Nausea in pregnancy is very common but it is astonishing that so little data are available concerning the cause and course of this disorder. A questionnaire was mailed to all women who had given birth to at least 3 children, the last delivered in 1980 or 1981 in our department. 244 (75%) responded, mean age 33 years, range 23–45. A total of 948 pregnancies resulted in 855 children, 56 spontaneous and 25 legal abortions, 8 twins and 4 ectopics. 70% of all pregnancies were associated with nausea and 52% of the patients always experienced nausea during their pregnancies, while 17% never and 31 % only occasionally felt sick. For 91 % of the cases, the onset of nausea was during the first 3 months. There was no difference concerning intensity, ‘peak nausea’ or onset, whereas duration decreased with subsequent pregnancies. 7 of 8 women with twin pregnancies complained of nausea, contrasting to 50% with spontaneous and 80% with legal abortions. Age, smoking or ‘pregnancy complications’ did not correlate with nausea. There were, however, correlations (p < 0.05) between nausea and gallbladder disease, gastritis and allergy. All patients with gallbladder disease had nausea and so had 90% of those with allergy and gastritis. There was also a strong correlation (p < 0.001) between nausea in pregnancy and ‘intolerance’ of oral contraceptives, as 98% of these women experienced nausea. The data obtained do not support a correlation between HCG and emesis gravidarum, but rather suggest an association with steroidal hormones and liver function.
Although nausea and vomiting in early pregnancy is extremely common, very little information on the cause and course of this disorder is available in the literature. A prospective laboratory and clinical study of 102 consecutive healthy pregnant women was undertaken to evaluate nausea and vomiting in relation to clinical data, serum electrolytes, creatinine, total protein and hemoglobin. Multigravidae suffered from emesis gravidarum at a higher rate than did primigravidae. The frequency of emesis was especially high in women with short intergestational intervals. During pregnancy there was a decline in systolic blood pressure only in non-emetic women. The diastolic blood pressure in late pregnancy was significantly higher in emetic women than in non-emetic subjects. All laboratory values were within normal ranges. However, major changes occurred during pregnancy but some alterations were noted only in the emetic pregnancy. A different response to the hormonal situation is suggested to explain the dissimilarities between the emetic and non-emetic pregnancy.
The gallbladder volume is increased in pregnancy, and its contraction during a meal is impaired. This is of importance for the increased risk of gallstones in pregnancy, since it may cause retention of cholesterol crystals in the gallbladder lumen. Cholecystokinin (CCK) is responsible for the food-induced gallbladder contraction. We have consequently measured the plasma concentrations of CCK in the fasting and the stimulated state in pregnant women and in age-matched non-pregnant controls. In a subset of pregnant women and controls the gallbladder volume was measured with ultrasound. The results show that whereas basal CCK concentrations were normal, the response to an oral preparation that contracts the gallbladder was increased in pregnancy. Moreover, the secretion of CCK correlated well with gallbladder emptying. We conclude that the behaviour of the gallbladder in pregnancy is not due to impaired secretion of CCK.
Nausea and/or vomiting in pregnancy (emesis gravidarum) is a very common event. The specific etiology of this disorder is still unknown. In this study we examined serum lipid and lipoprotein concentrations in 98 healthy pregnant women in early and late pregnancy. Sixty of these women complained of emesis gravidarum. Compared to non-pregnant controls the pregnancy values of serum cholesterol, triglycerides and phospholipids were elevated in all subjects due to an increase in all lipoprotein classes. In addition, low-density lipoproteins (LDL) and high-density lipoproteins (HDL) were enriched in triglycerides relative to other components. Differences in serum lipids and lipoproteins between the emetic and non-emetic subjects were found. The lipid contents of LDL and HDL were significantly higher and lower, respectively, in the emetic women in early pregnancy. During late pregnancy the total lipid content in all fractions was higher in previously emetic subjects. Thus, a metabolic difference between the groups persisted throughout pregnancy. It is suggested that an altered influence of estrogen on the liver might be responsible for these dissimilarities.
The etiology of nausea and vomiting in pregnancy is still unknown. One possibility is that ovarian and placental hormones may play some part. The liver is the major site of metabolic inactivation of steroid hormones. In this study, 102 healthy pregnant women, of whom 62 complained of nausea, were followed throughout pregnancy. Liver function tests were performed to ascertain whether emesis gravidarum is related to impaired hepatic function. In this series, all values were within the normal ranges. Serum levels of total bilirubin and gamma-glutamyl-transferase were significantly decreased and those of total serum bile acids significantly increased in emetic women compared to nonemetic subjects. Furthermore, the metabolic load on the liver seems to follow a biphasic course as there is an apparent minimum in liver function variables in the second trimester. It is concluded that a slow adaptation to the increased hormonal load on the liver might be responsible for the condition of emesis gravidarum.
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