The evidence bases of etiopathophysiology and preventive clinical management of nausea and vomiting in pregnancy

Abstract

Nausea and vomiting (NVP) are common disturbances during pregnancy that affect up to 80% of pregnant women. The severe form known as hyperemesis gravidarum (HG) is a debilitating and potentially life-threatening illness during pregnancy characterized by persistent nausea and/or vomiting; characterized by weight loss, malnutrition, and dehydration, increasing the risk of adverse consequences for the mother and child. Without the methodical intervention of experienced clinicians, life-threatening complications can develop. Effective prevention and treatment strategies for NVP and HG require an understanding of both pathophysiological and psychosocial factors, awareness of potential risks and complications, and proactive assessment and treatment strategies using innovative clinical tools, which is characterized by dehydration, electrolyte and metabolic imbalances, and nutritional deficiencies that may lead to hospitalization. The severity of nausea and vomiting during pregnancy can be assessed using the Pregnancy Unique Vomiting Qualification (PUQE), which has been shown to be a relatively accurate assessment of the patient's lifestyle, including hours of sleep. To rule out a differential diagnosis, a focused history and examination are necessary, since the diagnosis of this condition is mainly determined clinically. In addition, laboratory tests are useful tools for evaluating complications such as electrolyte or metabolic imbalances or kidney damage. In addition, they help to determine the etiology in refractory cases. Hypotheses that contribute to the understanding of the pathogenesis of NBV have been postulated based on associations that are causal, sequential, or coincidental. Much effort is needed to precisely establish these relationships in well-designed studies. NVP and HG are associated with the most common indication for hospitalization in the first half of pregnancy. Numerous nutrient deficiencies have been identified, such as thiamine deficiency, which can lead to Wernicke's encephalopathy, vitamin K deficiency, and severe hypokalemia. It is noteworthy that in addition to the physical complications mentioned above, LBW is also associated with psychological adverse consequences. Although it has been associated with serious complications, little is known about its prognostic factors. The purpose of our systematic review was to find and critically evaluate studies that investigated the priority areas of clinical management of vomiting in pregnant women based on differentiation and pathophysiological components, to evaluate the safety profile of non-pharmacological agents used to prevent the development of the above gestational pathology, and to clarify effective strategies of interprofessional teams to improve care coordination and outcomes in pregnant women with nausea and vomiting. A systematic data search was conducted in the databases MEDLINE, ISI Web of Science, PubMed, Scopus, Google Scholar, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects and publications in professional publications of Ukraine for 2010–2023. The main result was forecasting the development of NVP and HG, the effectiveness of the preventive intervention, determined by severity, reduction, or cessation of nausea/vomiting; the number of episodes of vomiting; and days of hospitalization. Secondary outcomes included other measures of preventive strategy effectiveness, adverse maternal/fetal/neonatal outcomes, quality of life measures, and economic costs. Preventive measures: ginger, acupressure/acupuncture, diet, hypnotherapy. The economic evaluation of prevention strategies took into account the assumed perinatal outcomes. The therapeutic strategies, primarily infusion therapy, will be reviewed and analyzed by us in the following review. The results of evidence-based medicine presented in the reviews can be used in the creation of a clinical guideline, protocol, consensus, or clinical recommendations regarding the clinical management of nausea and vomiting of pregnancy and hyperemesis gravidarum of pregnancy.