A woman's quality of life can be adversely affected by nausea and vomiting in pregnancy and hyperemesis gravidarum and healthcare professionals should address the severity of their symptoms and impact on their mental health, outlines new guidance published today at the Royal College of Obstetricians and Gynaecologists World Congress in Birmingham.
Nausea and vomiting in pregnancy, commonly known as 'morning sickness' but can actually occur at any time of day and night, affects up to 80% of pregnant women and is one of the most common reasons for pregnant women being admitted to hospital. Clinically it is defined as the symptom of nausea and/or vomiting during early pregnancy where there are no other causes.
A severe form of nausea and vomiting in pregnancy is hyperemesis gravidarum. This is much rarer and affects around 1 to 3% of pregnant women. It is characterised by severe, protracted nausea and vomiting associated with weight loss of more than 5% of pre-pregnancy weight, fluid loss or dehydration.
For most women, their symptoms of nausea and vomiting in pregnancy or hyperemesis gravidarum improve or disappear by around week 14, although for some women it can last longer.
This new Green-top Guideline, the first national guideline to cover this, looks at the management of nausea and vomiting of pregnancy and hyperemesis gravidarum and provides healthcare professionals with guidance on diagnosis, monitoring severity, treatment, effects of condition, particularly on mental health and follow up care.
Treatment options for women include the use of antiemetics, specific drugs used to treat nausea and vomiting in pregnancy and hyperemesis gravidarum. The evidence gathered, including a Cochrane review, have reported on the safety and efficacy of many drugs used for treating these conditions.
The use of complementary therapies are also discussed in the guidance, including analysis of the usefulness of ginger, acupressure and hypnotherapy.
The new guidance addresses the effect nausea and vomiting in pregnancy and hyperemesis gravidarum can have on quality of life and states that clinicians should consider the effect on a woman's mental health during pregnancy and postnatally and refer her for psychological support if needed, such as counselling.
Women with hyperemesis gravidarum have been found to be three to six times more likely to have low quality of life compared to women with the more common nausea and vomiting in pregnancy. Furthermore, numerous studies have shown a link between depression and poor psychological health in women with nausea and vomiting in pregnancy and hyperemesis gravidarum.
Dr Manjeet Shehmar, Consultant Obstetrician and Gynaecologist and lead author of the guideline, said:
"Women suffering from nausea and vomiting and hyperemesis gravidarum can face a challenging time in early pregnancy. The more severe the condition, the more it can affect their day-to-day quality of life and mental health.
"Women with persistent nausea can often feel that there is a lack of understanding of their condition, they may be unable to eat healthily, have to take time off work and feel a sense of grief for loss for what they perceive to be a normal pregnancy.
"It is therefore vital that women with this condition are given the right information and support and are made aware of the therapeutic and alternative therapies available to help them cope. Women should be encouraged to rest as much as they can as this has been shown to relieve symptoms."
Professor Alan Cameron, RCOG Vice President, Clinical Quality, added:
"This is the first edition of this guideline on this important topic, which affects many women at a crucial time in their lives.
"Women suffering severely may need input from a multi-disciplinary team including midwives, nurses, dieticians and a mental health team. This will ensure they receive the best possible care and support."
Caitlin Dean, 33, from Cornwall, has had hyperemesis gravidarum in three pregnancies. She is now Chair and Trustee for the charity Pregnancy Sickness Support. She describes how the condition affected her:
"When I first found out I was pregnant I was really excited. Six weeks into my first pregnancy I felt sick for the first time. It was early in the morning and I remember feeling happy as I knew this was a good sign and I felt reassured that the baby was healthy and growing. However, I was sick again and this continued all day and the following day. I couldn't make it into work and I had been sick constantly for 48 hours. I couldn't move without being sick. I couldn't keep even a sip of water down. It felt like I had been poisoned.
"On top of the nausea and vomiting (this could be up to 30 times a day), I had a pounding headache, incredibly heightened sense of smell and excessive saliva. My days would be spent lying in bed with a quiet audio book as I couldn't read or watch TV because it all made me sick.
"I soon became very dehydrated and was admitted to hospital at eight weeks pregnant. I was housebound for most of the pregnancy which made me feel incredibly lonely."