Natural factors making NVP worse
40. NATURAL FACTORS MAKING NVP WORSE
1. Fatty smells, cooking smells and smoke precipitate NVP. 78 women in study.(23)
2. The following items women stated made their symptoms worse. Smell of food, cooking, smell of fatty foods, tea, coffee, being hungry. 363 women in study. (Gadsby - not published).
3. From 147 women, the following made NVP worse:
Ingesting particular foods and beverages, 34.3%.
Not eating (being hungry), 20.3%.
Physical position or position changes, 16.8%.
Mental or auditory, 5.6%.
Visual, 2.8%. (54)
4. Among those affected with aversions in pregnancy, there were dislikes or much reduced consumption of tea, coffee, meat, fish, fatty or oily foods. 1,771 women in study. (41)
5. Passive smoking is associated with more than a two-fold increased risk of severe vomiting. 201 women with severe vomiting in study. (65)
6. Foods’ appearance, texture and smell. - Smells, especially food and cooking smells make NVP worse. Also, the smell of coffee pots or perfume. Swallowing saliva can precipitate NVP. (70)
7. Increased sensitivity to odours. Aromas of cooking food as well as aromas in the workplace may initiate nausea, e.g. perfume, smoke. (92)
8. Hyperolfactory and sensitivity to motion are seen in many patients with hyperemesis. Some women are able to tolerate a meal in bed in the morning but not after rising or moving around. (74)
9. Travel sickness is aggravated during pregnancy in emetic women. 92 patients in study. (19)
10. Many pregnant women have aversions to alcoholic and non-alcoholic (coffee and tea) beverages and strong tasting vegetables, especially during the first trimester. However, the greatest aversions are to meat, fish, poultry and eggs. 20 study summaries included information from 5,432 women who had food aversions. Usually the foods were reported aversions because they provoked nausea. (86)
11. NVP often co-existed with hunger, 43% and fatigue, 63%. Women described a sudden onset of intense hunger requiring them to eat immediately. This was followed by nausea and often vomiting. (103) 27 women in study
12. Stimuli for NVP;
Positional changes, e.g. walking.
Odours which are usually inoffensive, e.g. perfumes, deodorants.
Any noxious odours - everything smells funny.
Sight of food.
Diaries. Detailed daily diaries can highlight problems to be avoided or be used beneficially. (108) 124 women in study
13. Factors contributing to nausea;
19 women in study, each kept record of nausea for seven days during the first trimester. (109)
14. Major factors which interfere with the ability to use relief measures for NVP.
Travel (particularly to work).
Decreased appetite. (109)
19 women in study kept diaries of NVP for seven days in the first trimester.
15. I can smell odours in a room nobody else can smell, with resultant increased NVP.
(personal communication to Barnie-Adshead)
16. I have said to my husband that room smells unpleasant. He replies “I cannot detect any problem”. (personal communication to Barnie-Adshead)
17. 50% of respondents to a questionnaire containing the nausea and vomiting instrument (NVPI) and open ended questions relating to perceived aversive and helpful stimuli, could identify something that made nausea worse, stated that olfaction appears to be the primary mechanism involved. (141)
Women with more severe NVP were more likely to state food or cooking odour as adverse stimuli. (141)
Aversive stimuli - a total of 72% of respondents stated a food; 26% a drink and 31% non-food. Of the food category n = 45 (28%) reported fat/fried food; n = 20 (12%) reported oriental, spicy, garlic; 17% fish, meat, eggs and poultry (combined strategy). Drinks included coffee, 19%; tea 11%; non foods included cigarettes 9%; perfumes 7% and cleaning products 5%. (141)
Increased olfactory sensation. (54) (74) (92) (108) (Barnie-Adshead - twice) (141)
Fatty or cooking smells
(23) (Gadsby) (54) (41) (70) (92) (74) (108) (109) (141) Ten References
Beverages, especially tea, coffee - taste or smell of
(Gadsby) (54) (41) (70) (86) (141) Six References
Cigarette smoke (23) (65) (92) (141) Four References
Perfume (smell of) (70) (92) (108) (141) Four References
Being hungry (Gadsby) (54) (103) (109) Four References
Positional change (54) (74) (19) (109) Five References
Fatigue or tiredness (109) (103) Two References
Various foods, e.g. meat, fish (41) (86) (141) Three References
Oriental, spicy, garlic (141) One Reference
Swallowing saliva (70) One Reference
Factors preventing women from
resting e.g. avoid loud noises (108) One Reference
Travel, particularly to work }
Child responsibilities }
Shopping } Please see Review Indices 41 and 42
Did you know?
Evidence is mounting from biological research that GDF15, the key driver of cancer cachexia, is linked to severe NVP
Please note this guideline is for moderate to severe NVP symptoms rather than HG
RCOG Green-top Guideline No. 69
The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum
BMJ Clinical Update 2018
Management of severe pregnancy sickness and hyperemesis gravidarum
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