Clinical Features Of Nausea And Vomiting Of Pregnancy (NVP) Which Can Be Related To Maternal Serum Prostaglandin E2

Clinical Features Of Nausea And Vomiting Of Pregnancy (NVP) Which Can Be  Related To Maternal Serum Prostaglandin E2

 
There are some features present in the symptom complex of nausea and vomiting of pregnancy
(NVP) which can be associated with maternal serum PGE2.  
 
Firstly, the variation in NVP from pregnancy to pregnancy, indeed no two pregnancies have exactly
similar symptoms, and the variation in NVP from one pregnancy to the next in the same mother,
which occurs in between 33-50% of pregnant women.  These variations can be explained by the
many different maternal serum concentrations of placental specific hormones and cytokines in each
individual pregnancy.  They stimulate the synthesis of hCG which, consequently, varies in each
pregnancy.  hCG itself is one of the factors which will stimulate PGE2 production, which
consequently differs in each pregnancy.  There is also a large variation in the amount of
Prostaglandin dehydrogenase (PGDH) activity between individual placentae at the same stage of
gestation.
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Secondly, the finding that whether NVP begins early or late, severely or mildly, it ceases on
average at approximately day 84 from LMP (1) suggests that another substance, possibly PGDH
activity, is required to reduce NVP.   
 
Thirdly, the median week of peak NVP is week 9 from LMP (ration 8-10 weeks) (1).  This week
corresponds with the week of peak maternal hCG serum levels, and the nadir of maternal serum
progesterone.  High serum hCG gives maximum stimulation of maternal PGE2 synthesis.  Low
maternal progesterone leads to reduced placental PGDH.  Both raised PGE2 and low PGDH will be
related to increased NVP at that time of gestation.   
 
Fourthly, the positive correlation with NVP and non-smoking status (2), agreeing with the finding
of 10 other authors, can be due to the damage cigarette smoking in pregnancy causes to the
placental cells, with resultant marked decrease in maternal hCG (3) and  PGE2.
 
Fifthly, we have published the paper Nausea and Vomiting of Pregnancy:  An Association between
Symptoms of NVP and Maternal Prostaglandin E2 (4), which demonstrates a positive relationship
between NVP and maternal serum PGE2 levels.  For each of 18 women the maternal serum PGE2
was higher when she had NVP than when she had no NVP on the same day.  This remained true
whether the sample taken at the time she had NVP was before or after midday.  However, we
would not recommend any attempt to reduce maternal PGE2 during early pregnancy, because of the
vital functions PGE2 has at that time of gestation.  We are, however, of the opinion that treatment
of NVP can and should be given safely and effectively as it is now in Canada and in America
(2013).

REFERENCES

1. GADSBY R, BARNIE-ADSHEAD A M, JAGGER C.

 A prospective study of nausea and vomiting in pregnancy.

 British J. Gen Pract. 1993;43:245-248.

2. GADSBY R, BARNIE-ADSHEAD A M, JAGGER C.

 Pregnancy nausea related to women’s obstetric and personal histories.

 Gynecol Obstet Invest. 1997;43:108-111.

3. BERNSTEIN L, PIKE M C, LOBO R A, DEPUE R H, ROSS R K, HENDERSON B E.

 Cigarette smoking in pregnancy results in marked decrease in maternal hCG and oestradiol levels.

 Brit J. Obstet Gynaecol. 1989;96:92-96.

4. GADSBY R, BARNIE-ADSHEAD A M, GRAMMATOPPOULOS D,

 GADSBY P.

 Nausea and vomiting in pregnancy: An association between symptoms and Maternal Prostaglandin E2.

 Gynecol Obstet Invest. 2000;50:149-152. (See Appendix A)

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85%

85% of pregnant women have two episodes of nausea per day.

70-80%

Nausea & vomiting in pregnancy (NVP) is very common, on average it affects 70-80% of pregnant women to a greater or lesser extent.

30%

30% of pregnant women in paid employment need time off work due to NVP.

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