Summary of results from references

43.      SUMMARY OF RESULTS FROM REFERENCES

 

 

Index No.

Subject

Number of references

Stating same result

1.

Incidence of NVP. 73.4% of births

Twenty Six References

2a.

2b.

2b.

 

2b.

2c.

2d.

2e.

2f.

2g.

Percentage of women with nausea only, 32.0%.

Episodic nature of NVP.

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

70% of episodes lasted 1-4 hours.

Regular daily pattern of episodes.

NVP lasts for a mean of approximately 6.5 weeks.

Nausea most distressing symptom of NVP.

HG develops from NVP

NVP is unusual compared to nausea associated with

other conditions.

Ten References

Five References

One Reference

 

Two References

Four References

Five References

Seven References

Six References

Four References

3.

Incidence of vomiting 47.1% of births.

Increased nausea statistically correlated with increased vomiting.

Thirteen References

Three References

4.

4a.

4b.

4c.

 

4f.

 

 

Analysis of early and late onset of symptoms.

Mean day of onset NVP 39 from LMP.

13.2% of women start NVP before day 28 from LMP.

90% of women start NVP before day 56 from LMP.

Maximum time for NVP weeks 7-13 from LMP.

Peak of NVP symptoms between weeks 7-9 from LMP, median week 9 after rising sharply from week 6.

 

Five References

Five References

Seven References

Six References

One Reference

5.

 

Mean week of cessation of NVP variation considerable.

60% end of week 12 from LMP.

50% by week 14 from LMP.

Range 91% ceased by end of week 16 from LMP. 90% resolved by 22nd week from LMP.

 

One Reference

One Reference

Two References

6.

25% of women who deliver a singleton normal infant had no NVP.

Sixteen References

 

 

7a.

 

7b.

7c.

 

7d.

Percentage of women with NVP in morning only 13.6%.

NVP most commonly occurs before and after midday.

Correct name pregnancy nausea and vomiting, not morning sickness.

Vomiting occurred in 42.6% of women before midday.

Six References

 

Thirteen References

Eight References

 

Two References

8a.

 

8b.

 

8c.

 

 

8d.

NVP and HG can vary from pregnancy to pregnancy in the same woman.

NVP can recur similarly from one pregnancy to the next in the same woman.

There is 50-66% chance that symptoms will be similar from one pregnancy to the next in the same woman.

 

Recurrence rate for HG in succeeding pregnancies

70-80%.

Five References

 

Six References

 

Four References

 

 

Seven References

9a.

 

9b.

 

9c.

 

9d.

 

 

 

 

9e.

 

 

9f.

Incidence of hyperemesis gravidarum (HG).

Range 0.14-1.3% (definitions of HG vary).

HG - Peak time of admission to hospital.

9-11 weeks from LMP.

Average length of stay in hospital for HG between 3-4 days.

Re-admission to hospital due to recurrence of HG about 25%.

 

Re-admissions reduced by oral steroid treatment.

 

Prompt recovery from NVP after termination, or delivery following HG or NVP

 

Importance of HG in early pregnancy.

Eighteen References

 

Twelve References

 

Eleven References

 

Thirteen References

 

Two References

 

Six References

 

 

Nine References

10.

Animals and NVP. Animals do not suffer from vomiting due to pregnancy.

Five References

11.

Marital status.

No relation between marital status and NVP.

Six References

12.

12a.

12b.

12c.

Wanted or unwanted pregnancies and NVP.

Wanted pregnancies more NVP.

Unwanted pregnancies more NVP.

No difference in NVP for wanted or unwanted pregnancy.

 

Five References

Two References

One Reference

 

 

13.

Ethnic origin and NVP.

No difference in incidence of NVP with ethnic origin.

NVP more common in Negros.

Low incidence of NVP in Eskimos and native African tribes.

White ethnicity associated with increased vomiting.

Stable diet of maize associated with no NVP.

 

Six References

Three References

One Reference

 

One Reference

One Reference

14.

Genetic factors in relation to NVP.

Women whose mothers suffered from NVP more likely to have NVP themselves.

Maternal factor responsible for NVP.

Mothers’ NVP not related to study subjects’ experience of NVP.

Women whose sisters had NVP more likely to have NVP.

Paternal contribution does not affect NVP.

 

Three References

 

Three References

One Reference

 

One Reference

 

One Reference

15.

Pre-pregnancy motion sickness in relation to NVP.

Women who regularly suffered from travel sickness get more NVP.

No difference in emesis rate, for those who did or did not have pre-pregnancy travel sickness.

Travel sickness worse during pregnancy.

 

Two References

 

Two References

 

Two References

16.

Smoking and NVP in the current pregnancy.

NVP including HG more common in non-smokers.

Smoking not associated with nausea or vomiting.

 

Fourteen References

One Reference

17.

Alcohol intake and NVP.

Alcohol consumption not related to NVP.

Women who consume alcohol prior to conception were at decreased risk of NVP.

 

Three References

Two References

18.

Age in relation to NVP.

Women of younger age, up to 26 years, likely to have increased NVP and HG. Six refer to HG.

Women of older age less likely to have NVP or HG

Women’s age not related to NVP.

 

Thirteen References

 

Three References

Eleven References

 

 

19.

Parity and NVP.

HG more common in primipara (nullipara).

The greater the gravida the less likely to have HG.

Primipara no marked increase in vomiting.

Primigravida (Parity 0) decreased risk of NVP.

Multipara more NVP than primipara.

No relationship between NVP and parity.

 

Seven References

Two References

One Reference

One Reference

Five References

Eight References

20.

Women’s initial weight and NVP.

NVP more common in heavier women.

No relation between NVP and mother’s body weight.

Initial low body weight associated with HG

 

Three References

Four References

Three References

21.

NVP in relation to nausea when previously taking an oral contraceptive.

Women who had nausea with an oral contraceptive more likely to have NVP.

Four statistically significant at the P<0.05 level.

A history of nausea when taking an oral contraceptive was unrelated to NVP.

 

 

Five References

 

 

One Reference

22.

Pre-pregnancy diabetes in relation to NVP.

No increase in NVP in diabetic women.

 

Four References

23.

HG as a cause of Maternal Mortality.

1925-1936 - 369 cases of HG, 15 maternal deaths.

1955-1959 - no maternal deaths.

 

One Reference

Four Similar References

24.

HG more common with Hydatidiform Moles than normal pregnancy.

Excessive vomiting doesn’t occur in trophoblastic diseases.

Eight References

 

One Reference

25.

NVP and previous unsuccessful pregnancy. Abortion, stillbirth and neonatal death.

Increased NVP

Not related to NVP

 

Four Refs, 3 Refer to HG

Four References

26.

NVP in relation to miscarriage.

There is a lower incidence or severity of NVP in pregnancies resulting in a spontaneous miscarriage.

 

Eighteen References

 

 

27.

Reduced maternal weight gain related to NVP and HG.

NVP not related to maternal weight gain.

HG associated with reduced weight gain.

 

Two References

Five References

28.

Pre-eclamptic Toxaemia (P.E.T) in the current pregnancy and NVP or HG.

NVP not increased in women who later develop P.E.T.

High incidence of HG in eclamptic patients.

Modest association between severe vomiting and P.E.T.

 

 

Eight References

One Reference

One Reference

29.

Intra-Uterine Growth Retardation and NVP or HG.

Severe HG associated with intra-uterine growth retardation.

HG not associated with intra-uterine growth retardation.

No association between freedom from NVP and intra-uterine growth retardation.

 

Four References

 

Two References

One Reference

30.

Length of pregnancy (<37 weeks) and NVP.

Women with HG and NVP not likely to experience delivery before 37 weeks.

Moderate increase in somewhat short pregnancies in  HG.

HG and low pregnancy weight gain delivered before 37 weeks

 

Sixteen References

 

One Reference

 

One reference

31.

Sex of baby and NVP.

No association between NVP and sex of baby.

In Hyperemesis Gravidarum more female infants.

 

Six References

Seven References

32.

Birth weight of baby and NVP.

Birth weight not related to NVP.

Hyperemesis associated with low birth weight babies

HG associated with average birth weight babies.

Severe HG associated with low birth weight babies.

Absence of NVP is associated with low birth weight babies.

 

Nine References

One Reference

Seven References

Five References

 

Three References

33.

Twins and Hyperemesis Gravidarum.

Increased incidence of HG in twin pregnancies.

Increased incidence of NVP with twin pregnancies.

 

Four References

Four References

34.

Placental weight and NVP.

NVP not associated with placental weight.

There was a positive correlation for heavier placental weight and increased total hours of nausea.

 

Three References

Two References

35.

 

35a.

 

35b.

 

 

35c.

 

35d.

 

35e.

35f.

 

 

 

 

 

 

35g.

Fetal abnormality and Hyperemesis Gravidarum or NVP.

Fetal abnormalities associated with HG. No specific abnormalities mentioned.

Specific fetal abnormalities associated with HG.

One different abnormality from each of the seven references used.

Specific fetal abnormalities less likely to be associated with HG. (Only cardiac defect significant)

No increased incidence of fetal abnormality for mothers who have HG.

No increased incidence of fetal abnormality and NVP.

No significant association with freedom from nausea with fetal abnormality.

Conclusion:- 35 a-f

The spread of evidence in these papers suggests there is no positive correlation between NVP or HG and specific congenital abnormalities.

 

In all pregnancies there is a base line risk of 1-3% of the baby having a major congenital abnormality at birth.

 

 

 

Five References

 

Seven References 

 

 

Four References

 

Ten References

 

Five References

Two References

 

 

 

 

 

 

Eight References

36.

Stillbirth, Perinatal Mortality and NVP in current pregnancy.

No increased risk of stillbirth or perinatal mortality with NVP or HG.

Significantly reduced risk of stillbirth with HG.

No significant association for freedom from nausea and stillbirth.

Higher neonatal and perinatal mortality rates in the absence of nausea and vomiting.

 

 

Seven References

 

One Reference

One Reference

 

One Reference

37.

Development of an increased number of or more pronounced food cravings associated with NVP.

Five References

37a.

Food aversion in pregnancy associated with increased NVP.

Five References

38.

Effects of taking caffeine and NVP.

Increased caffeine intake increased NVP.

Increased caffeine intake, associated with lower risk of NVP.

 

Nine References

One Reference

39.

Factors which improve symptoms of NVP.

Eating (before nausea starts and when one feels hungry, even when nauseous).

Nausea improved after eating in 55% of women with NVP

Frequent small meals.

Nausea improved after eating small frequent meals in 61% of women with NVP

Getting more rest.

Lying down. Positional changes avoided.

Minimise odours.

Getting fresh air.

Let them have their cravings.

Nothing helps.

Ginger.

Medication.

 

Eleven References

 

Eight References

 

Eight References

Six References

 

Eight References

Five References

Four References

Five References

Three References

Four References

Two References

Two References

40.

 

 

 

 

 

 

 

Factors which make NVP worse.

Increased or altered olfactory sensation.

Examples:

Fatty or Cooking smells.

Drinking or the smell of tea or coffee.

Cigarette smoke.

Perfume.

Other Factors:

Positional changes.

Being hungry.

Fatigue.

Various foods, e.g. meat, fish, fatty or oily foods.

 

Seven References

 

Ten References

Six References

Four References

Four References

 

Five References

Four References

Two References

Three References

41.

 

Time lost from work due to NVP very significant.

Approximately 30% of women need to take time off work.

Ten References

Five References

42.

Adverse effects of severe NVP on quality of pregnant women’s lives.

Seventeen References

42a.

NVP assessed for treatment.

NVP needs treatment.

Preferably early treatment of NVP advisable.

NVP does not need treatment.

 

Thirteen References

Nine References

One Reference

 


 

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