The association of temperament with nausea and vomiting during early pregnancy.

ABSRACT We aimed to investigate the relationship between affective temperaments and the severity of nausea and vomiting symptoms in early pregnancy (NVP). The pregnant women who did (n = 187) or did not report (n = 71) any nausea and vomiting at three consecutive assessments with the Pregnancy-Unique Quantification of Emesis Scoring Index (PUQE) (n = 71) were examined. Affective temperamental traits were assessed by Temperament Evaluation of Memphis, Pisa, Paris and San Diego auto-questionnaire (TEMPS-A). The anxious (p < .0001), depressive (p = .003), cyclothymic (p = .03) and irritable (p = .021) temperament traits in NVP patients were significantly higher than in controls. There were significant correlations between the PUQE scores and depressive (p = .002), cyclothymic (p = .001), irritable (p = .001) and anxious (p = .001) traits. Anxious temparement (p = .004) and being a housewife (p = .012) were significantly associated with NVP. Our results suggest that women with a predominantly anxious temperament are more vulnerable to developing somatic complaints such as nausea and vomiting during pregnancy. IMPACT STATEMENT What is already known on this subject? Although some studies have examined the link between NVP and some psychiatric disorders, to our knowledge the relationship between NVP and affective temperament has not been well investigated. What do the results of this study add? Predominantly anxious temperament make the individuals vulnerable to develop some somatic complaints such as nausea and vomiting during pregnancy. What are the implications of these findings for clinical practice and/or further research? The association of temperament and NVP might be linked to a psychosomatic process in pregnancy. Future research are required to examine the associations of temperament with NVP by including several other biological, social and psychological variables.

Transformation of quality of life in prenatal women with nausea and vomiting.

PROBLEM: Nausea and vomiting not only cause physical discomfort in pregnant women but also impact their quality of life. BACKGROUND: Few longitudinal studies have been conducted to investigate QOL of women over the course of pregnancy. AIM: To examine the transformation of health-related QOL and related factors among pregnant women with NV during three trimesters. METHODS: A longitudinal research design with convenience sampling was used. A structural questionnaire was used to repeatedly measure the data of 101 pregnant women with NV during the first, second, and third trimesters. A generalized estimating equation (GEE) was used to analyze the collecting data. FINDINGS: The results showed significant differences in symptom distress, prenatal stress, and health-related QOL among the three trimesters in pregnant women with NV (p<0.001). The scores of symptom distress, prenatal stress, and health-related QOL in the first trimester were significantly higher than those in the second and third trimesters (p<0.001). The GEE indicated that the trimester of pregnancy, severity of NV, symptom distress, and prenatal stress were key factors for the transformation of health-related QOL of women with NV during pregnancy. DISCUSSION: The findings of this study are seminal in terms of understanding the relationships between symptom distress, prenatal stress and health-related QOL in pregnant women with NV over the course of a pregnancy. CONCLUSION: This study can serve as a reference for designing interventions (i.e., professional support) for women in different pregnancy stages to improve their health-related QOL during pregnancy.

The impact of maternal nausea and vomiting in pregnancy on expectant fathers: findings from the Australian Fathers' Study.

INTRODUCTION: Nausea and vomiting in pregnancy (NVP) are common. Whilst the impact on pregnant women has been well documented, there is less data on the impact on partners. This study evaluated awareness and impact of maternal NVP on expectant fathers. METHODS: Observational study of 300 expectant fathers. Institutional ethics approval and consent were obtained. Fathers were recruited from antenatal clinics and community settings. Researchers administered demographic, attitudinal and the Hospital Anxiety and Depression scale questionnaires during the third trimester. Expectant fathers were asked if their partner experienced NVP. If aware, they were asked to comment upon the impact on their lives. RESULTS: Participants were similar in demographics to those of the wider Australian community of expectant fathers. Most fathers were aware whether their partner experienced NVP (82%). Of these fathers, 20% reported no NVP, and 30%, 37% and 13% men reported maternal NVP was mild, moderate and severe, respectively. There was no correlation between paternal depression and maternal NVP, but a significant association was found between moderate and severe maternal NVP and paternal anxiety. In qualitative comments, five themes emerged: disruption on work, feelings of frustration and helplessness, concern over depression in their partner, concern for the developing baby and a sense of being manipulated in the third trimester of pregnancy. DISCUSSION: Most expectant fathers are aware of NVP in their partner. Moderate and severe maternal NVP are associated with significantly higher symptoms of paternal anxiety.

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.

Nausea and Vomiting in Early Pregnancy of Adolescents: Relationship with Depressive Symptoms.

STUDY OBJECTIVE: To determine the relationship between severity of nausea and vomiting during pregnancy (NVP) and depressive symptoms in pregnant adolescents. DESIGN: Prospective cross-sectional study. SETTING: A maternity research hospital outpatient clinic, Ankara, Turkey. PARTICIPANTS: A total of 200 pregnant adolescents. INTERVENTIONS AND MAIN OUTCOME MEASURES: Demographic features and obstetric histories of the participants were assessed. The Rhodes test was performed to determine nausea and vomiting severity in a face-to-face interview, and the self-reported Edinburgh Postnatal Depression Scale was administered with supervision. RESULTS: The Rhodes test results showed that 52/200 patients (26%) were classified with none, 83/200 patients (41.5%) with mild, 48/200 patients (24.0%) with moderate, and 17/200 patients (8.5%) with severe symptoms. The mean depression score in the severe vomiting group was significantly higher than that in the no NVP and mild NVP groups (P = .028 and .041, respectively). No differences were found between the other groups. CONCLUSION: Severe nausea and vomiting was associated with greater depressive symptom severity in pregnant adolescents.

Is there relationship between social support, psychological distress, mood disorders and emesis gravidarum?

OBJECTIVE: Emesis Gravidarum (EG) is common medical condition in pregnancy with significant negatively effects on daily social life, physical and psychological health. In this study, relationship of social support, psychological distress and mood disorders on EG were investigated. METHODS: The pregnant women with mild EG were accepted as control group and moderate and severe EG were accepted as patient group. All patients completed sociodemographic data collection form, Pregnancy-Unique Quantification of Emesis and Nausea scale (PUQE-24), Symptom Check List questionnaire (SCL-90 R), Spielberger state-trait anxiety inventory (STAI), Beck depression inventory (BDI) and Multidimensional Scale of Perceived Social Support (MSPSS). STAI, BDI, MSPSS and GSI (global symptom index) scores of the patients and control groups were compared. RESULTS: Statistically significant differences were found between the patients and control group on STAI score, BDI score and GSI scores. No statistically significant were found between the patients and control group on MSPSS score. CONCLUSION: Social support does not prevent patients from EG. But, there is a clear relationship between EG and psychological distress. Thus, psychiatric evaluation should be done in patients with EG. Obstetricians should encourage their patients to have psychiatric support. Further studies on relationship of psychosocial factors and EG are needed.

The HAPPY study (Holistic Approach to Pregnancy and the first Postpartum Year): design of a large prospective cohort study.

BACKGROUND: The HAPPY study is a large prospective longitudinal cohort study in which pregnant women (N ≈ 2,500) are followed during the entire pregnancy and the whole first year postpartum. The study collects a substantial amount of psychological and physiological data investigating all kinds of determinants that might interfere with general well-being during pregnancy and postpartum, with special attention to the effect of maternal mood, pregnancy-related somatic symptoms (including nausea and vomiting (NVP) and carpal tunnel syndrome (CTS) symptoms), thyroid function, and human chorionic gonadotropin (HCG) on pregnancy outcome of mother and foetus. METHODS/DESIGN: During pregnancy, participants receive questionnaires at 12, 22 and 32 weeks of gestation. Apart from a previous obstetric history, demographic features, distress symptoms, and pregnancy-related somatic symptoms are assessed. Furthermore, obstetrical data of the obstetric record form and ultrasound data are collected during pregnancy. At 12 and 30 weeks, thyroid function is assessed by blood analysis of thyroid stimulating hormone (TSH), free thyroxine (FT4) and thyroid peroxidase antibodies (TPO-Ab), as well as HCG. Also, depression is assessed with special focus on the two key symptoms: depressed mood and anhedonia. After childbirth, cord blood, neonatal heel screening results and all obstetrical data with regard to start of labour, mode of delivery and complications are collected. Moreover, mothers receive questionnaires at one week, six weeks, four, eight, and twelve months postpartum, to investigate recovery after pregnancy and delivery, including postpartum mood changes, emotional distress, feeding and development of the newborn. DISCUSSION: The key strength of this large prospective cohort study is the holistic (multifactorial) approach on perinatal well-being combined with a longitudinal design with measurements during all trimesters of pregnancy and the whole first year postpartum, taking into account two physiological possible markers of complaints and symptoms throughout gestation: thyroid function and HCG. The HAPPY study is among the first to investigate within one design physiological and psychological aspects of NVP and CTS symptoms during pregnancy. Finally, the concept of anhedonia and depressed mood as two distinct aspects of depression and its possible relation on obstetric outcome, breastfeeding, and postpartum well-being will be studied.

Surviving morning sickness successfully: from patient's perception to rational management.

Nausea and vomiting of pregnancy (NVP) affects up to 85% of pregnant women, with varying degrees of severity. The most severe form of NVP, known as hyperemesis gravidarum (HG), affects up to 2% of pregnancies. Women who have suffered with severe NVP/HG in a previous pregnancy have a 75-85% recurrence rate. Both patients and physicians often fear the use of pharmacological therapies during pregnancy due to the concerns of potential risks to the fetus. The symptoms and impact of NVP and HG can vary greatly among women, therefore treatment must be tailored to the individual. Updated Motherisk guidelines are presented.

How evidence-based is the information on the internet about nausea and vomiting of pregnancy?

BACKGROUND: The Internet has become an important source of information about pregnancy and about health related concerns in general. This study assessed the quality of information available on the Internet for the common problem of nausea and vomiting of pregnancy (NVP). METHOD: We used three search terms, "nausea and vomiting in pregnancy," "morning sickness," and "hyperemesis gravidarum," to identify the most popular sites as rated by Google. With modifications of previously described tools, the quality of the websites was rated in three categories: accountability using the Silberg criteria, presentation using a modified Abbott's score, and readability using the Flesch-Kincaid grade level score. Subsequently the information on the websites was compared with the SOGC guideline on management of NVP. RESULTS: We identified 24 unique websites as most popular. The overall scores for accountability indicated poor quality, with only 25% of the websites meeting the required criteria and less than one half of the sites indicating authorship and credentials. Esthetic appeal criteria were met in over 75% of the websites. The readability score of the websites was significantly above the score recommended for the general population, with an average Flesch-Kincaid Grade level score of 10.7 (max = 12). Eighty-seven percent of the websites contained accurate, evidence-based recommendations according to the information provided in the SOGC clinical practice guideline on management of NVP. CONCLUSION: Overall, the majority of information available online is accurate; however, the web pages demonstrated poor accountability and targeted an audience with a higher reading ability than the general population. Consideration of these findings would help create easy to navigate, credible web pages containing information to help women make informed decisions during pregnancy.

Contexte : Internet est devenu une importante source de renseignements au sujet de la grossesse et des préoccupations de santé en général. Cette étude a évalué la qualité des renseignements disponibles sur Internet pour ce qui est des problèmes courants de la nausée et du vomissement pendant la grossesse (NVG). Méthodes : Nous avons utilisé trois termes de recherche (« nausea and vomiting in pregnancy ¼, « morning sickness ¼ et « hyperemesis gravidarum ¼) pour identifier les sites les plus populaires, tels que classés par Google. Au moyen de modifications apportées à des outils déjà décrits, la qualité des sites Web a été évaluée en fonction de trois critères : la responsabilité (au moyen des critères Silberg), la présentation (au moyen d'un score Abbott modifié) et la lisibilité (au moyen du score de niveau de langue Flesch-Kincaid). Par la suite, les renseignements offerts par ces sites Web ont été comparés aux renseignements offerts par la directive clinique de la SOGC sur la prise en charge des NVG. Résultats : Nous avons identifié 24 sites Web particuliers comme étant les plus populaires. Les scores globaux en matière de responsabilité ont indiqué une piètre qualité, seulement 25 % des sites Web satisfaisant aux critères requis et moins de la moitié de ces sites indiquant le nom du ou des auteurs et leurs références. Les critères traitant de l'attrait esthétique ont été satisfaits pour ce qui est de plus de 75 % des sites Web. Le score de lisibilité de ces sites Web se situait considérablement au-dessus du score recommandé pour la population générale (score de niveau de langue Flesch-Kincaid moyen de 10,7 [max. = 12]). Quatre-vingt-sept pour cent de ces sites Web contenaient des recommandations précises et factuelles, conformes aux renseignements offerts dans la directive clinique de la SOGC sur la prise en charge des NVG. Conclusion : De façon globale, la majorité des renseignements offerts en ligne sont précis; cependant, les sites Web identifiés présentaient un faible score de responsabilité et ciblaient un auditoire comptant des capacités de lecture plus élevées que celles de la population générale. La prise en considération de ces résultats contribuerait à la création de pages Web faciles à naviguer, crédibles et contenant des renseignements qui pourraient aider les femmes à prendre des décisions éclairées pendant la grossesse.

Neurolinguistic programming: a systematic review of the effects on health outcomes.

BACKGROUND: Neurolinguistic programming (NLP) in health care has captured the interest of doctors, healthcare professionals, and managers. AIM: To evaluate the effects of NLP on health-related outcomes. DESIGN AND SETTING: Systematic review of experimental studies. METHOD: The following data sources were searched: MEDLINE, PsycINFO, ASSIA, AMED, CINAHL, Web of Knowledge, CENTRAL, NLP specialist databases, reference lists, review articles, and NLP professional associations, training providers, and research groups. RESULTS: Searches revealed 1459 titles from which 10 experimental studies were included. Five studies were randomised controlled trials (RCTs) and five were pre-post studies. Targeted health conditions were anxiety disorders, weight maintenance, morning sickness, substance misuse, and claustrophobia during MRI scanning. NLP interventions were mainly delivered across 4-20 sessions although three were single session. Eighteen outcomes were reported and the RCT sample sizes ranged from 22 to 106. Four RCTs reported no significant between group differences with the fifth finding in favour of the NLP arm (F = 8.114, P<0.001). Three RCTs and five pre-post studies reported within group improvements. Risk of bias across all studies was high or uncertain. CONCLUSION: There is little evidence that NLP interventions improve health-related outcomes. This conclusion reflects the limited quantity and quality of NLP research, rather than robust evidence of no effect. There is currently insufficient evidence to support the allocation of NHS resources to NLP activities outside of research purposes.

Pregnancy sickness: a biopsychological perspective.

Pregnancy sickness is a universal phenomenon, affecting 70% to 85% of all pregnant women. The primary symptoms of pregnancy sickness are nausea, vomiting, and food aversions. In the past, pregnancy sickness was attributed to psychological disturbances of the pregnant woman. However, recent evolutionary psychological and biopsychological studies have reconsidered pregnancy sickness as an embryo-protective mechanism, an evolutionary adaptation to protect the embryo from phytotoxins and other environmental hazards. The biopsychological perspective of pregnancy sickness as an embryo-protective mechanism is presented.

Shifts in color discrimination during early pregnancy.

The present study explores two hypotheses: a) women during early pregnancy should experience increased color discrimination ability, and b) women during early pregnancy should experience shifts in subjective preference away from images of foods that appear either unripe or spoiled. Both of these hypotheses derive from an adaptive view of pregnancy sickness that proposes the function of pregnancy sickness is to decrease the likelihood of ingestion of foods with toxins or teratogens. Changes to color discrimination could be part of a network of perceptual and physiological defenses (e.g., changes to olfaction, nausea, vomiting) that support such a function. Participants included 13 pregnant women and 18 non-pregnant women. Pregnant women scored significantly higher than non-pregnant controls on the Farnsworth-Munsell (FM) 100 Hue Test, an objective test of color discrimination, although no difference was found between groups in preferences for food images at different stages of ripeness or spoilage. These results are the first indication that changes to color discrimination may occur during early pregnancy, and is consistent with the view that pregnancy sickness may function as an adaptive defense mechanism.

How women manage nausea and vomiting during pregnancy: a Jordanian study.

OBJECTIVE: to explore the strategies used by Jordanian women to manage nausea and vomiting during pregnancy. DESIGN: cross sectional descriptive study. SETTING: the three regions of Jordan. PARTICIPANTS: 235 women aged 18-54 years who had been pregnant. FINDINGS: there a number of strategies were used by Jordanian women in the sample for the alleviation of nausea and vomiting of pregnancy, varying from non-pharmacological strategies such as diet and lifestyle changes to the use of complementary alternative medicine and pharmacological treatments. IMPLICATIONS FOR PRACTICE: preparing women and their families to manage nausea and vomiting during pregnancy effectively is important; midwives should encourage women to seek help from care providers when they need it, and continue to assess nausea and vomiting and management strategies during the first weeks of pregnancy.

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.

Preferences of caregiver when experiencing nausea and vomiting during pregnancy.

AIM: To assess the preferences of pregnant women regarding the type of assistance desired to alleviate the consequences of nausea and vomiting of pregnancy (NVP). METHODS: Women with NVP were asked to complete an online survey of 12 questions assessing the extent of NVP and the perspective on the importance of different healthcare professionals for their improvement. RESULTS: A total of 121 pregnant women completed the survey. The median maternal age was 29 years and the average gestational age was 12.4+/-7.6 weeks. Sixty-four of the women (52.9%) had NVP in their previous pregnancy, which resulted in an average of 14.6+/-21.1 lost days of paid work. NVP necessitated admission to the emergency room in 36 (29.7%). When asked to rate (max 4 points) which healthcare professional would provide the best assistance for NVP, the physician was rated as the most important (average score of 3.56/4), followed by dietician (3.40/4), nurse (3.05/4) and social worker/psychologist as least important (1.77/4). CONCLUSION: Our findings illustrate women's perspective on NVP. According to our online survey, women perceive medically- and nutritionally-based care as most useful, whereas psychosocial factors are perceived to be less useful despite playing a central role in NVP.

Food cravings, aversions and pica among pregnant women in Dar es Salaam, Tanzania.

Food cravings, aversions and pica are common during pregnancy and may have a significant input on pregnancy progress and outcome. A study was carried out to determine the frequency and duration of pronounced dietary cravings, aversions and pica during pregnancy among 204 pregnant and lactating women attending two health facilities in Dar es Salaam City, Tanzania. Nausea and vomiting were reported by 82.8% of all women of which 43.2% experienced severe nausea alone, 9.5% severe vomiting alone and 35.5% experienced severe vomiting and nausea. Mild cases of each of the symptoms either occurring alone or both of them occurring together were also reported. Both behaviours were observed more in <3 months of pregnancy. The proportions of women with dietary cravings, aversions, and pica were 73.5%, 70.1% and 63.7% of all women respectively. More women (70.1%) experienced both food cravings and aversions than either symptom alone. Foods craved most were meat (23.3%), mangoes (22.7%), yoghurt (20.0%) oranges (20.0%), plantain (15.3%) and soft drinks (13.3%). Foods avoided most were rice (36.4%), meat (36.4%) and fish (30.8%). Eggs, beans, tea and stiff porridge were also avoided. Reasons given for avoiding foods were unpleasant smell/taste (10.3%), to reduce nausea (11.8%), no particular reason (58.3%) and dislike by foetus (belief) (3.9%). Pica was experienced by 63.7%% of the women and soil, ice and ash were the most commonly non-food substances eaten. The frequency of nausea and vomiting was highest in the early months of pregnancy and most women experienced the symptoms during morning hours. Craving in most women was more intense in the first trimesters. Most women craved for meat and sour and savoury foods, and avoided rice, meat and fish. Soil consumption was the pica observed in most women. Since aversions and cravings are closely linked to dietary intake of pregnant woman understanding these behaviours is important in addressing maternal nutrition.

Nausea and vomiting of pregnancy: what about quality of life?

OBJECTIVE: The objective of this study was to determine the impact of nausea and vomiting of pregnancy (NVP) and other determinants on generic and NVP-specific health-related quality of life (QOL) in the first trimester of pregnancy. DESIGN: Prospective study. SETTING: Centre Hospitalier Universitaire (CHU) Sainte-Justine or René-Laennec clinics, Montreal, Quebec, Canada. POPULATION: Pregnant women attending the clinics for their prenatal care from 2004 to 2006. Women were eligible if they were > or =18 years of age and < or =16 weeks of gestation at the time of their first prenatal visit. METHODS: After their first prenatal visit, women were asked to fill out a questionnaire covering maternal characteristics, presence and severity of NVP, and health-related QOL. MAIN OUTCOME MEASURES: QOL was measured by the generic 12-item Short Form Health Survey v.1 (SF-12) and the NVP-specific Quality of Life for Nausea and Vomiting during Pregnancy. RESULTS: Of the 367 pregnant women included in the study, 78.5% of women reported NVP in the first trimester of pregnancy. Multivariable linear models showed that presence of NVP in the first trimester of pregnancy was significantly associated with a lower physical component summary scale (P < 0.0001) and mental component summary scale (P = 0.0066) of the SF-12 scores. More severe NVP (moderate versus mild: P = 0.0002; severe versus mild: P = 0.0177 as measured by the validated modified Pregnancy-Unique Quantification of Emesis and Nausea index), intensity of nausea symptoms reported on a visual analogue scale (P < 0.0001), and nonpharmacological methods used to ease NVP symptoms in the first trimester of pregnancy (P = 0.0059) were significantly associated with poorer NVP-specific QOL among women suffering from NVP. CONCLUSION: These findings show that presence and severity of NVP have a negative impact on health-related QOL, which emphasises the importance of an optimal management of NVP.

Nausea and vomiting in early pregnancy: relationship with anxiety and depression.

OBJECTIVE: To investigate the association between either depression or anxiety early in pregnancy, and nausea and vomiting, in a clinical sample. METHODS: Anxiety and depression scores of 230 women were investigated by using the Hospital Anxiety and Depression Scale. Nausea and vomiting of pregnancy (NVP) were scored by using the Rhode's system. These scores and demographic data were compared and P < 0.05 was considered significant. RESULTS: A significant correlation between Rhode's score and both anxiety (r=0.388, P < 0.001) and depression score, (r=0.351, P < 0.001) was found. Gestational age showed and inverse correlation with anxiety scores (P=0.019). There was no significant correlation between demographic data and anxiety/depression scores, or Rhode's scores. CONCLUSION: There is an association between anxiety and depression early in pregnancyand severity of NVP.