Nausea and Vomiting of Pregnancy

Nausea and Vomiting of Pregnancy

NVP is the most common medical condition of pregnancy, affecting up to 80% of all pregnant women1-3 For the UK, this could be as many as 751,923 women4

Women with NVP typically experience symptoms early on:

  • For most women NVP starts between 4-7 weeks of pregnancy3,5,6
  • Although Nausea and Vomiting of Pregnancy usually resolves spontaneously for most women, 20% of women continue to experience nausea, vomiting and retching beyond 20 weeks gestation1,6

When conservative management fails:

  • Whilst many women with NVP can cope with conservative management, one third of women are prescribed an off license medication for this condition.7
  • NVP can have serious adverse effects on quality of life for pregnant women and their families2,8-10 with a peak of 87% of NVP sufferers experiencing nausea more than 5 times or constantly throughout the day.8
  • 41% of women rate their NVP as either moderate or severe, which indicates a serious health burden11
  • Up to 55% of pregnant women have daily episodes of vomiting and the average duration of NVP in the average sufferer is 6 weeks12
  • Severe NVP is associated with severe dehydration, malnutrition and electrolyte imbalances.3,13,14
  • The most severe form of NVP is known as hyperemesis gravidarum (HG) and affects up to 3.6% of pregnant women.3,15
  • In women who have had severe NVP or HG in a prior pregnancy, failing to treat the early stages of NVP increases the risk of subsequent hospitalisation.3,16-18
  • 78.9% of women with HG in a prior pregnancy felt that better access to anti-emetics earlier in their second pregnancy reduced their need for admission.19
  • The severity of NVP can range from mild to severe11
  • 41% of women rate their NVP as either moderate or severe, which indicates a serious health burden11

NVP classification:11

Experience of NVP was assessed at the 11 week interview and graded as none, mild (nausea only), moderate (sometimes sick), or severe (regularly sick, cannot retain meals); women with hyperemesis were included within the “severe” category.

In this study, 11% experienced no NVP11

References:

  1. Einarson A, Maltepe C, Boskovic R, Koren G. Treatment of nausea and vomiting in pregnancy. An updated algorithm. Can Fam Phys 2007; 53: 2109-2111.
  2. Association of Professors of Gynecology and Obstetrics. Nausea and Vomiting of Pregnancy. Continuing series on Women’s Health Education. 2011; Jespersen & Associates, LLC, Boston, Massachusetts.
  3. Royal College of Obstetricians and Gynaecologists. The management of nausea and vomiting of pregnancy and hyperemesis gravidarum (Greentop Guideline No. 69). 22 June 2016. Royal College of Obstetricians and Gynaecologists: London. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg69/.
  4. Office for National Statistics. 2016. Statistical bulletin, 27 March 2018.
  5. Piwko C, Ungar WJ, Einarson TR, et al. The weekly cost of nausea and vomiting of pregnancy for women calling the Toronto Motherisk Program. Current Medical Research and Opinion 2007; 23: 833–40.
  6. Clark SM, Costantine MM, Hankins GD. Review of NVP and HG and early pharmacotherapeutic intervention. Obstet Gynecol Int. 2012;252676(10):24.
  7. Gadsby R et al. Nausea and vomiting of pregnancy and resource implications: The NVP Impact Study. Br J Gen Pract. 2018. Manuscript submitted for publication.
  8. Mazzotta R, Stewart D, Atanackovic G, et al. Psychosocial morbidity among women with nausea and vomiting of pregnancy: prevalence and association with antiemetic therapy. J PsychosomObstet Gynecol 2000;21:129-136.
  9. O’Brien B et al. Nausea and vomiting during pregnancy: effects on the quality of women’s lives. Birth 1992; 19:138-143.
  10. Vellacott ID et al. Nausea and vomiting in early pregnancy. Int J Gynecol Obstet. 1988;27:57-62.
  11. Crozier SR, Inskip HM, Godfrey K. Nausea and vomiting in early pregnancy: Effects on food intake and diet quality. Matern Child Nutr. 2017;13:e12389.
  12. Gadsby R et al. A prospective study of nausea and vomiting during pregnancy. Brit J Gen Pract. 1993:43:245–8.
  13. Mitchell-Jones N, et al. Ambulatory versus inpatient management of severe nausea and vomiting of pregnancy: a randomised control trial with patient preference arm. BMJ Open 2017;7:e017566. doi:10.1136/bmjopen-2017-017566.
  14. Stokke G, Gjelsvik BL, Flaatten KT, Birkeland E, Flaatten H, Trovik J. Hyperemesis gravidarum, nutritional treatment by nasogastric tube feeding: a 10-
    year retrospective cohort study. Acta Obstet Gynecol Scand. 2015;94:359–67
  15. Madjunkova S et al. Pediatr Drugs 2014; 16: 199-211.
  16. Maltepe C et al. The management of nausea and vomiting of pregnancy and hyperemesis gravidarum – a 2013 update. J Popul Ther Clin Pharmacol. 2013;20:184-192.
  17. Neutel CI. Variation in rates of hospitalisation for excessive vomiting in pregnancy by Bendectin/Diclectin use in Canada. Nausea and Vomiting of Pregnancy: State of the Art 2000. 54-59.
  18. Koren G et al. Pre-emptive therapy for severe nausea and vomiting of pregnancy and hyperemesis gravidarum. J Obstet Gynaecol. 2004 Aug;24(5):530-533.
  19. O’Hara ME. Experience of hyperemesis gravidarum in a subsequent pregnancy. MIDIRS Midwifery Digest 2017;27(3):309-318 O’Hara ME. Experience of hyperemesis gravidarum in a subsequent pregnancy. MIDIRS Midwifery Digest 2017;27(3):309-318.