Clinical features and evaluation of nausea and vomiting of pregnancy
- Jerrie S Refuerzo, MD
Jerrie S Refuerzo, MD
- Associate Professor
- Division of Maternal Fetal Medicine
- Department of Obstetrics and Gynecology
- University of Texas Health Science Center at Houston
- Judith A Smith, PharmD, BCOP, CPHQ, FCCP, FISOPP
Judith A Smith, PharmD, BCOP, CPHQ, FCCP, FISOPP
- Associate Professor and Director
- Women's Health Integrative Medicine Research Program, Department of Obstetrics and Gynecology
- Susan M Ramin, MD
Susan M Ramin, MD
- Section Editor — Obstetrics
- Professor of Obstetrics and Gynecology
- Baylor College of Medicine
Nausea with or without vomiting is so common in early pregnancy that mild symptoms may be considered part of the normal physiology of the first trimester. However, these symptoms can significantly impact the pregnant woman’s quality of life, especially when persistent and/or severe . Hyperemesis gravidarum is the term used to describe the severe end of the symptom spectrum (weight loss exceeding 5 percent of prepregnancy body weight), but no universally accepted criteria distinguish between mild and severe disease.
The clinical manifestations and diagnostic evaluation of women with nausea and vomiting of pregnancy will be reviewed here. Treatment and outcome of this disorder are discussed separately. (See "Treatment and outcome of nausea and vomiting of pregnancy".)
Some degree of nausea with or without vomiting occurs in up to 90 percent of pregnancies . The incidence of women with severe symptoms is not well-documented; reports vary from 0.3 to 3 percent of pregnancies . Ethnic differences and differences in the definition of the disease may account, in part, for the variability.
EPIDEMIOLOGY AND RISK FACTORS
Epidemiology — The epidemiology of pregnancy-related nausea and vomiting remains unclear, but the disorder appears to be more common in Western countries and urban areas than in Africa and Asia [3,4]. Younger primigravid women are more likely to be affected than older multiparous women , but data are not consistent.
Risk factors — Nonpregnant women who experience nausea and vomiting related to estrogen-based medication, motion, or migraine are more likely to experience pregnancy-related nausea and vomiting . Supertasters are also at increased risk; by contrast, anosmic women appear to be at low risk . Other risk factors include multiple gestation [8,9], hydatidiform mole , nonuse of multivitamins before six weeks of gestation or during the peri-conceptional period [11,12], and heartburn and acid reflux .
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