Rates of nausea and vomiting in pregnancy and dietary characteristics across populations

Abstract

Nausea and vomiting in pregnancy (NVP) is a pervasive and debilitating phenomenon in humans. Several adaptive explanations for NVP occurrence have been recently proposed, the two most prominent of which predict associations with nutritional intake or specific dietary components. Here we extend previous crosscultural analyses by analysing associations between NVP prevalence in 56 studies (21 countries) and quantitative estimates of per capita intake across major dietary categories, measured for the year of study by the Food and Agriculture Organisation (FAO). Rates of nausea and vomiting in pregnancy were correlated with high intake of macronutrients (kilocalories, protein, fat, carbohydrate), as well as sugars, stimulants, meat, milk and eggs, and with low intake of cereals and pulses. Restricting analyses to studies from North America and Europe caused relationships between macronutrient intake and NVP to disappear, suggesting that they might be influenced by non-dietary confounds associated with geographical region of study. However, factor analysis of dietary components revealed one factor significantly associated with NVP rate, which was characterized by low cereal consumption and high intake of sugars, oilcrops, alcohol and meat. The results provide further evidence for an association between diet and NVP prevalence across populations, and support for the idea that NVP serves an adaptive prophylactic function against potentially harmful foodstuffs.

Nausea and vomiting in early pregnancy: Effects on food intake and diet quality

“…Three previous studies examined the effects of NVP on food intake using cross‐sectional data, two in Scandinavia (Latva‐Pukkila et al, 2010; Chortatos et al, 2013) and one ecological study based on international data (Pepper & Craig Roberts, 2006). There is little consistency in the findings.…”

“…It has been suggested that NVP confers functional advantages by preventing intake of substances that may be harmful to the mother or fetus (Flaxman & Sherman, 2000; Pepper & Craig Roberts, 2006) (the maternal and embryo protection hypothesis), or by decreasing nutrient intake thereby stimulating placental growth (Huxley, 2000) (the placental growth and development hypothesis). This latter hypothesis is based on the assumption of a reduction in appetite and overall energy intake resulting from NVP which may be supported by the current study in which severely nauseous women reduced their energy intake.…”

“…In a recent Norwegian study (Chortatos et al, 2013), women with NVP had slightly higher intakes of fruit and vegetables and more noticeably higher intakes of sugar‐containing soft drinks than other pregnant women. In a smaller Finnish study (Latva‐Pukkila, Isolauri, & Laitinen, 2010) women with NVP ate less meat and somewhat fewer vegetables than other pregnant women, whereas an ecological study across 21 countries (Pepper & Craig Roberts, 2006) suggested that high rates of NVP are associated with high intakes of meat, milk and eggs, and low intakes of cereals and pulses. Some of the inconsistencies in findings may be due to the use of cross‐sectional data, and reporting differences among women whose diets have changed in early pregnancy.…”

Nutritional models of the developmental programming of adult health and disease

“…Importantly, adaptations of this type appear not only to be dependent on the period in which the mother's diet is altered but also the diet to which she is rehabilitated (7) . One fundamental consideration is that the self-limitation in food intake between early-to-mid gestation that occurs commonly as a result of the nausea affecting approximately 90% of pregnant women in the UK may be directly linked to Western diets (8) . The extent to which this factor relates to changes in placental function and/or fetal growth remains less clear, but there is a need to match global preand postnatal nutritional requirements in order to avoid accelerated growth and the concomitant increased risk of later obesity and metabolic complications (9) .…”

Dietary changes during first trimester pregnancy for women with nausea and vomiting in the Norwegian Mother and Child Cohort Study

“…In the present study we found that carbohydrate-rich foods such as breads and cereals, sugared soft-drinks, and biscuits were foods the NVP women had high odds of eating more of. That women suffering from NVP increase their intake of bread, biscuits, and sweet sugar-containing foods during pregnancy, as well as total carbohydrates, has been * Number (%) of women with outcome ** Adjusted for total energy intake observed by others (2,5,12,18). Elsewhere it has been found that a diet high in carbohydrates may aggravate gastric dysrhythmias when compared to high protein diets, which can lead to nausea, suggesting that women suffering NVP may potentially be exasperating their condition by virtue of their dietary choices (19).…”