Nausea and vomiting in health-related quality of life among Chinese pregnant women
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Australian and New Zealand Journal of Obstetrics and Gynaecology 2010; 50: 512–518 DOI: 10.1111/j.1479-828X.2010.01216.x
Original Article
Nausea and vomiting in health-related quality of life among
Chinese pregnant women
Oi Ka CHAN, Daljit S. SAHOTA, Tak Yeung LEUNG, Lin Wai CHAN, Tak Yuen FUNG
and Tze Kin LAU
Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
Background: Nausea and vomiting in pregnancy (NVP) is the most common pregnancy complication affecting women
during the first trimester of pregnancy. The cause of NVP remains unknown and factors associated with the occurrence
of NVP are contradictory. There is currently little information on its effects of NVP in general and specifically in the
Chinese population.
Aims: To assess the prevalence of NVP with different degree of severity and identify their relationship with health-related
quality of life (HRQoL) and to determine its association with the sociodemographic and obstetric factors.
Methods: In a prospective cross-sectional study, 396 women who attended the antenatal clinic between 10 and 14 weeks
of gestation were invited to complete a structured questionnaire covering maternal characteristics, severity of NVP and
their HRQoL. The status of NVP and HRQoL was measured by the frequency of symptoms and the Medical Outcomes
Study Short-Form-36 (SF-36) respectively. Logistic regression analysis was performed to delineate the factors associated
with NVP.
Results: The prevalence of NVP was 90.9%. Almost all domains and dimensions of SF-36 were affected by the presence
of NVP and its severity. Factors associated with the presence and severity of NVP were non-smoking, younger age and
history of NVP in previous pregnancy.
Conclusions: The various degrees of severity of NVP significantly impair both physical and mental HRQoL in Hong
Kong Chinese women. Awareness and care should be given to women with symptoms of nausea or retching alone, as
well as vomiting.
Key words: Chinese, factor, health-related quality of life, nausea and vomiting in pregnancy.
factors were either not significant or in some cases, found to
Introduction be protective. The factors related to NVP thus appear
Nausea and vomiting in pregnancy (NVP), is the most inconsistent and population specific.
common pregnancy complication, experienced by 70–90% of Perceived health-related quality of life (HRQoL) has
pregnant women during the first trimester of pregnancy.1–3 become an increasingly important outcome when evaluating
The symptoms of NVP and its severity in early pregnancy the impact of specific conditions. Health-related quality of
vary greatly amongst women, with the worst form, life questionnaires measure the person’s perceptions of daily
hyperemesis gravidarum occurring in 0.5–2% of all functioning and well-being in various domains, including
pregnancies.4 The symptoms of NVP typically start at 4– physical, social and psychological. Nausea and vomiting in
6 weeks of gestation, peak at 8–12 weeks and usually pregnancy can cause some women physical discomfort,
spontaneously resolve by 20 weeks of gestation.5 which if debilitating prevents them from performing routine
Sociodemographic factors reported to be associated with housework or to take leave of absence from their work.12
occurrence of NVP in pregnancy from previous The severity of NVP can reduce women’s ability to function
epidemiologic studies were contradictory. Maternal age,6–9 and is associated with significant psychiatric morbidity.13
parity,6,8,10,11 education11 and smoking1,9,11 have been shown Previous studies have demonstrated that women with NVP
to be positively associated with the occurrence of NVP in often felt depressed and their interpersonal relationships
some studies. However, these significant epidemiological were adversely affected.14
Previous studies that have looked at the quality of life and
its association with NVP have been performed in
Correspondence: Ms Oi Ka Chan, Department of Obstetrics and predominantly Western countries within predominantly
Gynaecology, Prince of Wales Hospital, Shatin, New Territo- Caucasian populations.15–18 The relationship between
ries, Hong Kong, China. Email: cokchan@cuhk.edu.hk
ethnicity and NVP symptoms, and severity in the first
Received 7 June 2010; accepted 7 July 2010. trimester are contradictory. Caucasians have been reported
512 2010 The Authors
Australian and New Zealand Journal of Obstetrics and Gynaecology 2010 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
The Australian and
New Zealand Journal
of Obstetrics and
GynaecologyNausea and vomiting in pregnancy and quality of life to have both more and less NVP than non-Caucasians19,20 Questions related to the frequency of nausea, vomiting and Afro-Caribbeans,9,19,21,22 whereas Asians had less severe and retching used within the PUQE questionnaire were symptoms than Caucasians.22However, the studies included modified to ask respondents the frequency of these few women of South and East Asian origins. Furthermore, if symptoms per day over the past 4 weeks rather than the last South and East Asian women were recruited, they were 12 h so that the time period assessed was consistent with the combined into a single group because of their small 4-week interval assessed by the SF-36 questionnaire.4 Each numbers. The effect of NVP on both physical and item of the PUQE was scored on a five-point Likert scale psychological in Chinese population therefore remains (range 1–5) and then summated to give an overall score largely unknown. ranging from 3 to 15. Total scores were categorised into four The objectives of this study were first to determine the groups: score
O. K. Chan et al.
Table 1 Sociodemographic and obstetric characteristics of women by the presence and absence of nausea and vomiting in pregnancy
(N = 396)†
(I) (II) (III) (IV) P
Moderate ⁄
Symptomless Mild severe All NVP I versus I versus I versus I versus
(n = 36) (n = 149) (n = 211) (N = 360) II versus III II III IV
Sociodemographic characteristics
Age (years) 32.5 (23–40) 32.0 (20–41) 31.0 (19–42) 31.0 (19–42) 0.070 0.146 0.030 0.051
BMI (kg ⁄ m2) 21.5 (16.6–26.0) 21.2 (17.2–36.4) 20.8 (16.6–33.9) 21.1 (16.6–36.4) 0.066 0.801 0.249 0.557
Education level
Non-tertiary 63.9 55.7 62.1 59.4 0.542 0.469 0.890 0.687
Tertiary 36.1 41.6 37.0 38.9
Occupation
Housewives, students, 22.2 19.5 24.2 22.2 0.207 0.849 0.303 0.546
unskilled workers
Skilled workers 58.3 57.0 45.5 50.3
Semi-professionals, 19.4 23.5 30.3 27.5
professionals
Monthly family income (HKD)‡
£$20 000 41.7 38.3 44.1 41.7 0.629 0.460 0.496 0.456
$20 001–50 000 41.7 49.7 45.5 47.2
>$50 000 16.7 10.1 10.0 10.0
Marital status
Married or cohabiting 97.2 94.0 94.3 94.2 0.740 0.690 0.699 0.708
Single or divorced 2.8 6.0 5.7 5.8
Place of birth
Hong Kong 69.4 76.5 71.6 73.6 0.502 0.379 0.795 0.590
Outside Hong Kong 30.6 23.5 28.4 26.4
Smoking
Non-smoker 86.1 97.3 93.8 95.3 0.027 0.015 0.154 0.039
Smoker 13.9 2.7 6.2 4.7
Obstetric characteristics
Gestation age (weeks)
10 11.1 14.1 8.5 10.8 0.004 0.687 0.513 0.903
11 11.1 6.0 21.8 15.3
12 61.1 65.8 55.9 60.0
‡13 16.7 14.1 13.7 13.9
Gravida ⁄ previous history of NVP
Multigravida ⁄ no 44.4 24.2 21.3 22.5Nausea and vomiting in pregnancy and quality of life
50
45
40
35
Percentage (%)
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25
20
15
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Nausea Id Vomiting Retching
Figure 1 The frequency of occurrence of symptoms among those with nausea and vomiting in pregnancy (n = 360).
Table 2 The adjusted odds ratios and 95% confidence interval of the independent factors of the severity of nausea and vomiting in
pregnancy
All NVP (n = 360) Mild (n = 149) Moderate ⁄ severe (n = 211)
Gravida ⁄ previous history of NVP
Multigravida ⁄ no previous history of NVP 1 1 1
Multigravida ⁄ with previous history of NVP 7.18 (1.95–26.37) 3.17 (0.79–12.70) 9.83 (2.61–36.96)
Nulligravida ⁄ first pregnancy 1.88 (0.88–3.98) 1.83 (0.80–4.20) 1.69 (0.76–3.78)
Age 0.59 (0.39–0.89) 0.62 (0.39–0.98) 0.55 (0.36–0.84)
Smoking
Non-smoker 1 1 1
Smoker 0.24 (0.07–0.75) 0.16 (0.03–0.72) 0.34 (0.10–1.14)
NVP, nausea and vomiting in pregnancy.
‘Symptomless (n = 36)’ as reference group. Severity of NVP was classified by Pregnancy Unique Quantification of Emesis Scores.
increasing maternal age (aOR 0.59) were associated with life as severity of symptoms increased (Table 3). When
women being least likely to have NVP (Table 2). compared with the general population, our pregnant women
had significantly lower mean scores in all the domains (all
P < 0.001) except for general health (P = 0.100). Women
The impact of NVP on the women’s life
with ‘mild’ NVP were significantly lower in role-physical,
in first trimester
bodily pain, vitality and social functioning than those
Among those with NVP, hospitalisation occurred in only without symptoms of NVP. Women with ‘moderate’ or
0.8% (n = 3). Of all women, 107 (27.0%) required at least ‘severe’ NVP had significantly lower mean scores in all
1 day of sick leave because of NVP during their first domains compared with women with ‘mild’ symptom except
trimester of pregnancy and 29 (7.3%) required ‡7 days of for physical functioning (P = 0.226) and bodily pain
sick leave. The number of days of sick leave was (P = 0.076), whereas they had significantly lower mean
significantly correlated with the PUQE scores (R = 0.305, scores in all domains compared with those who were
P < 0.001). Of the 257 (64.8%) who reported a change in ‘symptomless’.
appetite, 237 (92.2%) reported a loss whereas only 20
(7.8%) reported an increase.
Discussion
In this study, we explored the association of HRQoL of
Relationship between SF-36 and severity
women and its association with the severity of NVP
of NVP
symptoms in the first trimester. The prevalence of NVP, at
SF-36 scores were significantly negatively correlated with 91%, was within the range of 70–90% reported in the
PUQE scores in all domains indicating a loss of quality of literature.1–3 However, the symptoms of NVP were less
2010 The Authors 515
Australian and New Zealand Journal of Obstetrics and Gynaecology 2010 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists; 50: 512–518O. K. Chan et al.
Table 3 Comparison of SF-36 subscale scores in our study population with various severities of nausea and vomiting in pregnancy and
Hong Kong norms†
(I) (II) (III) P
Hong Kong Symptomless Mild Moderate ⁄ I versus II I versus I versus II versus
norms23 (n = 36) (n = 149) severe (n = 211) versus III‡ II§ III§ III§
Physical functioning 95.19 (7.57) 76.94 (17.54) 70.77 (15.73) 68.46 (19.16) 0.027 0.063 0.009 0.226
Role-physical 84.47 (28.72) 63.89 (33.51) 39.09 (37.14) 23.93 (31.65)Nausea and vomiting in pregnancy and quality of life
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