Understanding and Treating Nausea and Vomiting of Pregnancy
Nausea and vomiting of pregnancy: An obstetric syndrome

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Abstract

Although the cause of nausea and vomiting of pregnancy is not known, there is strong evidence linking human chorionic gonadoptropin or estrogens. Evidence is presented to show that the incidence and severity of nausea and vomiting of pregnancy is linked to temporal and pathologic alterations in these hormones during pregnancy. The way in which the pregnant woman responds to the primary stimulus to nausea and vomiting of pregnancy appears to depend on her susceptibility mediated by vestibular, gastrointestinal, olfactory, and behavioral pathways. Conceiving of nausea and vomiting of pregnancy as a syndrome suggests new pathways of investigation and possible therapies. (Am J Obstet Gynecol 2002;186:S184-9.)

Section snippets

A new model for nausea and vomiting during pregnancy

Nausea and vomiting of pregnancy is a syndrome caused by the complex interaction of genetic and environmental factors beginning during a unique period of time: organogenesis. The fundamental trigger, a product of the placenta, may be modified in intensity by genetic variation or specific disease states to produce more or less severe nausea and vomiting of pregnancy. The way in which the maternal organism initially responds to the fundamental trigger arising from the placenta is modified at 2

The vestibular system

Chronic nausea and vomiting in the adult, nonpregnant population is largely attributable to disease of the neurovestibular system and the gastrointestinal tract. Diseases of the vestibular system that result in chronic nausea and vomiting are best exemplified by Menniere's disease and idiopathic vertigo. Apart from discrete pathologic states, there is a spectrum of susceptibility to vestibular-mediated sickness or other dysfunction in the population. For example, about half of otherwise

The gastrointestinal tract

Gastroparesis and unexplained nausea and vomiting are examples of diseases of the gastrointestinal tract that are associated with chronic nausea and vomiting. The cardinal abnormality in these conditions is gastric dysrhythmia detected on the electrogastrogram.43, 44 These slow-wave disturbances precede nausea45 and resolve with treatments that reduce nausea.46 Similar to what is seen with the vestibular system, patients who are apparently symptom free who are nevertheless prone to gastric

Taste and olfaction

One of the most common observations of clinicians caring for women with nausea and vomiting of pregnancy is that they often develop aversions to certain smells and tastes. Spatial taste patterns and taste acuity were studied in 60 women (21 “high-vomit” and 39 “low-vomit” based on their obstetric histories). Women in the high-vomit group were less likely to be nontasters and more likely to have increased perception of bitterness on the posterior tongue.52 The ability to taste the bitterness of

Behavioral aspects of nausea and vomiting of pregnancy

Chronic and recurrent nausea and vomiting after cancer chemotherapy may be due to the direct effect of the medication, but it is increasingly recognized that a behavioral-mediated, so-called anticipatory nausea and vomiting contributes to this problem.59 It is unknown to what extent anticipatory nausea and vomiting contributes to nausea and vomiting of pregnancy. Nausea and vomiting of pregnancy and chemotherapy-induced nausea and vomiting are virtually the only examples of chronic nausea

New conceptual framework

A new conceptual framework for nausea and vomiting of pregnancy, on the basis of the discussion above, is summarized in Fig 1.

. Nausea and vomiting of pregnancy as a syndrome. TSHr, Thyrotropin receptor; LHr, luteinizing hormone receptor; NV, nausea and vomiting; OCP, estrogen-containing oral contraceptive.

At present, all patients with nausea and vomiting of pregnancy are treated as if the condition were a single entity. This may account for much of the frustration in the management of nausea

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