Medline ® Abstracts for References 148-151
of 'Treatment and outcome of nausea and vomiting of pregnancy'
Hyperemesis gravidarum and birth outcomes-a population-based cohort study of 2.2 million births in the Norwegian Birth Registry.
Vandraas KF, Vikanes AV, Vangen S, Magnus P, Støer NC, Grjibovski AM
OBJECTIVE: To study associations between hyperemesis gravidarum (HG) and birth outcomes.
DESIGN: Population-based cohort study.
SAMPLE: Singleton births in the Norwegian Birth Registry, 1967-2009 (n = 2 270 363).
METHODS: Multiple logistic regression was applied to study associations between HG and dichotomous outcomes; multiple linear regression to study associations between HG, birthweight and gestational length. Generalised estimating equations were applied to obtain valid standard errors. Sub-analysis on data with available information on smoking was conducted (1999-2009).
MAIN OUTCOME MEASURES: Small and large for gestational age (SGA/LGA), Apgar score after 5 minutes, very preterm and preterm birth (VPTB/PTB), perinatal death, stillbirth, neonatal death, birthweight and gestational length.
RESULTS: No associations between HG and adverse pregnancy outcomes were observed in crude analyses, except for VPTB (odds ratio [OR]0.79, 95% CI 0.67-0.93). In adjusted analysis, HG was associated with perinatal death (OR 1.27, 95% CI 1.08-1.48). Inverse associations were observed between HG and VPTB (OR 0.80, 95% CI 0.68-0.94) and LGA (OR 0.95, 95% CI 0.90-0.99). Sub-analyses showed no associations between HG and perinatal death (OR 1.29, 95% CI 0.91-1.83). The inverse associations between HG, VPTB and LGA were strengthened (OR 0.66, 95% CI, 0.48-0.91 and OR 0.86, 95% CI 0.79-0.93, respectively). Exposed babies had reduced birthweight and gestational length compared with unexposed, adjusted difference - 21.4 g and - 0.5 days, respectively. Adjustment for smoking slightly strengthened the impact of HG on birthweight.
CONCLUSIONS: Inverse associations for HG and VPTB and LGA were observed. HG was associated with slight reductions in birthweight and gestational age.
Department of Genes and Environment, Division for Epidemiology, Norwegian Institute of Public Health, Oslo, Norway; Norwegian Resource Centre for Women's Health, Rikshospitalet, Oslo, Norway.
Attitudes, management and consequences of nausea and vomiting of pregnancy in the United States and Canada.
Mazzotta P, Maltepe C, Navioz Y, Magee LA, Koren G
Int J Gynaecol Obstet. 2000;70(3):359.
BACKGROUND: Nausea and vomiting of pregnancy (NVP) affects a large proportion of pregnant women. In 1983, Bendectin((R)), the only FDA-approved drug for NVP, was removed from the market by its manufacturer due to legal costs based on claims of teratogenicity, which were subsequently proven to be unsubstantiated. In Canada, a generic form of Bendectin (Diclectin; a doxylamine/pyridoxine combination) has continued to be available, with increasing use over the last few years.
OBJECTIVE: To characterize the attitudes, management and consequences of NVP among pregnant women in the USA, where no approved drug for NVP is available, and in Canada, where such a drug is available.
DESIGN: Prospective, observational study.
RESULTS: Women suffering from NVP (N = 1444) were interviewed, of which 42% were American and 58% were Canadian. The two groups had similar maternal characteristics and a similar distribution of severity of NVP, although amongCanadian women the NVP continued for slightly longer. American respondents were treated significantly more often by an obstetrician as their primary caregiver, were more commonly advised by their caregiver to change their diet and/or lifestyle and to use non-pharmacological agents to manage their NVP, and more often perceived anti-emetics as posing an increased risk for malformations (all P<0.001). Canadian respondents reported a family physician as their primary caregiver significantly more often, were more commonly advised to take anti-emetic medications and perceived their NVP as causing a concern to their unborn (all P<0.001). American women experienced significantly larger weight loss, more hospitalizations and more time lost from paid work.
CONCLUSIONS: Lack of an approved drug for symptoms of NVP may be associated with unwarranted and preventable adverse health effects. Because this is an observational study, these associations do not necessarily prove causation.
The Motherisk Program, Department of Pediatrics and Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
The impact of nausea and vomiting on women: a burden of early pregnancy.
Smith C, Crowther C, Beilby J, Dandeaux J
Aust N Z J Obstet Gynaecol. 2000;40(4):397.
Nausea and vomiting are troublesome symptoms occurring in the first trimester of pregnancy. The aim of this study was to describe the impact these symptoms have on women in early pregnancy by interviewing, using a structured questionnaire, 593 pregnant women presenting with nausea and vomiting in the first trimester of pregnancy. The women were asked to complete the Rhodes index of nausea and vomiting and the MOS 36 Short Form Health Survey (SF-36). Symptoms of nausea and vomiting started early in pregnancy. Nausea was the most troublesome symptom experienced by women, both in its duration and intensity. Low scores for the SF-36 were found for all items, particularly physical functioning, energy and social functioning. The women described substantial effects on working, household duties and parenting activities. Findings from this study suggest nausea and vomiting in early pregnancy has a profound impact on women's general sense of well-being and day to day life activities.
Department of Obstetrics and Gynaecology,University of Adelaide, South Australia, Australia.
Nausea and vomiting during pregnancy: effects on the quality of women's lives.
O'Brien B, Naber S
More than 70 percent of all pregnant women experience nausea and vomiting during pregnancy, and 28 percent report that symptoms cause them to change their usual activities. We investigated the magnitude of problems that nausea and vomiting impose on the lifestyle of pregnant women and their families. Twenty-seven women who were experiencing different degrees of nausea and vomiting were selected from 147 pregnant women and asked to participate in semistructured telephone interviews. All participants reported changes in family, social, or occupational functioning as a result of these symptoms. Nausea and vomiting can impose substantial lifestyle limitations on pregnant women that can have short- and long-term consequences for them and their families. Both the duration and severity of symptoms were greater for many participants than is generally believed. All participants reported that recumbent rest or dietary alterations provided relief. Caregivers should recognize and validate the need for pregnant women to make changes in lifestyle that will enable them to achieve comfort.