Association of maternal weight gain in early pregnancy with congenital heart disease in offspring: a China birth cohort study.

OBJECTIVES: Little study has reported the association of maternal weight gain in early pregnancy with fetal congenital heart disease (CHD). We aimed to explore the potential relationship based on a China birth cohort while adjusting by multiple factors. DESIGN: Cohort study. SETTING: China birth cohort study conducted from 2017 to 2021. PARTICIPANTS: The study finally included 114 672 singleton pregnancies in the 6-14 weeks of gestation, without missing data or outliers, loss to follow-up or abnormal conditions other than CHD. The proportion of CHD was 0.65% (749 cases). PRIMARY AND SECONDARY OUTCOME MEASURES: Association between maternal pre-pregnancy weight gain and CHD in the offspring were analysed by multivariate logistic regression, with the unadjusted, minimally adjusted and maximally adjusted methods, respectively. RESULTS: The first-trimester weight gain showed similar discrimination of fetal CHD to that period of maternal body mass index (BMI) change (DeLong tests: p=0.091). Compared with weight gain in the lowest quartile (the weight gain less than 0.0 kg), the highest quartile (over 2.0 kg) was associated with a higher risk of fetal CHD in unadjusted (OR 1.36, 95% CI: 1.08 to 1.72), minimally adjusted (adjusted OR (aOR) 1.29, 95% CI: 1.02 to 1.62) and maximally adjusted (aOR 1.29, 95% CI: 1.02 to 1.63) models. The association remains robust in pregnant women with morning sickness, normal pre-pregnancy BMI, moderate physical activity, college/university level, natural conception or with folic acid (FA) and/or multivitamin supplementation. CONCLUSIONS AND RELEVANCE: Although the association of maternal pre-pregnancy weight gain on fetal CHD is weak, the excessive weight gain may be a potential predictor of CHD in the offspring, especially in those with morning sickness and other conditions that are routine in the cohort, such as normal pre-pregnancy BMI, moderate physical activity, college/university level, natural conception or with FA and/or multivitamin supplementation.

The Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum (Green-top Guideline No. 69).

An objective and validated index of nausea and vomiting such as the Pregnancy-Unique Quantification of Emesis (PUQE) and HyperEmesis Level Prediction (HELP) tools can be used to classify the severity of NVP and HG. [Grade C] Ketonuria is not an indicator of dehydration and should not be used to assess severity. [Grade A] There are safety and efficacy data for first line antiemetics such as anti (H1) histamines, phenothiazines and doxylamine/pyridoxine (Xonvea®) and they should be prescribed initially when required for NVP and HG (Appendix III). [Grade A] There is evidence that ondansetron is safe and effective. Its use as a second line antiemetic should not be discouraged if first line antiemetics are ineffective. Women can be reassured regarding a very small increase in the absolute risk of orofacial clefting with ondansetron use in the first trimester, which should be balanced with the risks of poorly managed HG. [Grade B] Metoclopramide is safe and effective and can be used alone or in combination with other antiemetics. [Grade B] Because of the risk of extrapyramidal effects metoclopramide should be used as second-line therapy. Intravenous doses should be administered by slow bolus injection over at least 3 minutes to help minimise these. [Grade C] Women should be asked about previous adverse reactions to antiemetic therapies. If adverse reactions occur, there should be prompt cessation of the medications. [GPP] Normal saline (0.9% NaCl) with additional potassium chloride in each bag, with administration guided by daily monitoring of electrolytes, is the most appropriate intravenous hydration. [Grade C] Combinations of different drugs should be used in women who do not respond to a single antiemetic. Suggested antiemetics for UK use are given in Appendix III. [GPP] Thiamine supplementation (either oral 100 mg tds or intravenous as part of vitamin B complex (Pabrinex®)) should be given to all women admitted with vomiting, or severely reduced dietary intake, especially before administration of dextrose or parenteral nutrition. [Grade D] All therapeutic measures should have been tried before considering termination of pregnancy. [Grade C].

Nausea and vomiting of pregnancy and prenatal cannabis use in a Michigan sample.

BACKGROUND: Nausea and vomiting of pregnancy, also referred to as morning sickness, affects more than 70% of all pregnancies. Symptoms range from mild to severe and, in some cases, can be debilitating, resulting in a reduced quality of life. Moreover, prenatal cannabis use prevalence has doubled in the United States, and cannabis potency, measured by the concentration of delta-9-tetrahydrocannabiniol, has increased from 10% in 2009 to 14% in 2019. State-level recreational legalization of cannabis may contribute to the liberalization of its use and reduced risk perception. Furthermore, the relatively recent discovery of cannabinoid hyperemesis syndrome may contribute to the mischaracterization of morning sickness in individuals who use cannabis during pregnancy. Although cannabis has well-documented antiemetic properties, there is insufficient research on the topic. Therefore, it is essential to establish a tangible understanding of the association between nausea and vomiting of pregnancy and prenatal cannabis use. OBJECTIVE: This study aimed to estimate the degree to which nausea and vomiting of pregnancy might be associated with prenatal cannabis use in a sample of pregnant people in Michigan, a state where recreational cannabis use became legal in December 2018. STUDY DESIGN: This was a prospective study of participants from the Michigan Archive for Research on Child Health, a population-based pregnancy cohort that was recruited using a probability-based sampling approach. Participants were recruited from 22 prenatal clinics located throughout Michigan's lower peninsula. Cross-sectional analyses were performed for data available between October 2017 and January 2022. RESULTS: Among this sample of Michigan pregnant people, 14% (95% confidence interval, 11%-16%) reported cannabis use. Participants who experienced increasing morning sickness severity had higher odds of using cannabis (adjust odds ratio, 1.2; 95% confidence interval, 1.1-1.2). When the sample was restricted to first-trimester morning sickness and cannabis use, the results remained statistically robust. When the direction of the association was reversed, an increase in morning sickness severity was detected among participants who used cannabis during pregnancy (ßadjusted, 0.2; 95% confidence interval, 0.1-0.2). Lastly, the association between prepregnancy cannabis use and first-trimester morning sickness was investigated. Study findings suggest an increase in morning sickness severity among people who used cannabis in the 3 months before pregnancy compared with those who did not use cannabis (ßadjusted, 0.1; 95% confidence interval, 0.003-0.200). CONCLUSION: Study findings indicated a link between nausea and vomiting of pregnancy and prenatal cannabis use. Moreover, this study revealed that using cannabis in the 3 months before pregnancy is associated with first-trimester morning sickness severity. The strengths of our study contribute to the scant epidemiologic evidence in this area of research. More fine-grained, time-specific data on nausea and vomiting of pregnancy and prenatal cannabis use are necessary to draw inferences about cause-effect relationships. Our study might provide a basis to discourage cannabis use during pregnancy until more evidence is collected.

Rapid gastric emptying during pregnancy in a rat model.

BACKGROUND/AIMS: The effect of pregnancy on gastric emptying has not been established, although the predominant clinical assumption is that gastric emptying is delayed during pregnancy. We hypothesized that the rate of emptying of nutrients during pregnancy is not delayed, but is actually more rapid when compared to the non-pregnant state. The rate of gastric emptying is a major determinant of postprandial glucose elevations. MATERIALS AND METHODS: 24 female and 4 male Spague-Dawley rats were used. Female rats were randomly divided into two groups: eight rats for the control group and sixteen rats for the pregnant group. Using physiologic, non-traumatic nuclear medicine scintigraphy imaging methodology, the authors studied gastric emptying of a liquid mixed meal in pregnant rats and non-pregnant controls. Body weights, daily food ingestion, and the rate of nutrient gastric emptying were recorded in both groups at pre-pregnancy, early pregnancy, and late pregnancy. RESULTS: The authors found that pregnancy in this rat model is associated with a 37-43% increased rate of nutrient gastric emptying from the stomach in late pregnancy as compared to non-pregnant control rats and pre-pregnancy rats. CONCLUSION: These findings contradict the current clinical assumption that gastric emptying is delayed in pregnancy. If further studies confirm a more rapid gastric emptying rate during human pregnancy, new therapies aimed at slowing the rate of nutrient absorption should be considered for the prevention and treatment of pregnancy-associated nausea, gestational diabetes, and other insulin-resistant pregnancy-associated states such as pre-eclampsia.

Efficacy of Olanzapine in Addition to Standard Triplet Antiemetic Therapy for Cisplatin-Based Chemotherapy: A Secondary Analysis of the J-FORCE Randomized Clinical Trial.

Importance: It is unknown whether olanzapine combined with triplet antemetic therapy is effective for all patients undergoing highly emetogenic chemotherapy. A secondary analysis of randomized clinical trials using olanzapine may provide insight into the effectiveness of olanzapine for chemotherapy-induced nausea and vomiting (CINV), including cisplatin. Objective: To examine the add-on effect of olanzapine according to risk factors for CINV. Design, Setting, and Participants: This preplanned secondary analysis evaluated results of the J-FORCE trial, a large double-blind, placebo-controlled phase 3 randomized clinical trial conducted in Japan from February 9, 2017, to July 18, 2018. Participants were enrolled from 26 participating hospitals across Japan and included patients aged 20 to 75 years who had a malignant tumor and were cisplatin-naive. The efficacy analysis population of the J-FORCE trial was analyzed according to allocation adjustment factors (sex [male or female], age [≥55 years or <55 years], and cisplatin dose [≥70 mg/m2 or <70 mg/m2]) and patient-related risk factors (history of motion sickness, drinking habit [defined as alcoholic drinks consumption in excess of occasional drinking], and history of morning sickness during pregnancy). Statistical analysis was performed from February 18 to April 18, 2020. Interventions: Patients were randomized 1:1 to receive 5 mg of olanzapine or placebo combined with standard triplet antiemetic therapy. Main Outcomes and Measures: The primary end point was complete response (CR, defined as no vomiting and no use of rescue medication) in the delayed phase (24-120 hours after cisplatin-based chemotherapy administration). Secondary end points were CR, complete control, and total control in the acute, delayed, and overall phases for 6 CINV risk factors as well as time to treatment failure. The CR point estimates and 95% CIs of the differences between groups were calculated, and a Mantel-Haenszel test was performed. Results: Of the 705 patients (mean [SD] age, 63.0 [9.2] years; 471 males [66.8%]) included in the efficacy analysis population; 581 patients (82.4%) were 55 years or older, and 526 (74.6%) were treated with a cisplatin dose of 70 mg/m2 or more. Risk difference (RD) for a CR in the delayed phase was significantly greater in the olanzapine group than the placebo group in males (RD, 12.6% [95% CI, 5.0%-20.1%]; P = .001); in females (RD, 14.5% [95% CI, 2.2%-26.3%]; P = .02); in those 55 years or older (RD, 11.1% [95% CI, 3.9%-18.2%]; P = .003) or younger than 55 years (RD, 23.6% [95% CI, 7.3%-38.3%]; P = .005); for a cisplatin dose of 70 mg/m2 or more (RD, 13.5% [95% CI, 5.9%-21.0%]; P < .001); for those without a history of motion sickness (RD, 13.9% [95% CI, 6.9%-20.6%]; P < .001); for those with a drinking habit (RD, 14.9% [95% CI, 6.1%-23.4%]; P = .001) or without a drinking habit (RD, 12.0% [95% CI, 2.5%-21.3%]; P = .01); and for those with a history of morning sickness during pregnancy (RD, 27.2% [9.7%-42.6%]; P = .002). In other subgroups, a delayed CR was higher in the olanzapine group than the placebo group, although not significantly higher. Conclusions and Relevance: Results of this study suggest a benefit of using 5 mg of olanzapine plus triplet antiemetic therapy to counter CINV regardless of the presence or absence of risk factors. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry Identifier: UMIN000024676.

Bonjesta: nuevo tratamiento de las náuseas y vómitos del embarazo con liberación inmediata / Bonjesta: New Treatment for Nausea and Vomiting of Pregnancy with Immediate Release

Las náuseas y los vómitos en el embarazo son dos de los síntomas más frecuentes durante la gestación. Se estima que hasta el 85 % de las mujeres experimentan algún grado de náuseas con o sin vómitos durante la gestación. (AU)

Effectors of Pregorexia and Emesis among Pregnant Women: A Pilot Study.

During pregnancy, women tend to improve their lifestyle habits and refine their dietary intake. Quite often, however, these dietary improvements take an unhealthy turn, with orthorexia nervosa (ON) practices being apparent. The aim of the present pilot cross-sectional study was to assess the prevalence of ON tendencies and the incidence of pica and record diet practices in a sample of pregnant women. A total of 157 pregnant women were recruited through private practice gynecologists during the first months of 2021. Nutrition-related practices were recorded, orthorexic tendencies were assessed using the translated and culturally adapted Greek version of the ORTO-15 questionnaire, pica practices were evaluated with a binary question and nausea and emesis during pregnancy (NVP) was evaluated using the translated modified Pregnancy-Unique Quantification of Emesis and Nausea (mPUQE). Only two women reported pica tendencies, with ice and snow being the consumed items. The majority (61.1%) of women reported improving their diet since conception was achieved. Folic acid and iron oral nutrient supplements (ONS) were reportedly consumed by the majority of participants (87.9% and 72.6%, respectively) and 9.6% reported using herbal medicine products. The ORTO-15 score was reduced with tertiary education attainment, ART conception, being in the third trimester of pregnancy, consumption of folic acid and MV supplements and was only increased among women who were at their first pregnancy. The majority of participants experienced severe NVP and the remaining experienced moderate NVP. NVP was associated with lower hemoglobin levels, lack of supplementary iron intake, avoidance of gluten-containing foods, as well as with increased gestational weight gain. The results highlight the need to screen pregnant women for disturbed eating behaviors and nutrition-related problems, in order to ensure a healthy pregnancy outcome.

Changes in Serum Levels of Ketone Bodies and Human Chorionic Gonadotropin during Pregnancy in Relation to the Neonatal Body Shape: A Retrospective Analysis.

Among the physiological changes occurring during pregnancy, the benefits of morning sickness, which is likely mediated by human chorionic gonadotropin (HCG) and induces serum ketone production, are unclear. We investigated the relationship between serum levels of ketone bodies and HCG in the first, second, and third trimesters and neonatal body shape (i.e., birth weight, length, head circumference, and chest circumference) in 245 pregnant women. Serum levels of 3-hydroxybutyric acid peaked in late-stage compared with early stage pregnancy (27.8 [5.0−821] vs. 42.2 [5.0−1420] µmol/L, median [range], p < 0.001). However, serum levels of ketone bodies and HCG did not correlate with neonatal body shape. When weight loss during pregnancy was used as an index of morning sickness, a higher pre-pregnancy body mass index was associated with greater weight loss. This study is the first to show that serum ketone body levels are maximal in the third trimester of pregnancy. As the elevation of serum ketone bodies in the third trimester is a physiological change, high serum levels of ketone bodies may be beneficial for mothers and children. One of the possible biological benefits of morning sickness is the prevention of diseases that have an increased incidence due to weight gain during pregnancy.

Nausea and vomiting during pregnancy: a possible correlation with obsessive compulsive disorder and alexithymia.

The possible correlation between nausea and vomiting during pregnancy (NVP) with obsessive-compulsive disorder (OCD) and alexithymia were examined in this cross-sectional study. A cohort of pregnant women at the first trimester of pregnancy experiencing NVP were divided into three groups, according to severity (mild, moderate and severe) with the Pregnancy Unique Quantification of Emesis and Nausea (PUQE) test. The Maudsley Obsessive Compulsive Disorder Scale (MOCQ) and the Toronto Alexithymia Scale (TAS-20) were applied. Scores of scales were compared in all three groups, and the relationship between NVP severity and OCD and alexithymia was evaluated. On the 110 enrolled pregnant women, 42 had mild, 36 had moderate and 32 had severe NVP. Pregnant women with mild NVP had lower MOCQ scores than those with severe NVP (p = .010). Total scores of TAS-20 were higher among subjects with greater NVP severity (p < .001). PUQE scores were demonstrated significant correlations with MOCQ and total and subsection scores of the TAS-20, regardless of NVP groups. Study results showed that women with more pronounced OCD and/or alexithymia can experience somatic complaints, such as NVP, particularly intense in their first trimester of pregnancies. For this reason, psychotherapy in addition to medical treatments could be recommended to pregnant women with severe NVP.Impact statementWhat is already known on this subject? NVP is a condition experienced by most women, particularly in the first trimester of pregnancy, which can be affected by the psychosomatic condition of the pregnant woman.What do the results of this study add? The severity of nausea and vomiting according to PUQE test were significantly associated with OCD and alexithymia presence in pregnant women during their first trimester period.What are the implications of these findings for clinical practice and/or further research? These findings might demonstrate the symptoms of NVP are correlated to OCD, as well as alexithymia. Longitudinal studies are required to demonstrate the clear causal relationship between NVP and psychiatric symptoms as in OCD and in alexithymia.

Dietary fibre intake and lifestyle characteristics in relation to nausea or vomiting during pregnancy-a questionnaire-based cohort study.

Nausea or vomiting in pregnancy (NVP) are among the commonest symptoms experienced in early pregnancy. We wanted to evaluate the association of dietary fibre intake, lifestyle characteristics and bowel function with NVP. One hundred and eighty-eight participants completed a self-administered questionnaire concerning bowel function, dietary fibre intake and lifestyle characteristics. Women suffering from NVP (n = 91) consumed significantly more fibre derived from cereal products (p=.026) and total fibre (p=.043) during pre-pregnancy period was compared to women without NVP (n = 97). In both groups, intake of total fibre and fibre derived from fruit and vegetables increased significantly during the first trimester. Dietary fibre intake did not protect from NVP. However, women suffering from NVP were able to maintain their fibre intake. Dietary fibre is tolerated well during NVP, and this finding can be used when giving diet counselling to women suffering from NVP.Impact statementWhat is already known on this subject? Nausea or vomiting in pregnancy (NVP) are among the commonest symptoms experienced in early pregnancy. The pathophysiology of NVP remains unknown, but it has been suggested to be multifactorial. Diet during pregnancy may have an impact on NVP. It is generally advised to avoid meat, poultry, fish, eggs and spicy and fatty foods during periods of NVP, but there is limited data on the effects of diet of NVP.What do the results of this study add? Women suffering from NVP have been shown to eat less meat (and thus protein) compared to women without NVP. Dietary fibre reduces constipation and heartburn and it also keeps blood glucose levels stable. Because of various beneficial effects of fibre on the digestive system, we hypothesised that a high fibre intake may alleviate the symptoms of NVP.What are the implications of these findings for clinical practice and/or further research? The aim of the present study was to investigate whether the amount or source of dietary fibre are associated with NVP. We wanted to investigate intake of fibre derived from cereal products (mostly representing insoluble fibre) and fibre derived from fruit and vegetables (containing mostly soluble fibre) separately in relationship to NVP, as the mechanisms of action of these fibre groups are different. There are no observational studies including also pre-pregnancy consumption of fibre when focussing on the association between fibre and NVP. The results of this study can be used when giving diet counselling to women suffering from NVP.

Self-medication practice and contributing factors among pregnant women.

BACKGROUND: The practice of self-medication during pregnancy is a global challenge that necessitates high attention as it poses a potential threat to the pregnant mother and fetus. However, little is known regarding self-medication practice and its contributors among pregnant women in our setting. OBJECTIVE: The main aim of this study was to investigate the practice of self-medication and its contributing factors among pregnant women. METHODOLOGY: A cross sectional study was conducted among pregnant women at antenatal care follow-up of Ayder comprehensive specialized hospital, Tigray, Ethiopia. Written informed consent was obtained from each participant before interview. Simple random sampling technique was employed to recruit participants in to the study. Data were collected by interviewing participants using the structured questionnaire. Binary logistic regressions analysis was performed to determine the contributing factors of self-medication practice during pregnancy. A p value of less than 0.05 was considered as significant. RESULTS: A total of 250 pregnant women were included in the study. Of the total, 40.8% practiced self-medication during the current pregnancy. Morning sickness (39.2%), headache (34.3%), and upper respiratory tract infections (29.4%) were the leading indications for self-medication. According to participant report, ease of access to medicines (25.5%), feelings that the disease is minor (21.6%) and timesaving (19.6%) were the most commonly reported reasons for self-medication practice. Absence of health insurance (AOR: 2.75, 95%CI: 1.29-5.89) and being on first trimester of pregnancy (AOR: 2.44, 95%CI: 1.02-5.86) were significant contributors of self-medication practice among pregnant women. CONCLUSION: In our study, high prevalence of self-medication was reported among pregnant women. Self-medication practice during pregnancy was higher among pregnant women on first trimester and those who were not having health insurance. Therefore, intervention programs should be designed to minimize the practice of self-medication during pregnancy.

Comparison of Pregnancy Outcomes of Patients Treated With Ondansetron vs Alternative Antiemetic Medications in a Multinational, Population-Based Cohort.

Importance: Ondansetron is frequently used to treat nausea and vomiting during pregnancy. Although some studies reported important safety signals, few studies have been sufficiently large to assess rare pregnancy outcomes. Objective: To study the association between ondansetron exposure during pregnancy and the risks of spontaneous abortion, stillbirth, and major congenital malformations. Design, Setting, and Participants: This is a cohort study conducted in 3 countries, with a meta-analysis. Participants included women and girls aged 12 to 55 years who experienced spontaneous abortion, induced abortion, stillbirth, or live birth between April 2002 and March 2016, as recorded in administrative data from 5 Canadian provinces (British Columbia, Alberta, Saskatchewan, Manitoba, and Ontario), the US IBM MarketScan Research Databases, and the UK Clinical Practice Research Datalink. The statistical analysis was completed in October 2020. Exposures: Exposure to ondansetron during pregnancy was compared with exposure to other commonly used antiemetics to minimize confounding by indication. Main Outcomes and Measures: The primary outcome was fetal death, defined as either spontaneous abortion or stillbirth. Secondary outcomes were the 2 components of the primary outcome and major congenital malformations identified during the year after a live birth. Adjusted hazard ratios were estimated using Cox proportional hazards models with time-dependent drug exposures and were adjusted using high-dimensional propensity scores. For major congenital malformations, adjusted odds ratios were estimated from logistic models. Site-level results were pooled using random-effects meta-analysis. Sensitivity analyses considered second-line antiemetic exposure and exposure specifically during 4 to 10 weeks of gestation. Results: Data from 456 963 pregnancies were included in this study of fetal death (249 787 [54.7%] in Canada, 197 913 [43.3%] in the US, and 9263 [2.0%] in the UK; maternal age, ≤24 years, 93 201 patients [20.4%]; 25-29 years, 149 117 patients [32.6%]; 30-34 years, 142 442 patients [31.2%]; and ≥35 years, 72 203 patients [15.8%]). Fetal death occurred in 12 907 (7.9%) of 163 810 pregnancies exposed to ondansetron, and 17 476 (5.7%) of 306 766 pregnancies exposed to other antiemetics. The adjusted hazard ratios were 0.91 (95% CI, 0.67-1.23) for fetal death with time-dependent ondansetron exposure during pregnancy, 0.82 (95% CI, 0.64-1.04) for spontaneous abortion, and 0.97 (95% CI, 0.79-1.20) for stillbirth. For major congenital malformations, the estimated odds ratio was 1.06 (95% CI, 0.91-1.22). Results of sensitivity analyses were generally consistent with those of the primary analyses. Conclusions and Relevance: In this large, multicenter cohort study, there was no association between ondansetron exposure during pregnancy and increased risk of fetal death, spontaneous abortion, stillbirth, or major congenital malformations compared with exposure to other antiemetic drugs.

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.

Does greater morning sickness predict carrying a girl? Analysis of nausea and vomiting during pregnancy from retrospective report.

PURPOSE: The prevalence of severe nausea and vomiting during pregnancy (NVP) requiring hospitalization has been associated with female fetal sex. However, the question of whether fetal sex and less severe forms of NVP share that association has not been investigated. The objective of this study was to evaluate the relationship between fetal sex and the frequency of NVP. METHODS: We collected self-reported data from mothers via an international web-based survey on the Amazon Mechanical Turk (MTurk) platform about pregnancy and first trimester NVP history. We considered the covariables of maternal age, parity status, proneness to nausea, geographic cohort, and preconceived notions of a relationship between fetal sex and NVP. RESULTS: Two-thousand five hundred and forty-three mothers met the inclusion criteria, yielding data from 4320 pregnancies. Women gestating a female fetus reported higher frequencies of NVP (M = 6.35 on a 1-9 scale) than did women gestating males (M = 6.04, p = .007). This effect held true when all other variables were included in the regression. General proneness to nausea, maternal age, and parity were also significant independent predictors of NVP. CONCLUSIONS: Women that carried a female fetus, as opposed to a male fetus, reported significantly higher frequency of NVP during the first trimester of pregnancy. Further research should evaluate both the proximate and ultimate causes of this relationship.

A history of severe nausea and vomiting during pregnancy predicts a higher incidence of postoperative nausea and vomiting after breast cancer surgery without breast reconstruction.

BACKGROUND: Postoperative nausea and vomiting (PONV) occur in up to 30 percent of patients after breast cancer surgery despite routine administration of antiemetic prophylaxis. A history of nausea and vomiting during pregnancy (NVP) has been reported as a risk factor of intraoperative nausea and vomiting in caesarean delivery. Nevertheless, whether a history of severe nausea and vomiting during pregnancy (SNVP) is associated with a higher occurrence of PONV remains unclear. METHODS: In this study, 121 sequential female patients who were scheduled to undergo breast cancer surgery were assigned to study group (30 cases, with SNVP) or control group (91 cases, with mild NVP (MNVP)). The incidence of PONV and the need for rescue antiemetic were recorded in post-anesthesia care unit (PACU), at 6 h, 12 h, 24 h, and 36 h after operation. Moreover, postoperative pain, level of satisfaction, and the relationship of ER/PR status in breast cancer tissue with SNVP and PONV were also investigated. RESULTS: Data from 115 patients were analyzed. The incidence of PONV in the SNVP group was significantly higher than that in the MNVP group at 6 h (P < 0.005), 12 h (P < 0.05), and 24 h after the operation (P < 0.05). The incidence of PONV in the MNVP group was approximately 30% lower than in the SNVP group. Besides, more severe PONV, a larger number of demands for rescue antiemetic, fewer patient satisfaction scores, and more dizziness were observed in the SNVP group. Yet, no relationship was found between ER/PR status of breast cancer tissue and SNVP or PONV. CONCLUSIONS: Compared to patients with MNVP, those with a history of SNVP experienced a higher incidence of PONV and severe PONV, presented with a larger number of requirements for postoperative antiemetic and a lower level of satisfaction.

Measuring the severity of nausea and vomiting of pregnancy; a 20-year perspective on the use of the pregnancy-unique quantification of emesis (PUQE).

Nausea and vomiting of pregnancy (NVP) is the most common medical condition in pregnancy, affecting up to 80% of expectant women. Measuring the severity of the condition over time is important for management decisions, as well as for research into different therapeutic modalities. Twenty years ago we described and validated the Pregnancy Unique Quantification of Emesis scale (PUQE), as a clinical and research tool. PUQE has become widely used for both ends, and has been incorporated in numerous practice guidelines worldwide. In this review we describe the inception of the tool, its rational, and its wide range of use worldwide.

Nausea, vomiting and poor appetite during pregnancy and adverse birth outcomes in rural Nepal: an observational cohort study.

BACKGROUND: Nausea and vomiting are experienced by a majority of pregnant women worldwide. Previous studies have yielded conflicting results regarding their impact on birth outcomes and few studies have examined this relationship in settings with limited resources. We aimed to determine the effect of nausea, vomiting and poor appetite during pregnancy on birth outcomes in rural Nepal. METHODS: Observational cohort study using data collected in two randomized, community-based trials to assess the effect of influenza immunization during pregnancy on reproductive and respiratory outcomes among pregnant women and their offspring. Pregnant women in Sarlahi District, Nepal were recruited from 2011 to 2013. Exposure was defined as nausea, vomiting or poor appetite at any point during pregnancy and by trimester; symptoms were recorded monthly throughout pregnancy. Adverse outcomes were low birth weight (LBW), preterm birth and small for gestational age (SGA). Adjusted relative risks (aRR) with 95% CIs are reported from Poisson regressions with robust variance. RESULTS: Among 3,623 pregnant women, the cumulative incidence of nausea, vomiting or poor appetite was 49.5% (n = 1793) throughout pregnancy and 60.6% (n = 731) in the first trimester. Significantly higher aRRs of LBW and SGA were observed among women experiencing symptoms during pregnancy as compared to symptom free women (LBW: aRR 1.20; 95% CI 1.05 1.28; SGA: aRR 1.16; 95% CI 1.05 1.28). Symptoms in the first trimester were not significantly associated with any of the outcomes. In the second trimester, we observed significantly higher aRRs for LBW and SGA (LBW: aRR 1.17; 95% CI 1.01 1.36; SGA: aRR 1.16; 95% CI 1.05 1.29) and a significantly lower aRR for preterm birth (aRR 0.75; 95% CI 0.59 0.96). In the third trimester, we observed significantly higher aRRs for LBW and SGA (LBW: aRR 1.20; 95% CI 1.01 1.43; SGA: aRR 1.14; 95% CI 1.01 1.29). CONCLUSIONS: Symptoms of nausea, vomiting or poor appetite during pregnancy are associated with LBW, SGA and preterm birth in a setting with limited resources, especially beyond the first trimester. TRIAL REGISTRATION: Prospectively registered at ClinicalTrials.gov on Dec 17, 2009 ( NCT01034254 ).

Protection Versus Progress: The Challenge of Research on Cannabis Use During Pregnancy.

A central tension in pediatric research ethics arises from our desire to protect children from harm while also allowing progress toward discoveries that could improve child health. A prime example of this tension is research on a controversial yet increasingly common practice: the use of cannabis by women to treat nausea and vomiting of pregnancy. Studies of cannabis use in pregnancy face a combination of ethical hurdles because of the inclusion of pregnant women and involvement of a schedule I controlled substance. Given the growing need for research on the safety and efficacy of cannabis for nausea and vomiting of pregnancy, we reflect on the multiple historical contexts that have contributed to the challenge of studying cannabis use during pregnancy and make a case for the ethical rationale for such research.