Nausea, vomiting and poor appetite during pregnancy and adverse birth outcomes in rural Nepal: an observational cohort study

Amanda Regodón Wallin, James M Tielsch, Subarna K Khatry, Luke C Mullany, Janet A Englund, Helen Chu, Steven C LeClerq, Joanne Katz, Amanda Regodón Wallin, James M Tielsch, Subarna K Khatry, Luke C Mullany, Janet A Englund, Helen Chu, Steven C LeClerq, Joanne Katz

Abstract

Background: Nausea and vomiting are experienced by a majority of pregnant women worldwide. Previous studies have yielded conflicting results regarding their impact on birth outcomes and few studies have examined this relationship in settings with limited resources. We aimed to determine the effect of nausea, vomiting and poor appetite during pregnancy on birth outcomes in rural Nepal.

Methods: Observational cohort study using data collected in two randomized, community-based trials to assess the effect of influenza immunization during pregnancy on reproductive and respiratory outcomes among pregnant women and their offspring. Pregnant women in Sarlahi District, Nepal were recruited from 2011 to 2013. Exposure was defined as nausea, vomiting or poor appetite at any point during pregnancy and by trimester; symptoms were recorded monthly throughout pregnancy. Adverse outcomes were low birth weight (LBW), preterm birth and small for gestational age (SGA). Adjusted relative risks (aRR) with 95% CIs are reported from Poisson regressions with robust variance.

Results: Among 3,623 pregnant women, the cumulative incidence of nausea, vomiting or poor appetite was 49.5% (n = 1793) throughout pregnancy and 60.6% (n = 731) in the first trimester. Significantly higher aRRs of LBW and SGA were observed among women experiencing symptoms during pregnancy as compared to symptom free women (LBW: aRR 1.20; 95% CI 1.05 1.28; SGA: aRR 1.16; 95% CI 1.05 1.28). Symptoms in the first trimester were not significantly associated with any of the outcomes. In the second trimester, we observed significantly higher aRRs for LBW and SGA (LBW: aRR 1.17; 95% CI 1.01 1.36; SGA: aRR 1.16; 95% CI 1.05 1.29) and a significantly lower aRR for preterm birth (aRR 0.75; 95% CI 0.59 0.96). In the third trimester, we observed significantly higher aRRs for LBW and SGA (LBW: aRR 1.20; 95% CI 1.01 1.43; SGA: aRR 1.14; 95% CI 1.01 1.29).

Conclusions: Symptoms of nausea, vomiting or poor appetite during pregnancy are associated with LBW, SGA and preterm birth in a setting with limited resources, especially beyond the first trimester.

Trial registration: Prospectively registered at ClinicalTrials.gov on Dec 17, 2009 ( NCT01034254 ).

Keywords: Nausea and vomiting in pregnancy; Nepal; adverse birth outcomes; birthweight; low birth weight; pregnancy; preterm birth; small for gestational age.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart showing the criteria used to reach the final analytical data set. Illustration of how we reached the number of women and infants included in the study based on the initial data set, the final number of women-infant dyads and number of infants with available birth outcome data
Fig. 2
Fig. 2
Visit data and symptoms of nausea, vomiting or poor appetite by pregnancy month. Proportion of women with at least one visit in a given pregnancy month and the cumulative incidence of symptoms of nausea, vomiting or poor appetite at any point during the corresponding pregnancy month
Fig. 3
Fig. 3
Symptom combinations throughout pregnancy and by trimester. Cumulative incidence of all combinations of nausea, vomiting and poor appetite throughout all trimesters of pregnancy and separated by trimester

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Source: PubMed

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