Maternal and Child Health Journal

, Volume 15, Issue 1, pp 122–127 | Cite as

Maternal Influences on Nausea and Vomiting in Early Pregnancy

  • Ronna L. Chan
  • Andrew F. Olshan
  • David A. Savitz
  • Amy H. Herring
  • Julie L. Daniels
  • Herbert B. Peterson
  • Sandra L. Martin


Symptoms of nausea and vomiting in early pregnancy (NVP) are common among pregnant women, but whether some women are more likely than others to experience these symptoms has not been well established. We examined potential risk factors for NVP symptom severity, timing of onset, and duration. We included 2,407 newly pregnant women who participated in a prospective cohort study on early pregnancy health between 2000 and 2004 in three U.S. cities. Data on NVP and other health information were collected through telephone interviews, early gestation ultrasound, and medical record abstractions. Generalized linear models were used to model possible risk factors for each NVP characteristic. Eighty-nine percent of women had NVP; for 99% of these, symptoms started in the first trimester. None of the characteristics examined were associated with having NVP. Among those with NVP, increasing risk of delayed symptoms onset was associated with advancing maternal age; increased risks were also seen among non-Hispanic Black [Risk ratio (RR) = 4.3, 95% confidence interval (CI): 1.6,11.6] and Hispanic women (RR = 2.3, 95% CI:0.4,11.5). NVP symptoms for multigravidae were more likely to last beyond the first trimester with each additional pregnancy. Most pregnant women experienced NVP. Nearly all of them, regardless of characteristics examined, had symptoms beginning in the first trimester. Maternal age, race/ethnicity, and gravidity were associated with delayed onset and symptoms that persisted into the second trimester.


Gravidity Maternal nausea and vomiting Pregnancy 


  1. 1.
    Jarnfelt-Samsioe, A. (1987). Nausea and vomiting in pregnancy: A review. Obstetrical and Gynecological Survey, 42, 422–427.CrossRefPubMedGoogle Scholar
  2. 2.
    Huxley, R. R. (2000). Nausea and vomiting in early pregnancy: Its role in placental development. Obstetrics and Gynecology, 95, 779–782.CrossRefPubMedGoogle Scholar
  3. 3.
    Gadsby, R., Barnie-Adshead, A. M., & Jagger, C. (1993). A prospective study of nausea and vomiting during pregnancy. The British Journal of General Practice: The Journal of the Royal College of General Practioners, 43, 245–248.Google Scholar
  4. 4.
    Lacroix, R., Eason, E., & Melzack, R. (2000). Nausea and vomiting during pregnancy: A prospective study of its frequency, intensity, and patterns of change. American Journal of Obstetrics and Gynecology, 182, 931–937.CrossRefPubMedGoogle Scholar
  5. 5.
    Weigel, M. M., & Weigel, R. M. (1989). Nausea and vomiting of early pregnancy and pregnancy outcome. An epidemiological study. British Journal of Obstetrics and Gynaecology, 96, 1304–1311.CrossRefPubMedGoogle Scholar
  6. 6.
    Tierson, F. D., Olsen, C. L., & Hook, E. B. (1986). Nausea and vomiting of pregnancy and association with pregnancy outcome. American Journal of Obstetrics and Gynecology, 155, 1017–1022.PubMedGoogle Scholar
  7. 7.
    Linseth, G., & Vari, P. (2005). Nausea and vomiting in late pregnancy. Health Care for Women International, 26, 372–386.CrossRefPubMedGoogle Scholar
  8. 8.
    Broussard, C. N., & Richter, J. E. (1998). Nausea and vomiting of pregnancy. Gastroenterology Clinics of North America, 27, 123–151.CrossRefPubMedGoogle Scholar
  9. 9.
    Coad, J., Al-Rasasi, B., & Morgan, J. (2002). Nutrient insult in early pregnancy. The Proceedings of the Nutrition Society, 61, 51–59.CrossRefPubMedGoogle Scholar
  10. 10.
    Gazmararian, J. A., Petersen, R., Jamieson, D. J., et al. (2002). Hospitalizations during pregnancy among managed care enrollees. Obstetrics and Gynecology, 100, 94–100.CrossRefPubMedGoogle Scholar
  11. 11.
    Mori, M., Amino, N., Tamaki, H., Miyai, K., & Tanizawa, O. (1988). Morning sickness and thyroid function in normal pregnancy. Obstetrics and Gynecology, 72, 355–359.PubMedGoogle Scholar
  12. 12.
    Cunningham, F. G., Leveno, K. J., Bloom, S. L., Hauth, J. C., Gilstrap, L., & Wenstrom, K. D. (2005). Williams Obstetrics: McGraw-Hill Medical Publishing Division.Google Scholar
  13. 13.
    Lagiou, P., Tamimi, R., Mucci, L. A., Trichopoulos, D., Adami, H. O., & Hsieh, C. C. (2003). Nausea and vomiting in pregnancy in relation to prolactin, estrogens, and progesterone: A prospective study. Obstetrics and Gynecology, 101, 639–644.CrossRefPubMedGoogle Scholar
  14. 14.
    Zhang, J., & Cai, W. W. (1991). Severe vomiting during pregnancy: Antenatal correlates and fetal outcomes. Epidemiology, 2, 454–457.CrossRefPubMedGoogle Scholar
  15. 15.
    Kallen, B., Lundberg, G., & Aberg, A. (2003). Relationship between vitamin use, smoking, and nausea and vomiting of pregnancy. Acta Obstetricia et Gynecologica Scandinavica, 82, 916–920.PubMedGoogle Scholar
  16. 16.
    Davis, M. (2004). Nausea and vomiting of pregnancy: An evidence-based review. Journal of Perinatal & Neonatal Nursing, 18, 312–328.Google Scholar
  17. 17.
    Louik, C., Hernandez-Diaz, S., Werler, M. M., & Mitchell, A. A. (2006). Nausea and vomiting in pregnancy: Maternal characteristics and risk factors. Paediatric and Perinatal Epidemiology, 20, 270–278.CrossRefPubMedGoogle Scholar
  18. 18.
    O’Brien, B., & Zhou, Q. (1995). Variables related to nausea and vomiting during pregnancy. Birth, 22, 93–100.CrossRefPubMedGoogle Scholar
  19. 19.
    Basso, O., & Olsen, J. (2001). Sex ratio and twinning in women with hyperemesis or pre-eclampsia. Epidemiology, 12, 747–749.CrossRefPubMedGoogle Scholar
  20. 20.
    Grun, J. P., Meuris, S., De Nayer, P., & Glinoer, D. (1997). The thyrotrophic role of human chorionic gonadotrophin (hCG) in the early stages of twin (versus single) pregnancies. Clinical Endocrinology (Oxf), 46, 719–725.CrossRefGoogle Scholar
  21. 21.
    Sayle, A. E., Wilcox, A. J., Weinberg, C. R., & Baird, D. D. (2002). A prospective study of the onset of symptoms of pregnancy. Journal of Clinical Epidemiology, 55, 676–680.CrossRefPubMedGoogle Scholar
  22. 22.
    Promislow, J. H., Makarushka, C. M., Gorman, J. R., Howards, P. P., Savitz, D. A., & Hartmann, K. E. (2004). Recruitment for a community-based study of early pregnancy: The Right From The Start study. Paediatric and Perinatal Epidemiology, 18, 143–152.CrossRefPubMedGoogle Scholar
  23. 23.
    Savitz, D. A., Singer, P. C., Hartmann, K. E., et al. (2005). Drinking water disinfection by-products and pregnancy outcome. Awwa Research Foundation.Google Scholar
  24. 24.
    Savitz, D. A., Singer, P. C., Herring, A. H., Hartmann, K. E., Weinberg, H. S., & Makarushka, C. (2006). Exposure to drinking water disinfection by-products and pregnancy loss. American Journal of Epidemiology, 164, 1043–1051.CrossRefPubMedGoogle Scholar
  25. 25.
    Zhang, J., & Yu, K. F. (1998). What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA, 280, 1690–1691.CrossRefPubMedGoogle Scholar
  26. 26.
    Zou, G. (2004). A modified poisson regression approach to prospective studies with binary data. American Journal of Epidemiology, 159, 702–706.CrossRefPubMedGoogle Scholar
  27. 27.
    Weigel, M. M., Reyes, M., Caiza, M. E., et al. (2006). Is the nausea and vomiting of early pregnancy really feto-protective? Journal of Perinatal Medicine, 34, 115–122.CrossRefPubMedGoogle Scholar
  28. 28.
    Klebanoff, M. A., Koslowe, P. A., Kaslow, R., & Rhoads, G. G. (1985). Epidemiology of vomiting in early pregnancy. Obstetrics and Gynecology, 66, 612–616.PubMedGoogle Scholar
  29. 29.
    Zhou, Q., O’Brien, B., & Relyea, J. (1999). Severity of nausea and vomiting during pregnancy: What does it predict? Birth, 26, 108–114.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Ronna L. Chan
    • 1
    • 2
  • Andrew F. Olshan
    • 2
    • 3
  • David A. Savitz
    • 4
  • Amy H. Herring
    • 3
    • 5
  • Julie L. Daniels
    • 1
    • 2
  • Herbert B. Peterson
    • 1
    • 6
  • Sandra L. Martin
    • 1
  1. 1.Department of Maternal and Child Health, Gillings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillUSA
  2. 2.Department of Epidemiology, Gillings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillUSA
  3. 3.Carolina Population CenterThe University of North Carolina at Chapel HillChapel HillUSA
  4. 4.Department of Community and Preventive MedicineMount Sinai School of MedicineNew YorkUSA
  5. 5.Department of Biostatistics, Gillings School of Global Public HealthThe University of North Carolina at Chapel HillChapel HillUSA
  6. 6.Department of Obstetrics and Gynecology, School of MedicineThe University of North Carolina at Chapel HillChapel HillUSA

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