The purposes of this prospective, longitudinal study were to examine the relationships between leptin, human chorionic gonadotropin (hCG), cortisol, and psychosocial stress and nausea and vomiting (NV) in women with mild-to-moderate NV throughout pregnancy. Participants comprised 91 pregnant women recruited from prenatal clinics in southern Taiwan. Data analysis using one-way analysis of variance (ANOVA) indicated that leptin, hCG, cortisol levels, and Index of Nausea, Vomiting, and Retching (INVR) scores, but not stress (measured with the Visual Analog Scale, VAS) scores, were significantly different among the three trimesters. The average INVR score and hCG level decreased from the first to third trimesters (p < .0001 for both). The average leptin and cortisol levels increased from the first to third trimesters (p = .001 and p < .0001, respectively). Analysis using mixed models indicated that the INVR scores decreased significantly in a progressive manner through the stages of pregnancy and were significantly lower in the second and third trimesters. Findings reveal that stress/VAS and hCG may both be significantly and independently associated with INVR scores. Future research should examine psychosocial reactions in addition to exploring other biochemical markers related to NV and stress.
Aka, N., Atalay, S., Sayharman, S., Kilic, D., Kose, G., & Kucukozkan, T. (2006). Leptin and leptin receptor levels in pregnant women with hyperemesis gravidarum. Australian and New Zealand Journal of Obstetrics and Gynecology, 46, 274-277.
2.
Attard, C.L., Kohli, M.A., Coleman, S., Bradley, C., Hux, M., Atanackovic, G., et al. (2002). The burden of illness of severe nausea and vomiting of pregnancy in the United States. American Journal of Obstetrics and Gynecology, 186, S220-S227.
3.
Black, F.O. ( 2002). Maternal susceptibility to nausea and vomiting of pregnancy: Is the vestibular system involved? American Journal of Obstetrics and Gynecology, 186, S204-S209.
4.
Brown, H., & Prescott, R. ( 2006). Applied mixed models in medicine (2nd ed.). NJ: John Wiley & Sons Inc.
5.
Buckwalter, J.G., & Simpson, S.W. ( 2002). Psychological factors in the etiology and treatment of severe nausea and vomiting in pregnancy. American Journal of Obstetrics and Gynecology, 186, S210-S214.
6.
Carr, B.R., Parker, C.R., Madden, J.D., MacDonald, P.C., & Porter, J.C. ( 1981). Maternal plasma adrenocorticotropin and cortisol relationships throughout human pregnancy. American Journal of Obstetrics and Gynecology, 139, 416-422.
7.
Chin, C.C. ( 1999). The effects of back massage on surgical stress responses and postoperative pain. Unpublished doctoral dissertation, Western Reserve University, Ohio.
8.
Chiou, C.J., & Wang, H.H. ( 1987). The epidemiological survey of pregnant women with nausea and vomiting and mild complications. Formosa Public Health , 14, 310-322.
9.
Chou, F.H., Avant, K.C., Kuo, S.H., & Cheng, H.F. ( 2005). Assessing the psychometric and language equivalency of the Chinese versions of the Index of Nausea, Vomiting and Retching, and the Prenatal Self-Evaluation Questionnaire. The Kaohsiung Journal of Medical Sciences, 21, 314-321.
10.
Chou, F.H., Avant, K.C., Kuo, S.H., & Fetzer, S.J. ( 2008). Relationships between nausea and vomiting, perceived stress, social support, pregnancy planning and psychosocial adaptation in a sample of mothers: A questionnaire survey. International Journal of Nursing Studies, 45, 1185-1191.
11.
Chou, F.H., Chan, T.F., & Kuo, S.H. ( 2005). Pregnancy-induced nausea and vomiting and stress: A longitudinal study for comparing psychological with physiological reactions. Taipei: National Science Council.
12.
Chou, F.H., & Chen, C.H. ( 2001). The perception and nursing care needs for women with nausea and vomiting during pregnancy. Chang Gung Nursing, 2, 261-270.
13.
Chou, F.H., Lin, L.L., Cooney, A.T., Walker, L.O., & Riggs, M.W. ( 2003). Psychosocial factors related to nausea, vomiting, and fatigue in early pregnancy. Journal of Nursing Scholarship , 35, 119-125.
Davis, M. ( 2004). Nausea and vomiting of pregnancy: An evidence-based review . Journal of Perinatal and Neonatal Nursing, 18, 312-328.
17.
Demir, B., Erel, C.T., Haberal, A., Ozturk, N., Guler, D., & Kocak, M. ( 2006). Adjusted leptin level (ALL) is a predictor for hyperemesis gravidarum. European Journal of Obstetrics & Gynecology and Reproductive Biology, 124, 193-196.
18.
Gadsby, R., Barnie-Adshead, A.M., & Jagger, C. ( 1993). A prospective study of nausea and vomiting during pregnancy . British Journal of General Practice, 43, 245-248.
Goodwin, T.M. ( 2002). Nausea and vomiting of pregnancy: An obstetric syndrome . American Journal of Obstetrics and Gynecology, 186, S184-S189.
21.
Goodwin, T.M., Hershman, J.M., & Cole, L. ( 1994). Increased concentration of the free β-subunit of human chorionic gonadotropin in hyperemesis gravidarum. Acta Obstetricia et Gynecologica Scandinavica, 73, 770-772.
22.
Guyton, A.C., & Hall, J.E. ( 2000). Textbook of medical physiology (10th ed.). New York: W. B. Saunders .
23.
Henson, M.C., & Castracane, V.D. (2000). Leptin in pregnancy. Biology of Reproduction, 63, 1219-1228.
24.
Henson, M.C., & Castracane, V.D. (2006). Leptin in pregnancy: An update. Biology of Reproduction, 74, 218-229.
25.
Highman, T.J., Friedman, J.E., Huston, L.P., Wong, W.W., & Catalano, P.M. (1998). Longitudinal changes in maternal serum leptin concentrations, body composition, and resting metabolic rate in pregnancy. American Journal of Obstetrics and Gynecology , 178, 1010-1015.
26.
Jarnfelt-Samsioe, A., Eriksson, B., Waldenstrom, J., & Samsioe, G. ( 1985). Some new aspects on emesis gravidarum: Relations to clinical data, serum electrolytes, total protein and creatinine. Gynecology & Obstetrics Investigation, 19, 174-186.
27.
Jarnfelt-Samsioe, A., Samsioe, G., & Velinder, G.M. (1983). Nausea and vomiting in pregnancy-A contribution to its epidemiology. Gynecology & Obstetrics Investigation, 16, 221-229.
28.
Kauppila, A., Ylikorkala, O., Jarvinen, P.A., & Haapalahti, J. (1976). The function of the anterior pituitary-adrenal cortex axis in hyperemesis gravidarum. British Journal of Obstetrics and Gynecology, 83, 11-16.
29.
Knackstedt, M.K., Hamelmann, E., & Arck, P.C. ( 2005). Mothers in stress: Consequences for the offspring. American Journal of Reproductive Immunology, 54, 63-69.
30.
Kuo, S.H., Wang, R.H., Tseng, H.C., Jian, S.Y., & Chou, F.H. ( 2007). A comparison of different severities of nausea and vomiting during pregnancy relative to stress, social support, and maternal adaptation . Journal of Midwifery and Women’s Health, 52, e1-e7.
31.
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 & Gynecology, 182, 931-937.
32.
Meighan, M., & Wood, A.F. ( 2005). The impact of hyperemesis gravidarum on maternal role assumption. Journal of Obstetric, Gynecologic & Neonatal Nursing, 34, 172-179.
33.
Ministry of the Interior in Taiwan.2007. Vital statistics. Retrieved January 25, 2007, from http://sowf.moi.gov.tw
34.
O’Brine, B., Evans, M., & White-McDonald, E. (2002). Isolation from ‘‘Being alive’’: Copying with severe nausea and vomiting of pregnancy . Nursing Research, 51, 302-308.
35.
O’Connor, T.M., O’Halloran, D.J., & Shanahan, F. ( 2000). The stress response and the hypothalamic-pituitary-adrenal axis: From molecule to melancholia. Quarterly Journal of Medicine , 93, 323-333.
36.
Ozturk Arslan, E., Cengiz, L., & Arslan, M. ( 2003). Thyroid function in hyperemesis gravidarum and correlation with serum leptin levels. International Journal of Gynecology & Obstetrics, 83, 187-188.
37.
Plata-Salaman, C.R. ( 1998). Cytokines and anorexia: A brief overview. Seminars in Oncology, 25, 64-72.
38.
Sherman, P.W., & Flaxman, S.M. ( 2002). Nausea and vomiting of pregnancy in an evolutionary perspective . American Journal of Obstetrics and Gynecology, 186, S190-S197.
39.
Sneed, N.V., Olson, M., Bubolz, B., & Finch, N. ( 2001). Influences of a relaxation intervention on perceived stress and power spectral analysis of heart rate variability. Progress in Cardiovascular Nursing, 16, 57-64.
40.
Soules, M.R., Hughes, C.L., Garcia, J.A., Livengood, C.H., Prystowsky, M.R., & Alexander, E., 3rd. (1980). Nausea and vomiting of pregnancy: Role of human chorionic gonadotropin and 17-hydroxyprogesterone. Obstetrics & Gynecology, 55, 696-700.
41.
Unsel, N., Benian, A., & Erel, C.T. ( 2004). Leptin levels in women with hyperemesis gravidarum. International Journal of Gynecology & Obstetrics, 84, 162-163.
42.
Whelan, T.L., Dishman, D., Burke, J., Levine, S., & Sciotti, V. ( 2002). The effect of chiropractic manipulation on salivary cortisol levels. Journal of Manipulative and Physiological Therapeutics , 25, 149-153.
43.
Yura, S., Sagawa, N., Mise, H., Mori, T., Masuzaki, H., Ogawa, Y., et al. (1998). A positive umbilical venous-arterial difference of leptin level and its rapid decline after birth. American Journal of Obstetrics and Gynecology, 178, 926-930.
44.
Zhou, Q., O’Brien, B., & Relyea, J. ( 1999). Severity of nausea and vomiting during pregnancy: What does it predict?Birth, 26, 108-114.
