PROJECT TOPIC: EVALUATION OF THE PERCEPTION OF NAUSEA AND VOMITING IN 1ST TRIMESTER OF PREGNANCY

Abstract Background: Though nausea and vomiting are very common during pregnancy, no studies have investigated the impact of this condition on women’s daily lives in a Scandinavian population. The aim of this study was to describe the burden of nausea and vomiting during pregnancy (NVP) on global quality of life, daily life functioning, and willingness to become pregnant again according to the severity of NVP symptoms. Methods: This study is a cross-sectional population-based study conducted in Norway. Pregnant women and mothers with children <1 year of age with current or prior NVP were eligible to participate. Data obtained from 327 pregnant women in their 1st trimester of pregnancy using structured questionnaires were cleaned, coded, summarised, and processed using ms excel and exported to SPSS version 21 for analysis using descriptive statistics and inferences drawn using Chi-square and logistic regression at 5% level of significance. Study findings were presented using frequency table graphs and charts. The findings indicated that 86.5% of the participants had suffered from nausea and vomiting in the past. The findings also showed that 91% of those who suffered from nausea and vomiting received treatment from the hospital due to perceived better facilities     CHAPTER ONE INTRODUCTION Background to the study Most pregnant women experience pregnancy-related conditions, of which nausea and vomiting during pregnancy (NVP) is by far one of the most common. Nausea affects approximately 70-80% of the pregnant population, and additional vomiting is experienced by about 50% (Jomeen et al., 2005). The symptoms of NVP range from mild to severe, with hyperemesis gravidarum (HG) at the most severe end of the scale. HG is characterized by excessive nausea and vomiting, leading to dehydration, electrolyte and nutritional disturbances, which often necessitates hospitalization (O’Brien & Naber, 1992). Given the high prevalence of NVP and its most often self-limiting nature, health care providers may tend to trivialize its impact (Smith et al., 2006). Though NVP, in general, is not associated with an increased risk of adverse pregnancy outcomes, NVP imposes a significant negative impact on women’s lives (Rodriguez et al., 2001). An extensive review of the literature from 1999 to 2011 included 38 studies that investigated the impact of NVP on health-related quality of life and occupational, social, and daily life functioning (Rodriguez et al., 2001). The review concluded that NVP causes a decreased quality of life, and has adverse effects on social, occupational, and domestic life functioning. Findings indicate that the effects of NVP are amplified with the increased severity of NVP symptoms. Furthermore, an increased risk of comorbidity, especially with feelings of depression and heartburn, and reflux problems has been described in the literature posing an even larger burden on the women. None of the studies included in the literature review were conducted in Norway or any other Scandinavian country. Cultural differences and differences between countries with respect to health care systems could infer that results obtained in other countries may not apply to the Norwegian pregnant population. In Norway, there are approximately 60.000 births annually. The pregnancy care program is free of charge. Furthermore, Norwegian employees are entitled to sickness benefit if occupationally disabled due to own illness. The sick leave might be full time or graded.   Statement of Problem Previous studies have evaluated health-related quality of life among women with NVP with generic health status measures such as the Medical Outcomes Study Short Form (SF36), SF12 (an abbreviated version of SF36), and the NVP specific NVPQOL developed by Magee et al. (O’Brien & Naber, 1992). Studies demonstrate a great impact of NVP on health-related quality of life, with increased adverse effects according to increased severity of NVP. Effects have been found on physical, social, and emotional functioning, bodily pain, general health perceptions, vitality and mental health. However, health-related quality of life instruments are focused on health status and do not capture how satisfied the women are with broader life domains. In specific, independence and material well-being are not captured in health status instruments (Rodriguez et al., 2001). The Quality of Life Scale (QOLS) belongs to the global or overall quality of life tools and is a questionnaire measuring an individual’s overall satisfaction with life using 16 questions covering relationships and material well-being, health and functioning, and personal, social and community commitment. To the best of our knowledge, no studies have been performed with this perspective in women with NVP (Jomeen et al., 2005). Utilization of the QOLS among women with NVP could be of great value in terms of obtaining a broader understanding of the quality of life in this group. Such understanding is valuable in order to optimize pregnancy care for this patient group. Research objective The primary aim of this study was to describe the impact of NVP on global quality of life as measured by QOLS, according to the severity of NVP symptoms as determined by PUQE. Secondary aims were to describe the impact of NVP on daily life functioning and willingness to become pregnant again according to the severity of NVP symptoms.