Emerging Progress in Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum: Challenges and Opportunities

Nausea and vomiting of pregnancy (NVP) is a common condition that affects up to 70% of pregnant women. Hyperemesis gravidarum (HG) is considered the serious form of NVP, which is reported in 0.3–10.8% of pregnant women. NVP has a relatively benign course, but HG can be linked with some poor maternal, fetal, and offspring outcomes. The exact causes of NVP and HG are unknown, but various factors have been hypothesized to be associated with pathogenesis. With the advance of precision medicine and molecular biology, some genetic factors such as growth/differentiation factor 15 (GDF15) have become therapeutic targets. In our review, we summarize the historical hypotheses of the pathogenesis of NVP and HG including hormonal factors, Helicobacter pylori, gastrointestinal dysmotility, placenta-related factors, psychosocial factors, and new factors identified by genetics. We also highlight some approaches to the management of NVP and HG, including pharmacological treatment, complementary treatment, and some supporting treatments. Looking to the future, progress in understanding NVP and HG may reduce the adverse outcomes and improve the maternal quality of life during pregnancy.

Integrative and Complementary Practices to Control Nausea and Vomiting in Pregnant Women: A Systematic Review Protocol

BackgroundThe stages of pregnancy are accompanied by several biopsychosocial changes, among them are nausea and vomiting, which are often associated with negative feelings, in addition to generating physical impacts and impacts on the maternal quality of life. In this scenario, the Integrative and Complementary Practices (ICPs) are inserted as a potential treatment to control nausea and vomiting in this public. This review aims to synthesize the available evidence in the literature on the effects of integrative and complementary practices in the treatment of nausea and vomiting in pregnant women. MethodThe review will include only randomized controlled trials (RCTs) that examine the effects of ICPs versus placebo, routine treatment, or pharmacological intervention for the control of nausea and vomiting in healthy pregnant women. The outcomes of interest are those related to nausea and vomiting and possible adverse effects of the intervention. A search for studies will be carried out in the following databases: MEDLINE via PubMed, EMBASE, CINAHL, CENTRAL, ICTRP, LILACS, CUMED, IBECS, Web of Science, Scopus, CNKI, the World Health Organization’s International Clinical Trials Registry Platform (ICTRP) and ReBEC until July 31, 2021. There will be no restrictions on the publication year or language of the manuscripts. The texts will be evaluated in their entirety, after which they will be selected, the data of interest will be extracted, and the risk of bias and quality of evidence will be evaluated. The entire selection process will be carried out by two independent reviewers and a third reviewer will be available in case of disagreement. In the event that a meta-analysis can be conducted, it will evaluate interventions for the absolute difference between averages and potential heterogeneity. If the data are deemed inadequate for a meta-analysis, a systematic narrative synthesis will be carried out. This protocol was proposed based on the preferred reporting item guidelines for systematic review and meta-analysis protocols (PRISMA-P). DiscussionThe results of this systematic review will robustly fill this knowledge gap and possibly assist in evidence-based practices provided for pregnant women experiencing nausea and vomiting.Systematic review registration: PROSPERO CRD42020221570

DOES BREASTFEEDING OR NOT AFFECT A BETTER MATERNAL QUALITY OF LIFE? : LITERATURE REVIEW

Quality of life is important to achieve the best performance of mothers. Maternal quality of life is usually measured by WHOQOL-BREF standards (quality of life of the World Health Organization-BREF), SF-36 (Short-36), or MGI (Mother Generated Index). One factor that affects the maternal quality of life is breastfeeding. The practice of breastfeeding is the mother who is breastfeeding (giving only breast milk) and the mother who is not breastfeeding (with formula milk) as well as seeing the length of breastfeeding time for less than 6 months or more than 6 months. This literature review has research question with PICO standard to get the aim about the correlation between the practice of breastfeeding and maternal quality of life. 466 literatures were obtained from the SCOPUS, Proquest, Google Scholar, PubMed and EBSCOhost databases. Literature screening is done by looking at the inclusion and exclusion criteria that have been set so that 10 literatures will be reviewed. Most of the literature reports that mothers who breastfeed and continue to breastfeed even though only a month has a better quality of life than mothers who did not breastfeed. One study said that breastfeeding causes a decrease in the maternal quality of life, as well as several other studies that found no significant correlation between breastfeeding practices and maternal quality of life. This result can be used as a reference for the health policy to promote breastfeeding and quality of life.

Development of a cumulative metric of vaccination adherence behavior and its application among a cohort of 12-month-olds in western Kenya

Objectives: The timely receipt of the recommended vaccination regimen, i.e. vaccination maintenance, is an underexplored, but important, indicator of public health. However, there is currently no standardized method for quantifying cumulative vaccination maintenance, and no simple way to explore predictors of adherence to vaccination schedules. We therefore sought to 1) develop a Vaccination Maintenance Score (VMS) and 2) apply this score to determine the predictors of vaccination behavior among infants in western Kenya (n=245).Methods: Women in western Kenya were enrolled during pregnancy and surveyed repeatedly through one year postpartum. Data were collected on a range of sociodemographic and health indicators and vaccinations. For each infant, we analyzed receipt of 11 vaccines recommended by the Kenyan Ministry of Health. We operationalized VMS as the total number of vaccines received on schedule. Vaccines that were not received or received off-schedule were scored 0. VMS was modeled using multivariable tobit regression models.Results: We found that 85.7% of infants were fully immunized, but only 42.4% had optimal VMS, i.e. scored 11. The median(IQR) VMS was 10(3). In multivariable regression, each one-point increase in maternal quality of life score (range: 0-32) was associated with a 0.22-point increase in VMS; each additional child in the household was associated with a 0.34-point increase in VMS; and initiating breastfeeding at birth was associated a 2.01-point increase in VMS.Conclusions: Coverage of the recommended vaccinations (85.7%) was nearly twice as high as the cumulative timely receipt (42.4%). The VMS satisfies a need for a location-specific but easily adaptable metric of vaccination adherence behavior. It can be used to complement traditional methods of vaccination coverage and timeliness to better understand underlying behaviors that influence vaccination events, and thereby inform interventions to improve vaccination rates and decrease the burden of vaccine-preventable disease.

The effect of PKU diet on the maternal quality of life and social discrimination in relation to their educational status and place of living

Background Phenylketonuria (PKU) is an inherited metabolic disorder characterized by high levels of phenylalanine in the blood and brain, resulting in mental retardation, etc. Dietary treatment with low phenylalanine is the common treatment for this disease. Patients with other metabolic disorders, such as diabetes mellitus, were reported to have a higher percentage of quality-of-life damage (QLD) and social discriminations (SDs). Methods To evaluate the degree (%) of maternal QLD and SD in relation to their educational status and place of living during the participation of their PKU children in public events, 110 mothers of PKU children with an average age of 25.7 years took part in this study. We evaluated their QLD and SD according to their educational status (primary school, high school and university) and place of living (small town ≤300,000, city >300,000 inhabitants). A control group was not needed. Special questions (checklist) were created to evaluate the QLD and SD of the mothers of children under dietary control. Cronbach’s α test was used for the measurement of the function of the items in the checklists. Results The covariance between the item pairs and the variance of the total score were calculated. Mothers who had completed primary school and lived in a city with a population >300,000 experienced the highest degree of QLD. In contrast, mothers with a university degree experienced the lowest SD. Overall, the highest SD was observed in mothers who lived in a small town. The affected group of mothers should be psychologically supported.