Time of day for NVP
7. TIME OF DAY FOR NVP
7a. EXCLUSIVELY IN THE MORNING
1. 19% of sufferers complained of NVP confined to the morning (500 women in the survey). (27)
2. 17% of women with nausea reported the symptoms occurred exclusively in the morning. 10% reported that they never had symptoms in the morning. This survey disputes the concept of morning sickness. 1,000 women in the survey. (40)
3. 4% had symptoms only in the morning. 1% had symptoms only in the evening, 95% had symptoms before and after midday. The condition should be called ‘pregnancy sickness’ not ‘morning sickness’. 363 women in study. (50)
4. In a group of 80 women only 10% experienced predominantly morning sickness.
Barnie-Adshead 1978 (not published)
5. Although 80.2% of women reported nausea in the morning, nausea limited to morning only occurred in only 1.8% of affected women. These figures suggest that the term morning sickness is misleading and should be avoided when one is referring to nausea and vomiting during pregnancy. 160 women in study. (80)
6. The largest proportion of women had nausea throughout the day (68 women - 58%). Only 13 women (11%) had symptoms only in the morning. 46 women (39%) who participated had constant nausea. Number of women in study 117. (118)
Total number of women with only morning sickness - 304.
Total number of women in studies - 2220.
Percentage of women with morning only sickness - 13.6%.
7b. NVP BEFORE AND AFTER MIDDAY
1. 41% of patients experienced NVP before midday.
49% of patients experienced NVP after midday.
95% before and after midday.
363 women in study. (50)
2. The more usual pattern was for symptoms to persist throughout the day. Morning 80%, afternoon 45%, evening 55% and night 15%. 500 women in study. (27)
3. Although the early morning was the most common time for symptoms of NVP, 20% of
the subjects stated they were most likely to experience NVP in the evening. Another 20% stated they were nauseated the entire day. 78 patients. (23)
4. The maximum incidence of NVP was in the period up to 10:00 hours, with the next highest incidence between 10:00 and 13:00 hours. 56 patients. (17)
5. Of all the women who reported nausea, 57% (n = 477) said the symptoms occurred in the morning and at other times during the day. 1,000 women. (40)
6. 61% of women experienced NVP which recurred intermittently throughout the day. 80 women in study. Barnie-Adshead, 1978 (not published)
7. Nausea and vomiting during pregnancy lasted until the afternoon in 3.7%, until after suppertime in 4.7% and all day long in 80%. The 10 remaining women reported no morning nausea but had nausea at various other times during the day. 160 women in study. (80)
8. About 50% (92 patients) experienced the peak of nausea in the morning. (19)
9. NVP symptoms occur with equal probability throughout normal working hours; 40-45% of women experience nausea at least once each 4 hour period from 07:00 - 23:00.
Morning sickness is actually a complete misnomer. (86) 5432 women in study
10. In the present sample if NVP were present, it lasted all day, and for some also all night. Morning sickness is an inappropriate name for NVP. 27 women in study. (103)
11. Percentage of hours in the day in which nausea was experienced during a seven day period:-
7am - 10am 43.2%
11am - 2pm 42.0%
3pm - 6pm 43.9%
7pm - 10pm 40.3%
11pm - 2am 8.3%
3am - 6am 4.9% 19 women in study. (98)
Nausea was not significantly more prevalent in the morning hours compared to other times during the waking hours, 7am - 10pm. (98)
12. NVP occurred at the following times during the day:-
Morning for 29.4% of women.
Later in the day 10.8%.
All day long 24.3%.
Varied times throughout the day 35.1%.
55 women in study. (102)
13. Occurrence of nausea during 24 hour period:-
On rising 21.4%.
Morning and/or evening 28.5%.
Intermittently during the day 31.0%.
At night 7.1%. (112) 42 women in this study
NVP most commonly occurs before and after midday.
(50) (27) (23) (17) (40) (Barnie-Adshead) (80) (19) (86) (103) (98) (102) (112)
Pooled population in 13 studies 7904 women.
7c. AUTHORS STATE NVP SHOULD NOT BE CALLED MORNING SICKNESS
1. The traditional label of morning sickness does not hold true for this study. Less than 20% of sufferers with NVP complained of symptoms only in the morning. (27) 500 women
2. In this study only 4% of women had only morning sickness. The episodic nature of pregnancy nausea and vomiting is rarely described. Perhaps a more appropriate description of the condition would be episodic daytime pregnancy sickness. (50) 363 women
3. An analysis of the time of day at which women felt nauseated or vomited clearly shows
that the term morning sickness is a misnomer. (40) 1000 women
4. Only 10% of patients had predominantly morning sickness, whereas 61% of patients experienced nausea and vomiting recurring throughout the day. The condition is better described as pregnancy sickness. 80 patients in the study.
(Barnie-Adshead 1978 not published).
5. Nausea and vomiting during pregnancy lasted all day in 80% of women. These figures suggest that the term morning sickness is misleading and should be avoided when one is referring to nausea and vomiting during pregnancy. (80) 160 women
6. NVP symptoms occur with equal probability throughout normal working hours. 40-45%
of women experience nausea at least once each four hour period from 07.00 - 23.00 hours. Morning sickness is actually a complete misnomer. (86) 5432 women
7. Continued references to nausea and vomiting of pregnancy as morning sickness may be confusing for women pregnant for the first time, and experiencing the symptoms at other times of the day. The results of this study support findings of previous investigators, who noted that morning sickness is too narrow a descriptive term for the experiences of nausea and vomiting of pregnancy. (98) 19 women
8. In the present sample, if nausea and vomiting were present, it lasted all day and for some also all night. Morning sickness is not an appropriate name for nausea and vomiting of pregnancy. (103) 27 women
Pregnancy nausea and vomiting should not be called morning sickness.
(50) (27) (40) (Barnie-Adshead - not published) (80) (86) (98) (103)
Pooled population in 8 studies 7581 women
Summaries for 7a, 7b and 7c stated together to show that morning sickness is the wrong name for the condition of pregnancy sickness
7a. NVP occurring exclusively in the morning. Only 13.6% of women.
(27) (40) (50) (Barnie-Adshead) (80) (118) Average of Five References
7b. NVP most commonly occurs before and after midday.
(17) (19) (23) (27) (40) (50) (Barnie-Adshead - not published) (80) (98) (102) (103) (86) (112) Total: Thirteen References
7c. Pregnancy nausea and vomiting should not be called morning sickness.
(27) (40) (50) (Barnie-Adshead - not published) (80) (86) (98) (103)
Total: Eight References
7d. TIME OF DAY FOR VOMITING IN NVP
1. 31% of women vomited in the morning. 41% vomited at other times during the day. 1,000 women; 206 vomited. (40)
2. 53% of episodes of vomiting occurred between 6am and 12 noon.
46% of episodes of vomiting occurred after midday.
363 women in study, 190 vomited. (50)
Total number of women who vomited, 396. Number of women who vomit before midday, 166. Vomiting occurred in 42.6% before midday, 57% after mid-day.
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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