Obstetrics & Gynaecology Search
Obstetrics & Gynaecology Obstetrics & Gynaecology
nausea%20-and-%20vomiting%20in%20pregnancy
NAUSEA & VOMITING IN PREGNANCY
Nausea & vomiting in pregnancy (NVP), commonly known as "morning sickness", affects 50-90% of pregnant women.
In most women, the condition manifests between the 4th-7th week after last menstrual period and resolves by the 16th week of gestation.
It manifests in a spectrum of severity from mild nausea to very rare life-threatening symptoms.
The etiology is multifactorial.
The pregnant woman's sense of well-being and her daily activities are greatly affected by nausea and vomiting; the physical and emotional impact often leads to anxiety and worry about the effect of the symptoms on the fetus and reduced job efficiency.

Introduction

  • Nausea and vomiting in pregnancy (NVP), commonly known as “morning sickness”, affects 50-90% of pregnant women
  • In most women (60%), the condition manifests between the 4th-7th week after the last menstrual period and resolves by the 16th-20th week of gestation
    • About 9% of women have symptoms that last after the 16th week 

Definition

Hyperemesis Gravidarum

  • The most severe form of nausea and vomiting in pregnancy (NVP) affecting 0.3%-2% of all pregnant women
  • Persistent vomiting (>3x daily) may lead to dehydration and electrolyte disturbances, ketosis, acetone in the blood, and weight loss >5% of prepregnancy weight
  • In severe cases, liver function tests (LFTs) may be deranged, urinalysis may show ketonuria, and imbalance is noted on serum creatinine and electrolyte measurements

Etiology

  • Etiology is multifactorial
    • Other possible causes include genetic, vestibulo-ocular reflex abnormality, H pylori infection, psychological,hormonal [progesterone, estrogen, human chorionic gonadotropin (hCG), thyroxin, ghrelin, leptin, nesfatin-1, PYY-3]

Signs and Symptoms

  • Symptoms can occur at any time of the day; therefore, the term “morning sickness” is incorrect
    • 95% of patients have symptoms before and after midday and 4% experience symptoms only in the morning
  • Nausea and vomiting in pregnancy (NVP) manifests in a spectrum of severity from mild nausea to very rare life-threatening symptoms
    • Generally a mild, self-limited condition that may be controlled with conservative treatment
    • Only a small percentage of patients have a profound course

Risk Factors

Maternal factors and fetal conditions associated with increased risk of hyperemesis gravidarum:

  • Nulliparity
  • Obesity
  • Young maternal age
  • Increased placental mass (multiple gestation, gestational trophoblastic disease)
  • Triploidy
  • Fetal down syndrome
  • Hydrops fetalis

Other predisposing factors for nausea and vomiting in pregnancy (NVP):

  • Family history or a history of hyperemesis gravidarum in previous pregnancy
  • Increased levels of human chorionic gonadotropin (hCG) and estrogen
  • Medical conditions like migraine and history of motion sickness
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS JPOG - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Gangliosides and cognition: An appraisal of the evidence
01 Sep 2018

Gangliosides and docosahexaenoic acid (DHA) play critical roles in early childhood brain development. 
Gestational diabetes associated with CVD later in life
30 Nov 2017
Gestational diabetes was positively associated with cardiovascular disease (CVD) later in life, according to a new study. Adhering to a healthy lifestyle may, however, offset this risk.