary and lifestyle changes to vitamins, antiemetics, and hospitalization for intravenous therapy. Treatment generally begins with nonpharmacologic interventions; if symptoms do not improve, drug therapy is added. Although NVP has been associated with a positive pregnancy outcome, the symptoms can significantly affect a woman's life, both personally and professionally. Given the substantial health care costs, as well as indirect costs, and the potential decrease in quality of life due to NVP, providers need to acknowledge the impact of NVP and provide appropriate treatment.