Features Of The Nausea Of NVP

Features Of The Nausea Of NVP

2a. PERCENTAGE OF WOMEN WITH NAUSEA ONLY

 

NVP

Vomited

Nausea Only

Women in Study

Ref

74%

37%

37%

160

(80)

67%

22%

45%

193

(83)

75%

63%

12%

1453

(63)

85%

40%

45%

129

(77)

76%

32%

44%

500

(27)

74%

37%

37%

234

(21)

81%

52%

29%

363

(50)

69%

46%

23%

903

(44)

71%

47%

24%

825

(31)

79%

38.2%

39.2%

3675

(132)

 

Total number of women in ten references: 8435.

Total number of women with nausea only: 2639.

Percentage of women who had nausea only: 32%

Percentage of women with vomiting only (no nausea): 0.64% (RI 3e).

 

2b. EPISIODIC NATURE OF NAUSEA IN PREGNANCY

 

1. 85% of pregnant women with nausea have two episodes per day and 56% have three episodes of nausea per day. 292 women in the study had nausea. (50)

2. 70% of episodes of nausea lasted 1-4 hours. (50)

3. 65.9% of subjects stated that the episodes of nausea lasted 2-4 hours. 78 women in study. (23)

4. NVP had a habit of coming and going in waves. 27 women in study. (103)

5. The nurse practitioner may suggest keeping a diary listing the time of onset and length of each episode. (107) Research article.

6. When nausea is at its worst women may have from one up to 5 separate episodes of nausea per day (very occasionally more than 5) (50) not published.

7. To assess at which week of pregnancy women experience the longest episodes of nausea the percentage of all episodes which lasted four or more hours was calculated for each woman for each week. Week 9 (from LMP) was the median week at which the longest episodes formed the greatest percentage of all episodes (intraquartile range 7-10 weeks) (50) not published.

8. Women with NVP who have nausea only in the morning have a mild form of the illness. (50)

9. When symptoms of NVP improve the episodes become shorter and less frequent, so that they often become once daily in the morning (50) not published.

10. Nausea at group time 1n = 306 gestation age approx. 9 weeks and group time 2n = 231 gestation age mean 12.8 weeks. 30-40% experienced nausea either all the time or more than once per day. (156)

 

Summary

 

Symptoms of NVP usually occur in at least two daily episodes, the majority of each episode lasting

1-4 hours.

Pooled Population in 4 studies 934 women.

 

 

2c. REGULAR DAILY PATTERN OF NVP

 

1. Observations of individual daily diaries appeared to suggest that during the period of maximum symptoms there was a consistent pattern of the daily timing, frequency and duration of episodes. 292 women in study has NVP. (50)

2. Nausea and vomiting during pregnancy are fairly stable in terms of their intensity in each individual. The ratings for mean nausea intensity among women with nausea were fairly constant, not only in the first trimester when they ranged from 1.4 to 2.1 on a five point scale, but throughout pregnancy and although the prevalence of nausea during pregnancy is considerably decreased by the third trimester, in those still experiencing such, the intensity stayed fairly constant (1.9) until nausea ended. (80) 160 women in study

3. These waves of NVP occurred at predictable times. 27 women in study. (103)

4. Some variations in daily nausea patterns were seen. Whereas some women demonstrated predictable patterns, others demonstrated variation in time of occurrence of nausea. 17 women kept daily diaries of nausea symptoms for seven days. (98)

 

Summary

 

During the period of maximum symptoms there was usually a consistent pattern of daily episodes.

4 references pooled population 496 women.

 

2d. SEVERITY OF NAUSEA

 

AVERAGE DURATION OF DAYS OF NAUSEA PER PREGNANCY

 

1. The median number of days of nausea per pregnancy in 292 women suffering from nausea was 41 days (inter-quartile range 38 to 56 days). (50)

2. From the time that daily self-recording began (mean of 8.3 weeks from LMP), nausea lasted a mean on 34.6 days (range 1-114 days). 160 women reported NVP in this study. (80)

3. A finding was that 23% of our study has uninterrupted daily nausea for an average of 44.6 days, while 20% who had one complete day of interruption of their nausea symptoms averaged 24.7 days with nausea (80). 160 women in study.

4. 46% of women experienced NVP for six weeks or less.

35% for seven to ten weeks.

19% for more than 11 weeks.

55 women in study, 37 had NVP. (110)

5. Among 3675 women who completed questionnaires, the average length of reported problems was 9.2 weeks (64 days), 8.2 weeks with only nausea, 9.5 weeks with occasional vomiting and 12.3 weeks when daily vomiting was reported. (132)

 

Summary

 

Number of women in 5 studies 4433.

Average duration of nausea per women with NVP 45 days = 6.5 weeks. Inter-quartile range 5-12 weeks.

 

AVERAGE DURATION IN HOURS OF NAUSEA PER PREGNANCY

 

6. The median number of hours of nausea per pregnancy in 292 women suffering from nausea was 56 hours (inter-quartile range 22 to 139 hours). (50)

 

7. Numbers of women with NVP classified by total hours of nausea

Hours of Nausea

Total No. Of Women

Percentage of Total With Nausea

0.1 – 16

57

19.5%

16.1 – 33

48

16.3% 35.8%

33+ - 66

58

19.7%

66+ - 100

37

12.6% 32.1%

100+ - 199.9

45

15.3%

200+ - 299.9

18

6.1% 21.4%

300+ - 399

11

3.75%

400+ - 499

5

1.7%

500+ - 599

7

2.3%

600+ - 699

3

1.0%

700+

3

1.0% 9.7%

 

292

99.2%

 

Total number of women with NVP in study = 292.

71 women, 19.5% had no NVP.

Total in study; 363 women. Gadsby (Not Published)

 

8. In about 35% of women who have NVP the nausea and vomiting are clinically significant resulting in lost work time and negatively affecting family relationships. (160)

 

 

Summary

 

For women who have NVP approximately 20% have nausea lasting 100-300 hours and a further about 10% have nausea lasting 300-700 hours per pregnancy.

 

2e. NAUSEA THE MOST DISTRESSING SYMPTOM OF NVP

 

1. Nausea was the most common symptom experienced. Vomiting was frequently experienced but did not cause as much distress. Clearly nausea would be the most troublesome symptom experienced by women in terms of its duration and intensity, with the day to day constancy becoming wearisome. 593 women with nausea and/or vomiting in study. (81)

2. Relief occurred if nausea was reduced or relieved. Vomiting was not the most distressing symptom. 27 women in study. (103)

3. Nausea was more prominent than vomiting. 56 women had NVP mainly of moderate severity. (13)

4. Nausea occurs in 99% of pregnant women who have NVP. Vomiting occurs in 47% of women who have NVP. Therefore, nausea is the more frequent symptom.
(Information from this Review).

5. Nausea is the main symptom effecting the quality of life of the women in this study.
500 women in this study. (114)

6. Our data shows that vomiting and retching are strongly interrelated, whereas nausea is perceived differently. Most women report that persistent nausea negatively affects their quality of life, whereas vomiting often signals relief of symptoms. (120)

7. In this study three times more women reported that nausea (and not vomiting) was their most bothersome symptom. (3201 callers to a health-line in Canada who had NVP in a previous pregnancy). (89)

 

 

Summary

 

Nausea in the most distressing of symptoms of NVP i.e. vomiting, retching or nausea.

(81) (103) (13) (this review) (114) (120) (89) Total: Seven References

4377 women in 7 studies.

2f. HYPEREMESIS GRAVIDARUM DEVELOPS FROM NVP

 

  1. There is no clear-cut division between morning sickness and what is excessive vomiting of pregnancy. It is only a matter of degree and both conditions should be treated. Probably the only value of drug therapy is at the stage of morning sickness when anti-emetics or mild sedatives may counter the feeling of nausea and prevent the woman from developing excessive vomiting and entering the vicious cycle of dehydration, starvation and electrolyte imbalance. (75)

  2. Each year a significant number of women are admitted to hospital for hyperemesis gravidarum. Early recognition and management therefore have a significant effect on the quality of life during pregnancy, as well as a financial impact on the health care system. Management of this problem is multi-faceted. It includes early recognition, dieting and lifestyle advice as well as pharmaceutical and alternative forms of therapeutic interventions. (92)

  3. In deciding whether or not to initiate anti-emetic treatment, consideration should be given to the impact NVP is having on the woman’s life. Treatment may be appropriate for less severe NVP that does not necessarily cause dehydration and/or malnutrition. (89)

  4. The value of drug treatment, if any, is at the stage of intractable vomiting when any of the stated anti-emetics, eg, antihistamines or phenothiazines, may be used to counter the feeling of nausea. If one can control the symptoms at this stage then it is likely that a large number of women can be prevented from developing excessive vomiting which, if prolonged, leads to hyperemesis gravidarum. (101)

  5. On June 9th 1983, Bendectin, widely used throughout the world to treat nausea and vomiting during pregnancy, was voluntarily removed from the market by the manufacturer Merrill Dow. At the time, the company faced 327 pending US product liability suits - eventually all lawsuits, which went to court, were dismissed. The company estimated that the drug was used in 33 million pregnancies by 1983. A generic version, Diclectin, which contains Doxylamine (an antihistamine with antinauseant properties) and Pyridoxine (Vit B6), has been available in Canada since 1983 with gradually increasing sales. Bendectin was shown to be an effective drug by default, as lack of use of the drug resulted in a measurable increase in rates of hospitalisation for the symptoms of excessive vomiting during pregnancy, which it was designed to control. (93)

  6. Benefits of recommendations. Nausea and vomiting of pregnancy (NVP) has a profound effect on women’s health and quality of life during pregnancy, as well as a financial impact on the health care system, and its early recognition and management are recommended. Cost including hospitalisation, additional office visits and time lost from work may be reduced if NVP is treated early. (115)

 

SUMMARY

 

HG develops from NVP. (75) (92) (101) (93) (89) (115) Total: Six References

 

2g. THE NAUSEA OF NVP IS UNUSUAL COMPARED TO THE NAUSEA ASSOCIATED WITH OTHER CONDITIONS

 

  1. 55% of women with NVP find their nausea is improved by eating food. (RI 39) 8 references with 2254 with NVP, 1248 nausea improved after eating.

  2. Women with NVP can also experience hunger (RI 39). Hunger can co-exist with NVP (103) or hunger can make NVP worse (54) or hunger can contribute to NVP (109).

  3. Food cravings in pregnancy are associated with a higher incidence of NVP.
    (27) (40) (77) (RI 37)

  4. NVP and HG are more common in non-smokers than in those women who smoke cigarettes. (RI 16)

  5. Increased nausea may be associated with greatly increased olfaction, even, for example when no one else can detect a noticeable odour in the room.
    Personal communication to Barnie-Adshead RI 40.

 

SUMMARY

 

The unusual nausea of NVP suggests a different (possibly hormonal) cause for the nausea of NVP compared to nausea associated with other conditions.

Did you know?

Early access to treatments is likely to be more effective and may prevent symptoms developing into HG

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