ArticleLiterature Review

Nausea and vomiting of pregnancy in an evolutionary perspective

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Abstract

The proximate mechanisms underlying gestational nausea and vomiting have been intensively studied, but the possibility that the symptoms themselves serve a useful function has only recently been considered seriously. We synthesized evidence to evaluate various hypotheses for the adaptive significance of nausea and vomiting of pregnancy, as well as the possibility that symptoms are nonfunctional byproducts of pregnancy hormones. We found greatest support for the hypothesis that normal levels of nausea and vomiting of pregnancy (excluding hyperemesis) protect pregnant women and their embryos from harmful substances in food, particularly pathogenic microorganisms in meat products and toxins in strong-tasting plants. We discuss the data that support critical predictions of this "maternal and embryo protection hypothesis" (and contradict other hypotheses), as well as appropriate implications of these results. Knowledge that normal nausea and vomiting of pregnancy indicates the functioning of a woman's defense system, rather than a bodily malfunction, may reassure patients and enable health care providers to develop new ways of minimizing the uncomfortable symptoms.

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... For example, the emergence of toxicosis is increasingly considered not from the point of view of a pathological condition, but as an adaptive advantage fixed by the action of natural selection in human populations [51,52]. It was shown that higher chances for successful carrying of an embryo/fetus are observed if pregnancy is accompanied by nausea and vomiting than in the absence of toxicosis symptoms [52][53][54]. According to the hypothesis of M. Profet [52], toxicosis during pregnancy is necessary to protect the developing embryo/fetus since it limits the mother's intake of toxic substances in food. ...
... It is noteworthy that the most intense symptoms of toxicosis are observed at 6-8 weeks of pregnancy, when organogenesis in the embryo is especially sensitive to external factors [52,53]. It is important to note that the traditional diet in populations with a low incidence of toxicosis consists mainly of plant products, not animal products, which because of the frequent presence of pathogenic microorganisms and parasites pose a potential danger to both the developing embryo/fetus and the pregnant woman [51,[53][54][55][56]. Pregnancy nausea probably aims to prevent the ingestion of Pleistocene toxins rather than modern poisons. ...
... Thus, the results of the studies conducted to date demonstrate that, when considering the effects of selection at different stages of human evolution, the role of pregnancy in the formation of the adaptability to the action of various factors cannot be underestimated, since this physiological state is characterized by a significant consumption of the body's resources necessary for survival in new rapidly changing environmental conditions. In addition, the results of a number of studies [33,54] confirm the supposed contribution of adaptive evolution to the formation of pathological states of pregnancy, and therefore their study in the context of evolutionary medicine may be of significant interest for understanding the causes of the origin, features of etiopathogenesis, and racial and ethnic variability in the frequency of development of these complications. ...
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The review discusses the data on the significant role of pregnancy in adaptive evolution of modern humans. In the aspect of evolutionary medicine, the main attention is paid to preeclampsia (PE), a severe hypertensive pathology of pregnancy. The current evolutionary hypotheses about the origin and causes of racial and ethnic variability in the incidence of this pathology in human populations are summarized. Studies that suggest the contribution of adaptive evolution to the formation of a hereditary predisposition to the development of PE are presented. Our results which first showed the significant role of negative selection in the formation of the genetic architecture of PE via the regulatory single nucleotide polymorphisms of new candidate genes for this pathology are demonstrated.
... On the other hand, nausea and vomiting were mentioned as the principal factors leading to the development of food aversions (13,14). Contrariwise, nausea and vomiting during pregnancy thought to expel potentially dangerous food in addition to motivating women so as to avoid consumption of foods that increase their risk of developing metabolic syndrome and/ or gestational diabetes mellitus (1,15). ...
... The result also supports the notion that aversion to commonly consumed foods is an inbuilt mechanism to diversify the types of foods consumed by avoiding monotonous diet (4). Unsurprisingly, the high proportion of aversion to cereal, which contains a signi cant amount of phytate that reduce the bioavailability of zinc, iron and calcium, seen in this study supports the assumption that, pregnant women avoid foods that contain plant toxins/phytochemicals (15). More importantly, it supports the hypothesis; "dietary aversions as preventive of the metabolic syndrome during pregnancy". ...
... Likewise, the nding of our result supports the assumptions of most anthropologists that aversion is mainly due to nausea (morning sickness) (4). This might be explained that; the presence of nausea help the women to expel offending foods containing potentially dangerous substances as the protection mechanism of both for her health and her baby's health (15). ...
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Background: Despite high prevalence, food aversions are closely linked to the dietary intake of pregnant women. Thus, understanding this behavior is important in addressing the issue of maternal nutrition. Therefore, the aim of this study is to provide information on the prevalence and associated factors of food aversion and its relationship with the nutritional status of pregnant women in Boricha Woreda, Sidama Zone, Southern Ethiopia, 2019. Methods: A community based mixed cross sectional study was conducted among 505 randomly selected pregnant mothers at Boricha Woreda, Southern Ethiopia from June 1-20, 2019. Pre-tested and structured face-to-face interview questionnaire and focus group discussion guide were used to collect quantitative and qualitative data respectively. The quantitative data were cleaned, coded and entered into Epi Info version 7.1.4.0 and then exported to SPSS IBM version 20 for further analysis. The qualitative data were analyzed manually using a content analysis.The bi-variable and multivariable logistic regression was used to identify the possible factors of food aversion. Pearson’s Chi-square test was used to assess the relationship between food aversion and nutritional status of pregnant women. AOR with the respective 95% CIs was used to declare statistical significance. Results: Nearly, seven-in-ten (69.2%) of the pregnant women were averted of at least one food. Cereal (45.9%) and enset (44.2%) were averted by majority of the participants. The mean (±SD) MUAC measurement was 22.7 (±2.4) cm. For age group 19 – 23 [AOR= 2.36, 95%CI (1.32 – 4.21)] and 24 – 28 of years [AOR= 2.84, 95% CI (1.61 – 5.01)], nausea [AOR= 1.70, 95%CI (1.10 – 2.65)] and having additional meal [AOR= 1.70, 95% CI (1.06 – 2.73)] were significantly associated with food aversion. Maternal nutritional status and food aversion was statistically significant (p-value=0.008). Conclusion: High prevalence of food aversions (69.2%) and under nutrition (34.6%) among pregnant women is found. Therefore, the Woreda Health Office needs to intensify the integration of maternal nutrition into ANC services and training of health providers as well as critical appraisal of health extension workers should also be considered.
... Nôn do thai là một biểu hiện khá thường gặp của thời kỳ đầu thai nghén, đa số là nôn chức năng, có tiến triển lành tính và khỏi tự nhiên. Tình trạng buồn nôn và nôn mửa thường xuất hiện giữa tuần thứ 4 đến tuần thứ 6, đạt đỉnh giữa tuần thứ 8 đến tuần thứ 12 và biến mất vào tuần thứ 20 của thai kỳ [2], [16]. Hình thái nôn nặng, xảy ra ở khoảng 0,5 đến 3% trong số thai phụ có nôn nghén [2], [13], là lý do phổ biến nhất gây nhập viện trong ba tháng đầu của thai kỳ [4]. ...
... Hầu hết các triệu chứng biến mất vào tuần thứ 14 -16 của thai kỳ. Kết quả của Gadsby và Sherman cho thấy các triệu chứng thường chấm dứt vào khoảng 10-16 tuần dù thời điểm khởi phát và mức độ nôn nghén khác nhau, các triệu chứng kéo dài quá 16 tuần chỉ khoảng 10-15% và một tỷ lệ rất nhỏ >20 tuần hoặc trong suốt thai kì [3], [16]. ...
Article
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Objectives: 1. To measure the severity of nausea, vomiting and retching among pregnant women during the first half of pregnancy by using the “Rhodes Index of Nausea, Vomiting and Retching” (INVR). 2. To identify associated factors and assess the quality of life of these women using the “Health-Related Quality of Life for Nausea and Vomiting during Pregnancy” (NVPQOL) questionnaire. Materials and methods: 97 pregnant women with gestational age ≤ 20 weeks, identified by LMP or ultrasound results from 1st trimester, having nausea and/or vomiting during the last week before the clinic visit at Department of Obstetrics & Gynecology, Hue Central Hospital during the period from 1st April 2011 to 30th March 2012. The “Rhodes Index of Nausea, Vomiting and Retching” (INVR) has been used to measure the severity of nausea, vomiting and retching; “Health-Related Quality of Life for Nausea and Vomiting during Pregnancy" (NVPQOL) questionnaire was used to assess the quality of life of these women. Results: Rate of asymptomatic subjects was 4.1%, mild level was 59.8%, moderate level was 24.6%, great level was 8.4%, and severe level was 3.1%. Results from quality of life scale showed average mark of physical symptoms and aggravating factors (PSAF) of 41.8±12.63; emotions (E) of 37.8±8.53; fatigue (F) of 17.6±6.34, and limitations (L) of 50.8±13.95; overall result of 147.2±39.12 - at acceptable level. Conclusions: Special attention and care should be paid to the group of women experiencing great and severe nausea and vomiting (11.5). Quality of life assessed by Health-Related Quality of Life for Nausea and Vomiting during Pregnancy questionnaire is proportionally influenced by the severity of nausea and vomiting. Key words: nausea and vomiting, pregnant, INVR, NVPQOL
... The result also supports the notion that aversion to commonly consumed foods is an inbuilt mechanism to diversify the types of foods consumed by avoiding monotonous diet [3]. Unsurprisingly, the high proportion of aversion to cereal, which contains a significant amount of phytate that reduce the bioavailability of zinc, iron and calcium, seen in this study supports the assumption that, pregnant women avoid foods that contain plant toxins/ phytochemicals [21]. More importantly, it supports the hypothesis; "dietary aversions as preventive of the metabolic syndrome during pregnancy". ...
... Likewise, the finding of our result supports the assumptions of anthropologists who have suggested that aversion is mainly evolved due to nausea (morning sickness) [3]. This might be explained that; the presence of nausea help the women to expel offending foods containing potentially dangerous substances as the protection mechanism of both for her health and her baby's health [21]. ...
Article
Full-text available
Background: Despite high prevalence, food aversions are closely linked to the dietary intake of pregnant women. Thus, understanding this behavior is important in addressing the issue of maternal nutrition. Therefore, the aim of this study is to provide information on the prevalence and associated factors of food aversion and its relationship with the nutritional status of pregnant women in Boricha Woreda, Sidama Regional state, Southern Ethiopia, 2019. Methods: A community based mixed cross sectional study was conducted among 505 randomly selected pregnant mothers at Boricha Woreda, Southern Ethiopia from June 1-20, 2019. Pre-tested and structured face-to-face interview questionnaire and focus group discussion guide were used to collect quantitative and qualitative data respectively. The quantitative data were cleaned, coded and entered into Epi Info version 7.1.4.0 and then exported to SPSS IBM version 20 for further analysis. The qualitative data were analyzed manually using a content analysis.The bi-variable and multivariable logistic regression was used to identify the possible factors of food aversion. AOR with the respective 95% CIs was used to declare statistical significance. Results: Nearly, seven-in-ten (69.2%) of the pregnant women were averted of at least one food. Cereal (45.9%) and enset (44.2%) were averted by majority of the participants. The mean (± SD) MUAC measurement was 22.7 (± 2.4) cm. Pregnant women of age group of 24-28 [AOR = 3.04, 95% CI (1.72-5.35)] and 29-33 years [AOR = 2.00, 95% CI (1.02-3.92)], nausea during [AOR = 1.77, 95% CI (1.16-2.70)] and having additional meal [AOR = 1.68, 95% CI (1.02-2.75)] were significantly associated with food aversion. Maternal nutritional status and food aversion was sstatistically significant (p-value < 0.001). Conclusion: High prevalence of food aversions (69.2%) and under nutrition (34.6%) among pregnant women is found. Therefore, the Woreda Health Office needs to intensify the integration of maternal nutrition into ANC services and training of health providers as well as critical appraisal of health extension workers should also be considered.
... Data are mean (95% CI) or number (%) encompass them both. Nausea and vomiting in pregnancy are thought to be protective towards the embryo/ fetus in terms of reducing exposure to food borne harmful substances such as infective microorganisms [43], and they can lead to changes in the maternal dietary intake [44]. There is evidence that this can lead to positive effects on the fetus such as decreased rates of miscarriage and congenital malformations [45]. ...
... Whilst potentially being an advantage in a mild form, in excess it is possible that this vomiting might reduce nutrient delivery to the fetus leading to the greater risk of LBW [46]. The fact that in our population as a whole there was no apparent decrease in mean birth weight despite the higher prevalence of LBW suggests that whilst there is a negative impact of vomiting on birth weight for some babies, in other babies a protective advantage may be evident [43]. The Kernel density estimation plot for birth weight in our population ( Fig. 1(a)) would appear to be consistent with this suggestion (as birth weight density around the mean appeared to be higher in those women affected by vomiting). ...
Article
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Background: Low birth weight has important short- and long-term health implications. Previously it has been shown that pregnancies affected by hyperemesis gravidarum in the mother are at higher risk of having low birth weight offspring. In this study we tested whether such risks are also evident with less severe nausea and vomiting in pregnancy. Methods: One thousand two hundred thirty-eight women in the prospective Cambridge Baby Growth Study filled in pregnancy questionnaires which included questions relating to adverse effects of pregnancy and drugs taken during that time. Ordinal logistic regression models, adjusted for parity, ethnicity, marital and smoking status were used to relate the risk of giving birth to low birth weight (< 2.5 kg) babies to nausea and/or vomiting in pregnancy that were not treated with anti-emetics and did not report suffering from hyperemesis gravidarum. Results: Only three women in the cohort reported having had hyperemesis gravidarum although a further 17 women reported taking anti-emetics during pregnancy. Of those 1218 women who did not take anti-emetics 286 (23.5%) did not experience nausea or vomiting, 467 (38.3%) experienced nausea but not vomiting and 465 experienced vomiting (38.2%). Vomiting during pregnancy was associated with higher risk of having a low birth weight baby (odds ratio 3.5 (1.2, 10.8), p = 0.03). The risk associated with vomiting was found in the first (p = 0.01) and second (p = 0.01) trimesters but not the third (p = 1.0). The higher risk was not evident in those women who only experienced nausea (odds ratio 1.0 (0.3, 4.0), p = 1.0). Conclusions: Vomiting in early pregnancy, even when not perceived to be sufficiently severe to merit treatment, is associated with a higher risk of delivering a low birth weight baby. Early pregnancy vomiting might therefore be usable as a marker of higher risk of low birth weight in pregnancy. This may be of benefit in situations where routine ultrasound is not available to distinguish prematurity from fetal growth restriction, so low birth weight is used as an alternative.
... Data are mean (95% CI) or number (%) encompass them both. Nausea and vomiting in pregnancy are thought to be protective towards the embryo/ fetus in terms of reducing exposure to food borne harmful substances such as infective microorganisms [43], and they can lead to changes in the maternal dietary intake [44]. There is evidence that this can lead to positive effects on the fetus such as decreased rates of miscarriage and congenital malformations [45]. ...
... Whilst potentially being an advantage in a mild form, in excess it is possible that this vomiting might reduce nutrient delivery to the fetus leading to the greater risk of LBW [46]. The fact that in our population as a whole there was no apparent decrease in mean birth weight despite the higher prevalence of LBW suggests that whilst there is a negative impact of vomiting on birth weight for some babies, in other babies a protective advantage may be evident [43]. The Kernel density estimation plot for birth weight in our population ( Fig. 1(a)) would appear to be consistent with this suggestion (as birth weight density around the mean appeared to be higher in those women affected by vomiting). ...
Article
Full-text available
Background: Low birth weight has important short- and long-term health implications. Previously it has been shown that pregnancies affected by hyperemesis gravidarum in the mother are at higher risk of having low birth weight offspring. In this study we tested whether such risks are also evident with less severe nausea and vomiting in pregnancy. Methods: 1,238 women in the prospective Cambridge Baby Growth Study filled in pregnancy questionnaires which included questions relating to adverse effects of pregnancy and drugs taken during that time. Ordinal logistic regression models, adjusted for parity, ethnicity, marital and smoking status were used to relate the risk of giving birth to low birth weight (< 2.5 kg) babies to nausea and/or vomiting in pregnancy that were not treated with anti-emetics and did not report suffering from hyperemesis gravidarum. Results: Only 3 women in the cohort reported having had hyperemesis gravidarum although a further 17 women reported taking anti-emetics during pregnancy. Of those 1,218 women who did not take anti-emetics 286 (23.5 %) did not experience nausea or vomiting, 467 (38.3 %) experienced nausea but not vomiting and 465 experienced vomiting (38.2 %). Vomiting during pregnancy was associated with higher risk of having a low birth weight baby (odds ratio 3.5 (1.2, 10.8), p = 0.03). The risk associated with vomiting was found in the first (p = 0.01) and second (p = 0.01) trimesters but not the third (p = 1.0). The higher risk was not evident in those women who only experienced nausea (odds ratio 1.0 (0.3, 4.0), p = 1.0). Conclusions: Vomiting in early pregnancy, even when not perceived to be sufficiently severe to merit treatment, is associated with a higher risk of delivering a low birth weight baby. Early pregnancy vomiting might therefore be usable as a marker of higher risk of low birth weight in pregnancy. This may be of benefit in situations where routine ultrasound is not available to distinguish prematurity from fetal growth restriction, so low birth weight is used as an alternative.
... [45][46][47][48] All of these factors are associated with HG pregnancies and may explain why a genetic predisposition to increased GDF15/GFRAL/ RET signalling can evolve from NVP to HG. 1 Nausea and vomiting in pregnancy (NVP) is hypothesized to have evolved as a mechanism to avoid the consumption of teratogenic foods that could disrupt fetal organogenesis. 49,50 In addition to regulating appetite, nausea and vomiting, GDF15 may be a T-cell inhibitor, protecting pregnancy from maternal immune attack. 51 Interestingly, GDF15 causes cancer cachexia, a condition with symptoms similar to HG that causes 20% of cancer deaths. ...
Article
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Objective: A genome-wide association study (GWAS) linked the placenta and appetite hormone gene GDF15 to hyperemesis gravidarum (HG). The paradigm-changing finding shifted the field away from the prevailing hypotheses, but more evidence is needed. This study was performed to identify coding variants in addition to the non-coding variants implicated by GWAS. Design: Case-control study. Setting: Hyperemesis Gravidarum cases requiring intravenous fluid treatment for disease (n=926) and controls with normal or no nausea and vomiting of pregnancy (n=660) from the United States. Methods: Whole exome-wide sequencing and genome informatics were performed using the standard Regeneron pipeline. All variants were compared between cases and controls using Dominant, Recessive, and Allelic models to identify variants with exome-wide significant p-values (p<10⁻⁰⁶ ). Odds ratios and associated p-values were calculated for exome-wide significant allele(s) in subgroups of genetically predicted ancestries. Variants were filtered to identify rare pathogenic variants occurring in >10 cases and no controls. Main outcome measures: Identification of exome-wide significant and rare genetic variant(s) associated with HG. Results: A common coding variant in GDF15 was the only exome-wide significant association, and a rare coding variant in GDF15 was the only predicted disease-causing variant occurring in 10 or more cases. Conclusions: This study confirms the GWAS finding that GDF15 is the greatest genetic risk factor for HG. The new variants identified may have implications for prediction and diagnosis. The findings provide insight into the cause and molecular mechanisms for developing therapeutics for HG.
... Some studies have shown that NVP represents a favorable hormonal milieu, accompanied by larger placentas and elevated levels of chorionic gonadotrophin and estrogens in pregnant women [5,6]. Another hypothesis asserts that the role of NVP is to protect pregnant women and embryos from foodborne pathogens and dietary toxins [7,8]. ...
Article
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Background Nausea and vomiting during pregnancy (NVP) is considered to be associated with favorable fetal outcomes, such as a decreased risk for spontaneous abortion. However, the relationship between NVP and preterm births remains unknown. This study was conducted to evaluate the association between NVP and the risk of preterm births. Methods The dataset of a birth cohort study, the Japan Environment and Children’s Study (JECS), was retrospectively reviewed. Participants’ experience of NVP prior to 12 gestational weeks were evaluated by a questionnaire administered from 22 weeks of pregnancy to 1 month before delivery. NVP responses were elicited against four choices based on which the study population was divided into four subcohorts. Preterm birth was the main study outcome. Logistic regression analysis was used to quantify an association between NVP and risk of preterm birth. ResultsOf 96,056 women, 79,460 (82.7%) experienced some symptoms of NVP and 10,518 (10.9%) experienced severe NVP. Compared to those who did not experience NVP, women with severe NVP had lower odds for preterm birth [adjusted odds ratio (aOR) 0.84, 95% confidence interval (95% CI) 0.74–0.95]. An even lower OR was found among very preterm birth and extremely preterm birth (aOR 0.44, 95% CI 0.29–0.65). Conclusion An inverse association exists between NVP and preterm births, especially, very preterm births and extremely preterm births.
... Nausea alone (NP) or nausea and vomiting in pregnancy (NVP) affect approximately 80% of pregnancies [1][2][3]. Symptoms usually emerge early in the first trimester, around gestational weeks 5-6, peaking around week 9, and subsiding by approximately gestational week 12 or later [1,4]. Women with a young age, previous deliveries, those overweight or obese, with an early menarche, with premenstrual symptoms, and non-smokers have been associated with symptoms of NP or NVP [5][6][7][8][9]. ...
Article
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Background: To better understand previous associations reported regarding nausea and vomiting in pregnancy (NVP) and pelvic girdle pain (PGP), an investigation into timing of symptom onset for NVP and PGP in pregnancy, as well as the association of NVP with PGP 4-6 months post-partum was performed. We hypothesised that women with NVP symptoms would be most susceptible to experiencing persistence of PGP post-partum. Methods: Fifty two thousand six hundred seventy-eight pregnancies from the Norwegian Mother and Child Cohort Study were analysed regarding nausea, vomiting, pelvic girdle pain, and health outcome data collected from questionnaires answered between gestation weeks 15, 20, 30, and 6 months post-partum. Logistic regression was used. Results: Women experiencing NVP and PGP together (6.9%) were heaviest in the sample, youngest at menarche and had highest proportion with education ≤12 years. The primiparous women in this group had the lowest timespan from menarche to pregnancy. Women with nausea alone (NP) and NVP had higher odds of PGP 4-6 months post-partum (adjusted odds ratio, aOR = 2.14, 95% CI 1.70-2.71, and aOR = 2.83, 95% CI 2.25-3.57, respectively), compared to symptom-free women. NP/NVP symptoms appeared early in the first trimester, while PGP symptoms appeared later in pregnancy. Women with longer durations of nausea and/or vomiting had a higher proportion of PGP compared to shorter duration women. Conclusions: Women with NP and NVP had increased odds of PGP 4-6 months post-partum, and women with a long duration of nausea and/or vomiting had a higher proportion of PGP than women with shorter duration, both during pregnancy and 4-6 months post-partum. This finding suggests a synergistic relationship between NP/NVP and PGP.
... Nausea and vomiting during pregnancy is estimated to affect 50e80% of pregnant women [1]. It is a common symptom experienced upto approximately 16 weeks without having any adverse effects on growing fetus as well as mother. ...
Article
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Background Emesis gravidarum is a common obstetrical problem affecting 50–80% of pregnant women during their first trimester which begins in the morning and frequently continues throughout the day; considered as one of the Vyakta Garbha Lakshana in Ayurveda. If it is not treated effectively in time; it may lead to complications in pregnancy affecting the quality of life and thus the pregnancy outcome. Objective To evaluate the clinical effectiveness of Bilwa-Lajadi syrup in emesis gravidarum. Material and methods A single arm open labeled clinical trial was conducted on 30 participants fulfilling the inclusion criteria from OPD and IPD of Prasuti Tantra Evam StreeRoga, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan and administered with Bilwa-Lajadi Syrup 20 ml per day in two divided doses, empty stomach before food for 30 days with followed up every 15 days during treatment and 15 days after completion of trial period. Results The drug showed statistically significant effect in reducing the frequency of vomiting per day, quantity of vomitus, aversion to smell, nausea and anorexia, altered content of vomitus, improved appetite, imparted lightness of body and increased haemoglobin gm%. Conclusion Thus, early medication with Bilwa-Lajadi syrup and following dietetic regimen played a vital role in relieving the symptoms of emesis gravidarum.
... Pathogen avoidance has been well-documented in the scientific literature, particularly focusing on the senses of smell and taste. For example, the smell of foods high in teratogens can elicit nausea and vomiting in pregnant women, which causes the individual to avoid such foods (Fessler 2002;Fessler et al. 2005;Lacroix et al. 2000;Profet 1992;Sherman and Flaxman 2002;Tierson et al. 1986;Weigel and Weigel 1989). Other research has revealed that individuals who become ill as a result of the food they consumed may suffer from conditioned taste aversion (Garcia and Koelling 1966;Garcia and Hankins 1977;Seligman and Hager 1972), which is an increased disgust response to the taste and/or smell of the food they associate with their illness. ...
Article
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Individuals often avoid pathogens by refraining from ingesting things that are associated with pathogen-prevalent stimuli. The present study examined whether individuals would be less likely to ingest water that is associated with pathogen-prevalent environments and whether individuals’ perceptions of water quality would decrease when they believed the water originated from a pathogen-prevalent environment, (even though the water actually did not originate from the indicated source). Across two experiments, undergraduates were asked to taste-test water they believed came from a variety of sources on their college campus. For each cup of water presented to participants, an image of its supposed water source (e.g., kitchen sink, drinking fountain, or bathroom sink) was also presented. Participants drank significantly less water when they believed it came from pathogen-prevalent environments (e.g., restrooms) and rated the water from pathogen-prevalent environments as lower in cleanliness, crispness, quality, and other characteristics when compared to water from environments not associated with pathogens (study 1). Similar results were also found after controlling for perceived cleanliness of the images of water sources (study 2). Ultimately, the results from both studies provide evidence that individuals’ beliefs can influence perception and behavior in a manner consistent with pathogen avoidance.
... Two hypotheses promote NVP as the cause of healthy pregnancies: the ''maternal-embryo protection hypothesis'' [36][37][38] and the ''growth-generating hypothesis.'' 39 Under the maternal-embryo protection hypothesis, NVP functions to reduce the consumption of potentially harmful foods (eg, plants with phytotoxins or meats contaminated with parasites or pathogens) during the period of organogenesis to prevent congenital malformations or pregnancy loss. ...
Article
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Approximately one-third of pregnancies end in loss; however, the natural history of early pregnancy loss, including signs and symptoms preceding loss, has yet to be fully described and its underlying mechanisms fully understood. We searched PubMed/MEDLINE and Embase to identify articles with prospective ascertainment of signs and symptoms, including vaginal bleeding, nausea, and vomiting, of pregnancy loss < 20 weeks gestation in spontaneous conceptions to ascertain existing literature on symptomatology of pregnancy loss. Two preconception and 16 pregnancy cohort studies that ascertained information on bleeding and/or nausea/vomiting prior to pregnancy loss ascertainment were included. Data from these studies indicated increased risk of loss with vaginal bleeding and decreased risk of loss with nausea/vomiting, though these studies were mostly comprised of pregnancies surviving into late first trimester. While such associations are biologically plausible, these study designs are subject to bias, given recruitment of women at later gestational ages and reliance on women presenting to care. Reporting symptoms to clinicians and over long periods may introduce reporting error. Data gaps remain regarding (1) relationships between signs and symptoms and losses occurring very early, prior to care entry; (2) empirical testing of whether relationships between signs and symptoms and loss differ across gestational age; (3) whether similar relationships between signs and symptoms and loss are observed in populations using assisted reproductive technologies; (4) the patterning of multiple signs and symptoms in relation to loss; and (5) how hormonal and physiologic adaptions to early pregnancy relate to symptomatology and pregnancy loss.
... Hiperemezis gravidarumun fetüs üzerine etkisi konusunda iki görüş bulunmaktadır. Bunlardan ilki fetüs üzerine zararlı etkisi olmadığı gibi, gebelerdeki teratojenik etkinin en çok izlendiği ilk trimestırdaki bulantı ve kusma, anne ve fetüsü gıdalardaki zararlı maddelerden koruyabildiğini savunmaktadır 86,87 . Ayrıca bulantı ve kusma bazı hormonların sekresyonunda değişikliğe neden olarak plasental gelişimi desteklediğini ileri süren çalışmalarda mevcuttur 88 . ...
... Decreased rates of early pregnancy loss in women with HG (2000;Bashiri et al. 1995;Hinkle et al. 2016;Weigel and Weigel 1989) have been reported. One speculation is that N/ V eliminates harmful substances from food or alters hormones that facilitate placental development, thereby improving embryologic health (Huxley 2000;Nulman et al. 2009;Sherman and Flaxman 2002). ...
Article
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Hyperemesis gravidarum (HG) is a severe and prolonged form of nausea and/or vomiting during pregnancy. HG affects 0.3-2% of pregnancies and is defined by dehydration, ketonuria, and more than 5% body weight loss. Initial pharmacologic treatment for HG includes a combination of doxylamine and pyridoxine. Additional interventions include ondansetron or dopamine antagonists such as metoclopramide or promethazine. The options are limited for women who are not adequately treated with these medications. We suggest that mirtazapine is a useful drug in this context and its efficacy has been described in case studies. Mirtazapine acts on noradrenergic, serotonergic, histaminergic, and muscarinic receptors to produce antidepressant, anxiolytic, antiemetic, sedative, and appetite-stimulating effects. Mirtazapine is not associated with an independent increased risk of birth defects. Further investigation of mirtazapine as a treatment for HG holds promise to expand treatment options for women suffering from HG.
... Aversions to strong-tasting plant foods are expected under the maternalembryo protection hypothesis because such flavors often indicate the presence of chemicals produced by the plant as a deterrent against consumption by other organisms (Billing and Sherman 1998;Fessler and Navarrete 2003;Profet 1988Profet , 1992Sherman and Hash 2001). Although the extent to which the consumption of such foods actually affects human embryo development is unclear (e.g., Brown et al. 1997;Chanda et al. 2006;Christian and Brent 2001), some women may be responding to olfactory or gustatory cues about the possible chemical toxicity of these plant foods and are thus developing aversions to them (Flaxman and Sherman 2000;Sherman and Flaxman 2002). ...
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Women often experience novel food aversions and cravings during pregnancy. These appetite changes have been hypothesized to represent adaptive responses to challenges posed by pregnancy, including maternal immune suppression, metabolic changes, and fetal organogenesis and growth requirements. We assess the extent to which data from an indigenous population in Fiji accord with predictions of this hypothesis. In this population, aversions focus predominantly on foods expected to exacerbate the challenges of pregnancy. Cravings focus on foods that provide calories and micronutrients while posing few threats to mothers and fetuses. Women that experience aversions to specific foods are more likely than other women to crave foods that meet similar nutritional needs as those provided by the aversive foods. The Fijian data are consistent with the hypothesis that pregnancy-related food aversions and cravings reflect adaptive responses to challenges of pregnancy. Appetite changes may function in parallel with cultural mechanisms for solving pregnancy challenges.
... The hypothesis, known as the "Maternal and Embryo Protection" hypothesis, suggests that normal levels of NVP (excluding hyperemesis gravidarum) and the associated temporary taste aversions protect pregnant women and their embryos from harmful substances in food, particularly pathogenic microorganisms in meat products and toxins in strongtasting plants. 72,73 The hypothesis also indicates that normal levels of NVP will not harm the embryo or mother. Support for this hypothesis comes from studies that demonstrated an association between NVP and positive pregnancy outcomes such as decreased risk of miscarriage. ...
Article
Nausea and vomiting symptoms affect 70% to 85% of pregnant women during early pregnancy. These symptoms can have a dramatic effect on a woman's family, social, and occupational functioning. Hence, nausea and vomiting of pregnancy is a medical condition that should be taken seriously by health care professionals responsible for providing care to pregnant women. This manuscript reviews the current state of knowledge concerning the etiology, underlying mechanisms, and management of nausea and vomiting associated with pregnancy. An abbreviated version of the material found in this article is presented to second year PharmD students at the University of the Pacific as part of an elective course on evidence-based complementary and alternative therapies.
... The gastric acids, which are present in the emesis, lead to erosion of enamel. 9 The main salivary changes involve its flow, composition, pH and hormone levels. The changes in the composition of the saliva include a decrease in the sodium concentration and pH, and an increase in the potassium, protein and the oestrogen levels. ...
Article
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Background: Oral health of pregnant patients is considered as an essential component of the overall health of the mother and the developing fetus. The aim of this study was to know dentist perspective regarding treatment options in pregnant patients.
... From the findings of the current study, excessive increase in physical activity during early pregnancy might be a risk factor for LBP, and the authors recommend that pregnant women should be more active after mid-pregnancy. Physical symptoms during the first period of pregnancy, such as nausea and vomiting, usually begin and peak in the first trimester [39,40] and these symptoms cause a reduction in physical activity among pregnant women [41]. In addition, pregnant women are advised to avoid strenuous activity to reduce the risk of miscarriage in the first trimester. ...
Article
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Purpose: To investigate the relationship between the change of daily step counts and low back pain (LBP) during pregnancy. Materials and Methods: Pregnant women at less than eight weeks of gestation (WG) were recruited. Daily step counts were measured with a pedometer. To assess LBP, the Oswestry disability index (ODI) score was recorded. Thirty-six individuals were divided into the LBP and non-LBP groups. The effect of step counts on LBP between the two groups was analyzed. Results: At 16-19 WG, step counts were not considerably changed in the non-LBP group but were significantly increased in the LBP group. At 24-27 and 32-35 WG, step counts were increased in the non-LBP group but were significantly decreased in the LBP group. Conclusions: Acute increase of daily step counts in early pregnancy is a risk for LBP, and gradual increases of step counts after mid-pregnancy is recommended for women.
... On close examination, however, pregnancy nausea does have an adaptive value. According to Sherman and Flaxman (2002), it is beneficial both to a pregnant woman and to her embryo because the nauseating food might contain chemicals that cause deformation or miscarriage: ...
Article
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Psychopaths are brutal individuals, having no empathetic concern for others. Initially, the existence of psychopaths seems to be a mystery from an evolutionary point of view. On close examination, however, it can be accommodated by evolutionary theory. Brutal individuals excelled meek individuals in the desperate circumstances where they had to fight their competitors over natural resources for survival and reproduction. This evolutionary explanation of psychopaths receives support from Pinker's observation of the history of brutality. We have good reasons for predicting (...) that psychopaths are likely to die out in the future.
... Women with pre-existing gingivitis may also show significant exacerbation of the condition during pregnancy [3]. In the first trimester, women commonly experience morning sickness, which leads to increased acidity in the oral cavity and this high acidity erodes the tooth enamel [4]. In the second trimester, pregnancy granuloma has been commonly documented, which frequently occurs in areas of inflamed gingivitis and other recurrent irritation areas. ...
Article
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Objective: To examine the correlations among oral health knowledge, attitude, practices and oral disease among pregnant Chinese women in Singapore. Methods: A descriptive correlational study was conducted in pregnant Chinese women in Singapore. A questionnaire was used to collect data of oral health knowledge, attitude and practices. Plaque index scores were used to assess the oral health of subjects. Results: A total of 82 pregnant women participated in the study, out of whom 38% showed adequate oral health knowledge, nearly half of them achieved adequate and oral health attitude and practice scores while 34% had good Plaque index scores. The lower income group had higher experience of self-reported dental problems during pregnancy than those in the higher income group (p = 0.03). There were significant positive correlations between scores of oral health practice, attitude and oral health knowledge levels. The plaque index scores negatively correlated with the oral health practice scores (p = 0.02). Conclusions: Our findings provided evidence that oral health knowledge, attitude and practices among Chinese pregnant women were not optimal which implies the importance of promoting their oral health during pregnancy through the improvement of knowledge and attitudes. This would facilitate formulation and implementation of appropriate oral health promotion policies.
... (1) Unlike morning sickness, hyperemesis gravidarum may have an adverse effect on maternal and fetal health, it affects various areas of women health, including homeostasis, electrolytes, and kidney function. (2) The incidence of HG varies between 0.3-2.3 in pregnancy populations and it is the most common indication for admission to hospital in the first half of pregnancy and second to preterm labor for pregnancy in general. (3), (4) It usually began in the first trimester of pregnancy and some sufferers will experience severe symptoms until delivery and even their after. ...
Article
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Background: Cholecystokinin is a gastrointestinal tract hormone synthesized and released from the upper part of small intestine and central nervous system. Objective: To assess the cholecystokinin level in pregnancy with and without hyperemesis gravidarum and correlate it with the severity of condition. Patients and methods: A case-control study conducted at AL-Yarmouk Hospital from March-November 2015. Sixty pregnant women were included, thirty with hyperemesis gravidarum and thirty pregnant women with normal pregnancy. For both groups, cholecystokinin level was measured with other hematological, biochemical, and hormonal parameters. The patient's group was classified according to the severity into mild, moderate, and severe according to classification posted by HER foundation. Results: The mean level of cholecystokinin for the hyperemesis gravidarum group was significantly lower than control group (p< 0.001). Blood urea nitrogen and free thyroxin were significantly higher, while sodium, potassium, and thyroid stimulating hormone levels were significantly lower in comparison to control group. Twenty women with moderate hyperemesis gravidarum and ten with severe condition. The cholecystokinin was significantly lower in the severe cases vs. moderate cases (28.7 ± 11vs. 39.8 ± 13.9; P=0.036). The β-HCG is significantly higher in patients with severe cases than moderate cases. Conclusion: serum cholecystokinin level was significantly reduced in hyperemesis gravidarum in comparison to the healthy pregnant women. This reduction is inversely correlated with the severity of the condition. This relationship with the severity triggers studies to evaluate the role of cholecystokinin as a marker of severity of hyperemesis gravidarum rather than a causal relationship.
... However, our study population was not restricted to women with HG, since this study intended to examine the whole NVP spectrum and not only women with hyperemesis gravidarum. The pathophysiology of NVP is multifactorial 41,42 . The dilemma whether NVP and HG are independent diseases is not yet resolved. ...
Article
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Abstract The aim of this population-based, longitudinal study was to assess the association between nausea and vomiting in pregnancy (NVP) and perinatal depressive symptoms. Pregnant women (N = 4239) undergoing routine ultrasound at gestational week (GW) 17 self-reported on NVP and were divided into those without nausea (G0), early (≤17 GW) nausea without medication (G1), early nausea with medication (G2), and prolonged (>17 GW) nausea (G3). The Edinburgh Postnatal Depression Scale at GW 17 and 32 (cut-off ≥13) and at six weeks postpartum (cut-off ≥12) was used to assess depressive symptoms. Main outcome measures were depressive symptoms at GW 32 and at six weeks postpartum. NVP was experienced by 80.7%. The unadjusted logistic regression showed a positive association between all three nausea groups and depressive symptoms at all time-points. After adjustment, significant associations with postpartum depressive symptoms remained for G3, compared to G0 (aOR = 1.66; 95% CI 1.1–2.52). After excluding women with history of depression, only the G3 group was at higher odds for postpartum depressive symptoms (aOR = 2.26; 95% CI 1.04–4.92). In conclusion, women with prolonged nausea have increased risk of depressive symptoms at six weeks postpartum, regardless of history of depression.
... NVP in psychoanalytic thinking is defined as a form of defense and self-expression against unclear disorders (Sherman & Flaxman, 2002). McCarthy et al. reported that psychosocial, behavioral and emotional disorders increased in pregnant women with severe nausea and vomiting (McCarthy et al., 2011). ...
Article
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The aim of this study is to determine the relationship between the severity of nausea and vomiting in pregnancy and fear of birth and psychosocial health level. This research, which is a relational-descriptive type was conducted with 659 pregnant women. Data were collected by being used Personal İnformation Form, The Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) Test, The Wijma Delivery Expectancy/Experience Questionnaire A Version (W-DEQ-A) and Pregnancy Psychosocial Health Assessment Scale (PPHAS). It was determined that pregnant women with severe nausea and vomiting severity had more fear of child birth than those with mild and moderate nausea and vomiting severity (p < 0.001). It was found that the severity of nausea and vomiting in pregnancy (NVP) was a factor related to the fear of birth. According to PUQE Test Classification, the difference between the mean scores of “Pregnancy and Family Relationships”, “Domestic Violence” and “Physical and Psychosocial Changes related to Pregnancy” subscales of PPHAS was statistically determined to be significant (p < 0.05).It was determined that those with mild nausea and vomiting had a better psychosocial health level in terms of “pregnancy and spousal relationship” and worse in terms of “domestic violence”. In addition, it was found that the psychosocial health level of pregnant women with severe nausea-vomiting severity was worse in terms of “physical-psychosocial changes related to pregnancy”. It was determined that the increase in anxiety and stress levels and the perception of insufficient psychosocial support are important variables that increase the severity of nausea and vomiting in pregnancy. In the evaluation of nausea and vomiting complaints, variables such as fear of birth and psychosocial health level can be taken into consideration to provide a holistic health service to pregnant women.
... Thus, diet must be analyzed, not only from a compositional standpoint but also from an evolutionary point of view. Pregnancy symptoms, such as nausea and vomiting in the first trimester, might protect both the pregnant woman and the embryo from potentially harmful substances present in food [24], while, in the last trimester, cravings for food expose the fetus to a higher number of antigens and increase immune contact with the outside environment, yielding an immune imprinting. The fetus' immune knowledge of the outer world is guaranteed by the IgG produced by the mother. ...
Article
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Background: The influence of diet in pregnant women on the immune tolerance process is intricate. Food-specific immunoglobulin G (IgG) was associated with exposure to particular food antigens. The IgG antibodies can cross the placental barrier and enter into the colostrum, and maternal IgG is amply present in breast milk. This justifies studying the immunological connection between food-specific IgG antibodies and the mother-fetus relationship. This study was designed to analyze food-specific IgG concentrations and possible food-specific IgG concentration clusters in a large cohort of subjects with a common food culture. Methods: Food-specific IgG antibody concentrations were detected in 18,012 Caucasian or Southern European subjects over 18 years of age. We used an unsupervised hierarchical clustering algorithm to explore varying degrees of similarity among food-specific IgG antibodies. Results: We identified five food groups by the evaluation of food-specific IgG values: one includes foods with a high nickel content, the second cluster is associated with gluten, the third cluster includes dairy products, the fourth one is connected to fermented foods, and the last group is correlated with cooked oils. Discussion: The knowledge derived from studying a large sample allows us to determine food-specific IgG values from a single pregnant woman, compare it to an epidemic standard, and establish modifications required in her lifestyle to modulate her nutritional habits.
... NVP may have evolved as a mechanism of patho gen avoidance 18,19 and/or undernutrition resulting in increased placental growth to maintain early pregnancy 20 . Despite the prevalence of NVP and the severity of HG, there is a paucity of research on the patho physiology, a lack of consensus on diagnosis, and inconclusive evi dence on the safety and effectiveness of common treat ments. ...
Article
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Nausea and vomiting of pregnancy (NVP) is a common condition that affects as many as 70% of pregnant women. Although no consensus definition is available for hyperemesis gravidarum (HG), it is typically viewed as the severe form of NVP and has been reported to occur in 0.3-10.8% of pregnant women. HG can be associated with poor maternal, fetal and child outcomes. The majority of women with NVP can be managed with dietary and lifestyle changes, but more than one-third of patients experience clinically relevant symptoms that may require fluid and vitamin supplementation and/or antiemetic therapy such as, for example, combined doxylamine/pyridoxine, which is not teratogenic and may be effective in treating NVP. Ondansetron is commonly used to treat HG, but studies are urgently needed to determine whether it is safer and more effective than using first-line antiemetics. Thiamine (vitamin B1) should be introduced following protocols to prevent refeeding syndrome and Wernicke encephalopathy. Recent advances in the genetic study of NVP and HG suggest a placental component to the aetiology by implicating common variants in genes encoding placental proteins (namely GDF15 and IGFBP7) and hormone receptors (namely GFRAL and PGR). New studies on aetiology, diagnosis, management and treatment are under way. In the next decade, progress in these areas may improve maternal quality of life and limit the adverse outcomes associated with HG.
... The most severe manifestations of Nausea and Vomiting of Pregnancy (NVP) result in Hyperemesis Gravidarum (HG). Although there is no standard definition of HG, the most diagnostic criteria include persistent vomiting before 9 weeks after the LMP, weight loss >5% of initial body weight, electrolyte imbalance (Hypokalemia), and dehydration and/or ketonuria [5] . ...
... Females may benefit from choosing males who, as a result of enhanced cognitive skills, are able to acquire more resources [40]; e.g., a male's success in a novel foraging task can correlate with his song complexity, a sexually selected trait females use to choose mating partners [zebra finches, Taeniopygia guttata : 41]. In this study, we predicted that female baboons would be more successful in a given task because, during gestation and lactation, females need to increase nutrient consumption while miminising exposure to plant secondary compounds [42,43], potentially selecting for more discriminative associative learning abilities where foods are concerned. ...
Article
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Cognitive abilities underpin many of the behavioural decisions of animals. However, we still have very little understanding of how and why cognitive abilities vary between individuals of the same species in wild populations. In this study, we assessed the associative learning abilities of wild chacma baboons (Papio ursinus) across two troops in Namibia with a simple operant conditioning task. We evaluated the ability of individuals to correctly associate a particular colour of corn kernels with a distasteful flavour through repeated presentations of two small piles of corn dyed different colours, one of which had been treated with a non-toxic bitter substance. We also assessed whether individual variation in learning ability was associated with particular phenotypic traits (sex, social rank and neophilia) and states (age and prior vigilance). We found no evidence of learning the association either within each trial or across trials, nor any variation based on individuals’ phenotypes. This appeared to be due to a high tolerance for bitter foods leading to similar acceptance of both palatable and unpalatable kernels. Earlier avoidance of the bitter kernels during pilot trials suggests this higher tolerance may have been largely driven by a drought during the experiments. Overall, our findings highlight the potential influence of current environmental challenges associated with conducting cognitive tests of animals in the wild.
... The gastric acids in the emesis, erode the enamel on the inner surface of the teeth, mostly the front teeth. 22 Erosion of the enamel can easily be controlled by advising the patients to rinse their mouths thoroughly after vomiting, with a solution that contains sodium bicarbonate. 23 Hormonal changes during pregnancy along with gastric acid exposure during recurrent morning sickness results in increased acidity in the oral cavity that can be a cause for eroding dental enamel. ...
... The flip side of specific cravings is selective avoidance of potentially noxious substances, which is achieved by reducing the sensitivity thresholds for sensors that detect them. This is best illustrated during pregnancy, when olfactory and gustatory sensitivity for and avoidance of foods with potentially noxious components (e.g., soft cheeses rich in bacteria) is increased to minimize the potential harmful effect on the fetus (Sherman and Flaxman, 2002). Tuning the sensitivity of the sensory pathways as a function of the organismal state allows for optimal food selection. ...
Article
Food is simultaneously a source of essential nutrients and a potential source of lethal toxins and pathogens. Consequently, multiple sensory mechanisms evolved to monitor the quality of food based on the presence and relative abundance of beneficial and harmful food substances. These include the olfactory, gustatory, and gut chemosensory systems. Here we argue that, in addition to these systems, allergic immunity plays a role in food quality control by mounting allergic defenses against food antigens associated with noxious substances. Exaggeration of these defenses can result in pathological food allergy.
... Endogenous acids have a pH of approximately 1.2 which is below the critical pH for dissolution of hydroxyapatite and fluorapatite crystals.This low pH rapidly causes demineralisation. [3,4] Erosion of the enamel can easily be controlled by advising the patients to rinse their mouths after vomiting, with a solution that contains sodium bicarbonate that neutralises the pH. [5] Morning dental appointments can be avoided for patients with morning sickness. ...
Article
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Pregnancy is a physiological state with significant changes in a woman's body. Pregnant women are more prone to gingival diseases due high levels of fluctuating pregnancy hormones.The aim of this article is to bring to light the changes in oral cavity during pregnancy, the consequences of not treating them and the current recommendations for dental management of pregnant patients in different trimesters.
... HG can lead to prolonged dehydration and undernutrition, which can be detrimental to maternal and fetal health and can de-crease reproductive fitness. It has been hypothesized that NVP may be beneficial to avoid food that may be toxic to the fetus [29]. Another theory is that decreased appetite leads to nutrient deficiencies that signal increased growth of the placenta to maintain early pregnancy [30]. ...
Article
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Objective Hyperemesis gravidarum, severe nausea and vomiting in pregnancy, occurs in up to 2% of pregnancies and leads to significant weight loss, dehydration, electrolyte imbalance, and ketonuria. It is associated with both maternal and fetal morbidity. Familial aggregation studies and twin studies suggest a genetic component. In a recent GWAS, we showed that placentation, appetite, and cachexia genes GDF15 and IGFBP7 are linked to hyperemesis gravidarum (HG). The purpose of this study is to determine whether GDF15 and IGFBP7 are upregulated in HG patients. Methods We compared serum levels of GDF15 and IGFBP7 at 12 and 24 weeksʼ gestation in women hospitalized for HG, and two control groups, women with nausea and vomiting of pregnancy (NVP), and women with no NVP. Results We show GDF15 and IGFBP7 serum levels are significantly increased in women with HG at 12 weeksʼ gestation. Serum levels of hCG are not significantly different between cases and controls. At 24 weeks gestation, when symptoms have largely resolved, there is no difference in GDF15 and IGFBP7 serum levels between cases and controls. Conclusion This study supports GDF15 and IGFBP7 in the pathogenesis of HG and may be useful for prediction and diagnosis. The GDF15-GFRAL brainstem-activated pathway was recently identified and therapies to treat conditions of abnormal appetite are under intense investigation. Based on our findings, HG should be included.
... There is a risk that women are being undertreated for nausea and vomiting during pregnancy due to the high prevalence and self-limiting nature of the condition as well as insufficient safety data for pharmacological treatment [13,14,[17][18][19]. The etiology of nausea and vomiting of pregnancy is assumed to be multifactorial and sometimes considered an evolutionary response that protects the woman from ingesting harmful foods, which may further contribute to its undertreatment [14,20]. One theory suggests that hormone levels, including human chorionic gonadotropin and estrogen, are responsible due to their concurrence with the peak of nausea and vomiting symptoms [6,21,22]. ...
Article
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Background: Nausea and vomiting are experienced by a majority of pregnant women worldwide. Previous studies have yielded conflicting results regarding their impact on birth outcomes and few studies have examined this relationship in settings with limited resources. We aimed to determine the effect of nausea, vomiting and poor appetite during pregnancy on birth outcomes in rural Nepal. Methods: Observational cohort study using data collected in two randomized, community-based trials to assess the effect of influenza immunization during pregnancy on reproductive and respiratory outcomes among pregnant women and their offspring. Pregnant women in Sarlahi District, Nepal were recruited from 2011 to 2013. Exposure was defined as nausea, vomiting or poor appetite at any point during pregnancy and by trimester; symptoms were recorded monthly throughout pregnancy. Adverse outcomes were low birth weight (LBW), preterm birth and small for gestational age (SGA). Adjusted relative risks (aRR) with 95% CIs are reported from Poisson regressions with robust variance. Results: Among 3,623 pregnant women, the cumulative incidence of nausea, vomiting or poor appetite was 49.5% (n = 1793) throughout pregnancy and 60.6% (n = 731) in the first trimester. Significantly higher aRRs of LBW and SGA were observed among women experiencing symptoms during pregnancy as compared to symptom free women (LBW: aRR 1.20; 95% CI 1.05 1.28; SGA: aRR 1.16; 95% CI 1.05 1.28). Symptoms in the first trimester were not significantly associated with any of the outcomes. In the second trimester, we observed significantly higher aRRs for LBW and SGA (LBW: aRR 1.17; 95% CI 1.01 1.36; SGA: aRR 1.16; 95% CI 1.05 1.29) and a significantly lower aRR for preterm birth (aRR 0.75; 95% CI 0.59 0.96). In the third trimester, we observed significantly higher aRRs for LBW and SGA (LBW: aRR 1.20; 95% CI 1.01 1.43; SGA: aRR 1.14; 95% CI 1.01 1.29). Conclusions: Symptoms of nausea, vomiting or poor appetite during pregnancy are associated with LBW, SGA and preterm birth in a setting with limited resources, especially beyond the first trimester. Trial registration: Prospectively registered at ClinicalTrials.gov on Dec 17, 2009 ( NCT01034254 ).
Article
Pregnancy expresses a balance between tolerance and inflammation. The excessive and recurrent intake of similar food clusters and the excessive production of corresponding IgG antibodies could start a cause-effect reaction and an increase of inflammatory mediators. The evaluation of BAFF and PAF could allow to measure levels of inflammation related to the personal profile of food consumption and modulate specific dietary changes. The best nutritional profile for pregnancy should probably be the most varied as possible, within the criteria of major food pyramids adopted for millennia by different macro-ethnicities.
Article
Hyperemesis gravidarum (HG) is a rare and severe form of nausea and vomiting of pregnancy associated with significant costs and psychosocial impacts. The etiology of HG remains largely unknown, although maternal genetics and placental factors are suspected. Prompt recognition and treatment of HG are essential to minimize associated maternal and fetal morbidity. Diagnosis is made on the basis of typical presentation, with exclusion of other causes of severe nausea and vomiting of pregnancy. Validated clinical tools are available to assess severity of symptoms and guide plans of care. Evidence to guide management of HG is limited, but many nonpharmacologic and pharmacologic interventions are available with published guidelines to inform implementation. Care of the woman with HG requires compassion and acknowledgement of individual needs and responses to interventions.
Article
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Nausea and vomiting in pregnancy (NVP) is common medical condition during pregnancy and associated with hormonal change. Early recognition and active treatment is warranted because it can be associated with adverse healthy effect in both fetus and mother. First, the possibility of other gastrointestinal disorder should be considered and precipitating factor, renal and liver function should be evaluated. Primay recommended pharmacotherapy is the combination of oral pyridoxine hydrochloride and doxylamine succinate. Other options including dopamin (D2) receptor antagonist, antihistamine and serotonine 5 hydroxytryptamine 3-receptor (5-HT3) can be used. Fluid mixed with multivitamine including thiamine supplement should be considered in case of severe dehydration and hyperemesis gravidarum. Emotional support is also an important part in the management of NVP. The physician shoud apply individualized approach for the safest and most appripriate treatment.
Article
An overview of the field of evolutionary consumption is provided. Brief summaries of disciplines within the evolutionary behavioral sciences that preceded evolutionary psychology (EP) are first offered. This is followed by a discussion of important EP principles including the domain-specificity of the human mind, and the difference between ultimate and proximate scientific explanations. The evolutionary bases of memory, attitude formation/change, emotions, perception (our five senses), personality, and decision making are addressed next, along with specific links to consumer research. Next, I demonstrate how numerous consumer acts could be classified into one of four basal Darwinian modules: survival, reproduction (mating), kin selection, and reciprocal altruism. The paper continues with an exploration of the evolutionary roots of cultural products (e.g., song lyrics) and Darwinian happiness (along with the evolutionary etiology of maladaptive phenomena such as pathological gambling and compulsive buying). I conclude with a discussion of key epistemological benefits of Darwinizing consumer research including greater consilience, increased interdisciplinarity, and an ethos of methodological pluralism.
Article
Vertebrates have evolved rapidly conditionable nausea and vomiting reflexes mediated by gut and brainstem receptors, clearly as a defense against neurotoxin ingestion. In 1977 Treisman proposed that sensory orientation linkages to emetic centers evolved for the same reason, and that motion sickness was an accidental byproduct. It was an "adaptationist" explanation for motion sickness, since it assumed that evolution has shaped all phenotypic traits for survival advantage. Treisman's "poison" theory is plausible, and frequently cited as the accepted scientific explanation for motion sickness. However, alternative explanations have been proposed. The creation of hypotheses is an essential part of science - provided they are testable. This paper reviews the evidence for the Poison theory and several other adaptationist explanations. These hypotheses are certainly not "just-so stories", but supporting evidence is equivocal, and contradictory evidence exists Parsimony suggests an alternative "pluralistic" view: The vertebrate reticular formation maintains oxygenated blood flow to the brain, discriminates unexpected sensory stimuli-including postural disturbances, and detects and expels ingested neurotoxins. The three systems share neuroarchitectural elements but normally function independently. Brainstem sensory conflict neurons normally discriminate brief postural disturbances, but can be abnormally stimulated during prolonged passive transport (e. g. by boat, beginning about 150-200 generations ago). Sensory conflict signals cross couple into the neurotoxin expulsion and avoidance system, producing an arguably maladaptive emetic phenotype.
Article
Nausea and vomiting of pregnancy (NVP) is a common medical condition which occurs in up to 85% of all pregnancies; however, many health care practitioners are uncertain as to how best to treat their patients. The symptoms and impact of NVP and/or hyperemesis gravidarum (HG) can vary greatly among women; therefore treatment must be tailored to the individual. This chapter provides an overview on the optimal management of NVP and HG, including dietary and lifestyle changes, non-pharmacological and pharmacological treatments, nutritional support for HG patients, as well as the importance of investigating for differential diagnosis. Importantly, as studies have shown a high rate of recurrent symptoms, it is beneficial for women to receive early treatment to help reduce the severity of symptoms in future pregnancies, hopefully preventing hospitalization and improving quality of life.
Article
Background: Nausea and vomiting of pregnancy (NVP) are common symptoms experienced during pregnancy. Both mild and severe symptoms can have significant morbidities and socioeconomic impact. Despite its frequency and associated distress, its exact cause is unknown. No study was done addressing this particular important issue in our country and this study will serve as a bench mark for future work on the topic in the Ethiopian context. Objective: To assess nausea and vomiting of pregnancy on ANC (antenatal care) clients of three hospitals of Addis Ababa. Methods: A descriptive facility based cross-sectional study, done in three teaching hospitals of Addis Ababa, the capital city of Ethiopia. Semi-structured questionnaires were administered to random sample of 384 pregnant women. Descriptive statistic was used to summarize data. P-value and χ2 test were used to measure associations. Results: The prevalence of nausea and vomiting of pregnancy was 74.5%, with 4.4% being admitted for severe symptoms. It was found out that 91% had symptoms in the 1st trimester, 2.1% after mid pregnancy, and 85% were triggered by smell and taste. Primigravidity, nulliparity, excessive salivation and food aversion were significantly associated with nausea and vomiting connected with pregnancy. Significant associations were also observed between admission for severity and being unmarried, loss to work, affected relationship, more frequent vomiting, and early onset of symptoms. Severe frequency of vomiting was a major factor associated with admission for severity and loss to work. Conclusion and recommendation: Nausea and vomiting of pregnancy found in this study were similar to other studies. Sensory stimuli were major trigger of symptoms and more frequent vomiting was linked with more admission. Importance of supportive measures, rest, counseling and advice on diet and life style modification needs to be underscored and early treatment of vomiting need to be considered.
Book
The development of a fully functional placenta was crucial to the evolution of human beings. It is the active interface of the most biologically intimate connection between two living organisms: a mother and her fetus. The Evolution of the Human Placenta discusses everything from the organ's methods of protecting the fetus from the mother's own immune system to placental diseases. Starting with some of the earliest events that have constrained or influenced the path of placental evolution in mammals and progressing to the specifics of the human placenta, this book examines modern gestation within an evolutionary framework. Human beings, in terms of evolution, are a successful, rapidly multiplying species. Our reproductive physiology would appear to be functioning quite well. However, human gestation is fraught with many poor outcomes for both the mother and fetus that appear to be-if not unique-far more common in humans than in other mammals. High rates of early pregnancy loss, nausea and vomiting during pregnancy, preeclampsia and related maternal hypertension, and preterm birth are rare or absent in other mammals yet quite typical in humans. Michael L. Power and Jay Schulkin explore more than 100 million years of evolution that led to the human placenta, and in so doing, they help unravel the mysteries of life's earliest moments. © 2012 The Johns Hopkins University Press. All rights reserved.
Article
Most anticancer drugs are teratogens, merely because they target vital cellular functions. Conversely, some plants produce agents that intentionally target embryonic signaling pathways, precisely to cause birth defects if pregnant animals eat such plants. Cyclopamine, a teratogen produced by a flowering plant, inhibits the Hh/Gli pathway, causing developmental defects such as cyclopia ( one eye in the middle of the face). In theory, selective teratogens may suppress cancer cells that reactivate embryonic pathways, while sparing most normal cells. I discuss the potential ( and limits) of teratogens in cancer therapy, linking diverse topics from morning sickness of pregnancy, embryonic pathways and poisonous plants to the mechanism of action of anticancer teratogens and their combinations with less selective cytotoxic agents.
Chapter
Animal experiments and limited number of human investigations in addition to clinical experiences suggested that gastrointestinal motility is inhibited during pregnancy due to metabolic and hormonal changes. Particularly the higher level of progesterone mediates this inhibitory effect inducing several digestive symptoms and diseases (Scott and Abu-Hamada, 2004).
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Background Nausea and vomiting are experienced by a majority of pregnant women worldwide. Previous studies have yielded conflicting results regarding their impact on birth outcomes and few studies have examined this relationship in settings with limited resources. We aimed to determine the effect of nausea, vomiting and poor appetite during pregnancy on birth outcomes in rural Nepal. Methods Observational cohort study using data collected in two randomized, community-based trials to assess the effect of influenza immunization during pregnancy on reproductive and respiratory outcomes among pregnant women and their offspring. Pregnant women in Sarlahi District, Nepal were recruited from 2011-2013. Exposure was defined as nausea, vomiting or poor appetite at any point during pregnancy and by trimester; symptoms were recorded monthly throughout pregnancy. Adverse outcomes were low birth weight (LBW), preterm birth and small for gestational age (SGA). Adjusted relative risks (aRR) with 95% CIs is reported from Poisson regressions with robust variance. Results Among 3,623 pregnant women, the cumulative incidence of nausea, vomiting or poor appetite was 49.5% (n=1793) throughout pregnancy and 60.6% (n=731) in the first trimester. Significantly higher aRRs of LBW and SGA were observed among women experiencing symptoms during pregnancy as compared to symptom free women (LBW: aRR 1.20; 95% CI 1.05 1.28; SGA: aRR 1.16; 95% CI 1.05 1.28). Symptoms in the first trimester were not significantly associated with any of the outcomes. In the second trimester, we observed significantly higher aRRs for LBW and SGA (LBW: aRR 1.17; 95% CI 1.01 1.36; SGA: aRR 1.16; 95% CI 1.05 1.29) and a significantly lower aRR for preterm birth (aRR 0.75; 95% CI 0.59 0.96). In the third trimester, we observed significantly higher aRRs for LBW and SGA (LBW: aRR 1.20; 95% CI 1.01 1.43; SGA: aRR 1.14; 95% CI 1.01 1.29). Conclusions Symptoms of nausea, vomiting or poor appetite during pregnancy are associated with LBW, SGA and preterm birth in a setting with limited resources, especially beyond the first trimester. Trial registration Prospectively registered at ClinicalTrials.gov on Dec 17, 2009 (NCT01034254)
Article
Objective To date, no previous study has examined the independent association between nausea, vomiting, and social support and health-related quality of life among early pregnant women. Methods To fill this gap, we investigated these associations within this group using repeated-measurement data. Methods A prospective cohort design was conducted from August 2018 to February 2019 with perinatal outpatients in a general hospital. Participants were 153 pregnant women aged 20 years or older and under 20 weeks of gestation at their first prenatal visit. Along with reporting their sociodemographic data, participants completed the Index of Nausea, Vomiting, and Retching (INVR), the 12-item Short Form Health Survey (SF-12), and the Multidimensional Scale of Perceived Social Support (MSPSS) and re-completed INVR, and SF-12 at follow-up checkups a maximum of three times. Results After controlling for internal correlations and confounding factors, INVR was found to be significantly negatively associated with the physical component summary scale score of SF-12; however, MSPSS showed no association with the physical component summary scale score. Conversely, the scores for both INVR and MSPSS were negatively and positively, respectively, significantly associated with the mental component summary scale score of SF-12. Conclusion The severity of nausea and vomiting significantly impacts physical quality of life during early pregnancy. Both nausea and vomiting and social support significantly and independently affect mental quality of life. Health professionals should recognize these impacts and be aware that social support contributes to improving mental quality of life.
Article
Introduction: Nausea and vomiting of pregnancy (NVP) is the most prevalent medical condition during gestation, affecting up to 85 % of pregnant women. Many of them hesitate to use medications due to perceived fetal risks. Areas covered: There are two main aspects to medication safety in NVP: The fetal safety of drugs used to treat NVP symptoms, and the risks of untreated NVP. While mild and moderate NVP are not associated with major increase in fetal or maternal risks, and may render protective fetal effects, they have major impact on the quality of life of the mother. In contrast, severe NVP and hyperemesis gravidarum (HG) are associated with increased maternal and fetal risks, from in utero growth restriction to developmental delay. For the doxylamine/pyridoxine combination, H1blockers and metoclopramide there are large studies documenting fetal safety. There are also large reassuring studies on the fetal safety of ondansetron, but they are contrasted by some studies claiming increased fetal risk. Expert opinion: Fetal safety of the doxylamine/pyridoxine combination, H1blockers and for metoclopramide has been documented. Reassuring studies on the fetal safety of ondansetron, are contrasted by some studies claiming increased teratogenicity. More studies are needed to quantify fetal risks of HG.
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According to some psychological studies, women approaching ovulation feel the increased desire to have short-term sexual affairs with “sexy cads” while they are in long-term relations with “good dads.” I argue that this psychological property is a vestige of our evolutionary history. Early hominid females occasionally acquired good genes from top-ranking males while they were in long-term relations with low-ranking males. The Paleolithic living conditions indicate that women with the foregoing psychological trait were more likely to have viable children than (...) those without it. Sexy cads are the descendents of the top-ranking males, and good dads are the descendents of the low-ranking males. Sexy cads and good dads will continue to coexist in the future, developing better methods to detect cheaters and to escape detection.
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Spices and morning sickness may shield us from toxins and microorganisms in the diet.
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The Hata Member of the Bouri Formation is defined for Pliocene sedimentary outcrops in the Middle Awash Valley, Ethiopia. The Hata Member is dated to 2.5 million years ago and has produced a new species of Australopithecus and hominid postcranial remains not currently assigned to species. Spatially associated zooarchaeological remains show that hominids acquired meat and marrow by 2.5 million years ago and that they are the near contemporary of Oldowan artifacts at nearby Gona. The combined evidence suggests that behavioral changes associated with lithic technology and enhanced carnivory may have been coincident with the emergence of the Homo clade from Australopithecus afarensis in eastern Africa.
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Approximately two-thirds of women experience nausea or vomiting during the first trimester of pregnancy. These symptoms are commonly known as morning sickness. Hook (1976) and Profet (1988) hypothesized that morning sickness protects the embryo by causing pregnant women to physically expel and subsequently avoid foods that contain teratogenic and abortifacient chemicals, especially toxic chemicals in strong-tasting vegetables, caffeinated beverages and alcohol. We examined this hypothesis by comprehensively reviewing the relevant medical, psychological and anthropological literature. In its support, (i) symptoms peak when embryonic organogenesis is most susceptible to chemical disruption (weeks 6-18), (ii) women who experience morning sickness are significantly less likely to miscarry than women who do not (9 of 9 studies), (iii) women who vomit suffer fewer miscarriages than those who experience nausea alone, and (iv) many pregnant women have aversions to alcoholic and nonalcoholic (mostly caffeinated) beverages and strong-tasting vegetables, especially during the first trimester. Surprisingly, however, the greatest aversions are to meats, fish, poultry, and eggs. A cross-cultural analysis using the Human Relations Area Files revealed 20 traditional societies in which morning sickness has been observed and seven in which it has never been observed. The latter were significantly less likely to have animal products as dietary staples and significantly more likely to have only plants (primarily corn) as staples than the 20 societies in which morning sickness occurred. Animal products may be dangerous to pregnant women and their embryos because they often contain parasites and pathogens, especially when stored at room temperatures in warm climates. Avoiding foodborne microorganisms is particularly important to pregnant women because they are immunosuppressed, presumably to reduce the chances of rejecting tissues of their own offspring (Haig 1993). As a result, pregnant women are more vulnerable to serious, often deadly infections. We hypothesize that morning sickness causes women to avoid foods that might be dangerous to themselves or their embryos, especially foods that, prior to widespread refrigeration, were likely to be heavily laden with microorganisms and their toxins. The alternative hypotheses that morning sickness is (i) an epiphenomenon of mother-offspring genetic conflict or hormones associated with viable pregnancies, or (ii) an indicator to potential sexual partners and kin that the woman is pregnant, resulting in reduced sexual behavior and increased nepotistic aid, were not well supported. Available data are most consistent with the hypothesis that morning sickness serves an adaptive, prophylactic function.
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Pregnancy sickness, a suite of "symptoms" that frequently co-occur during pregnancy, may be an adaptation providing behavioral prophylaxis against infection. Maternal immunosupression, necessary for tolerance of the fetus, results in gestational vulnerability to pathogens. Throughout the period of maximal vulnerability, dietary behavior is significantly altered via changes in nausea susceptibility and olfaction and the development of marked aversions and cravings. Of food types, meat is both the most likely to carry pathogens and the principal target of gestational aversions and pregnancy taboos. Because meat was prominent in ancestral human diets but hygienic procedures that effectively eliminate the risk of meat-borne infection are recent, such pathogens likely constituted a source of selective pressure on pregnant females throughout human history. Both the relatively low protein and energy demands of the first trimester and the existense of nonmeat alternatives would have allowed for the evolution of time-limited gestational meat-avoidance mechanisms.Complementing these mechanisms, gestational cravings target substances that may influence immune functioning and affect the availability of iron in the gastro-intestinal tract, thereby limiting the proliferation of iron-dependent pathogens. Clinical and ethnographic findings are examined in light of these proposals, and directions for future research are outlined.
Article
Humans have borrowed plants' chemical 'recipes' for evolutionary survival for use in cuisine to combat foodborne microorganisms and to reduce food poisoning.
Article
The Hata Member of the Bouri Formation is defined for Pliocene sedimentary outcrops in the Middle Awash Valley, Ethiopia. The Hata Member is dated to 2.5 million years ago and has produced a new species of Australopithecus and hominid postcranial remains not currently assigned to species. Spatially associated zooarchaeological remains show that hominids acquired meat and marrow by 2.5 million years ago and that they are the near contemporary of Oldowan artifacts at nearby Gona. The combined evidence suggests that behavioral changes associated with lithic technology and enhanced carnivory may have been coincident with the emergence of the Homo clade fromAustralopithecus afarensis in eastern Africa.
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In immunointact individuals, infection by the ubiquitous protozoan parasite Toxoplasma gondii is common, but clinical disease is rare; however, fetal and immunocompromised populations are at risk for clinical toxoplasmosis. T. gondii organisms persist as quiescent tissue cysts in various tissues of the body with the possibility of tissue cysts reactivating to actively multiplying parasites if there is a decline in the infected individual's immune system. In more recent years, there has been an increase in toxoplasmosis due to a steadily increasing immunocompromised population. T. gondii infections are controlled principally by the cellular immune system. Thus, individuals with defective cell-mediated immunity cannot control a T. gondii infection and if they have been infected previously, reactivation of a previous infection may occur. Congenital toxoplasmosis can cause severe complications in the fetuses of women who are infected with T. gondii during pregnancy. Toxoplasmosis can be serious in individuals with malignancies or AIDS. Since transplant recipients are immunosuppressed by drug treatment, they too are at risk for toxoplasmosis if they receive an organ from an infected donor. Vaccines against T. gondii suitable for human use have not been developed. No drug is available that can eliminate the encysted stage of the parasite; thus, infected individuals are always at risk for reactivation of the parasite if there is a failure of their immune system. More emphasis should be placed on the elimination of T. gondii by development of drugs which can eliminate the cyst stage in tissues and on development of vaccines suitable for protecting humans against infection or reactivation.
Article
Contends that there are 4 different levels of analysis (evolutionary origins, functional consequences, and cognitive and physiological ontogenetic processes) on which every hypothesis in evolutionary biology is based. Thus, there are multiple types of correct answers to any question about causality and that the category of the answer depends on the researcher's training and/or inclination. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
We conducted a case-control study of spontaneous abortion in Santa Clara County, California between 1986 and 1987- We analyzed data on 607 cases and 1,284 controls to evaluate the potential association between caffeine consumption during the first trimester of pregnancy and spontaneous abortion. About 70% of the women consumed caffeinated coffee, tea, and/or soda; 7% of the women consumed more than an average of 300 mg of caffeine daily. The crude odds ratio (OR) for heavy caffeine consumption (> 300 mg/day) was 1.55 (95% CI: 1.04-2.31), which decreased to 1.22 (95% CI: 0.80-1.87) after controlling for confounding factors. For these heavy users, nausea modified the association of spontaneous abortion and caffeine; heavy caffeine consumers reporting nausea had a doubled risk for spontaneous abortion (adjusted OR = 2.10, 95% CI: 1.20-3.70), in contrast to those who did not report nausea (adjusted OR = 0.5 3, 95% CI: 0.27-1.04). Heavy caffeine consumers who decreased their caffeine intake early in pregnancy had a risk of spontaneous abortion similar to that of nonconsumers (C) Lippincott-Raven Publishers.
Article
The generalizability of the apparent decreased risk of miscarriage and perinatal mortality associated with early pregnancy nausea and vomiting was investigated by examining data available from 11 previous studies. Statistical reanalyses of these studies indicated a strong significant association of nausea and vomiting of pregnancy with decreased risk of miscarriage, and no consistent associations with perinatal mortality. A statistical meta-analysis confirmed the decreased risk of miscarriage associated with gestational nausea and vomiting (common odds ratio = 0·36, 95% CI 0·32 to 0·42) and indicated that the association with decreased fetal mortality was restricted to the first 20 weeks gestation. The meta-analysis also revealed that over 150 additional possibly unreported studies with contradictory evidence would be required to refute this observed association.
Article
Two hundred and two female rhesus monkeys were monitored for completion of meals and instances of food rejection during nonpregnant menstrual cycles and during pregnancy. Two prominent periods of increased food rejection were found. The first occurred midway through the menstrual cycle, around the expected time of ovulation. Incidence of food rejection during this periovulatory period was significantly greater than that observed during the early follicular or midluteal stages of the cycle. Food rejection also rose sharply during the third through the fifth weeks of pregnancy and then tapered off over the next month and a half. The feeding changes during early rhesus pregnancy are contrary to what has been described for rodents, but the pattern is consistent with the incidence of nausea and feeding changes reported for human pregnancies. The observations on rhesus females indicated a systematic relationship between levels of food intake and reproductive condition in primates. When feeding changes are compared to reports of endogenous estrogen and progesterone determinations, a positive correlation is noted between incidence of food rejection and levels of circulating estrogens.
Article
Nausea and vomiting are routine features of early pregnancy in humans. But are they adaptive or pathological? Several lines of evidence suggest that they protect mothers and developing embryos from dietary mutagens and pathogens. Nausea and vomiting in pregnancy (NVP) coincide with the vulnerable period of embryogenesis, are associated with food aversions, and are predictors of positive pregnancy outcomes. Here, I argue that NVP is not directly adaptive, but arises as a byproduct of genetic conflict between mother and embryo. The negative correlation between first-trimester spontaneous abortion and NVP is not the result of protection of embryos from environmental mutagens or pathogens, but the result of intrinsic chromosomal defects. These low-quality embryos produce subnormal levels of human chorionic gonadotropin, a hormone involved in pregnancy maintenance, and the probable proximate trigger for NVP.
Article
The association of nausea and vomiting in pregnancy with the outcome of pregnancy was investigated in a historical cohort of 903 women in Los Angeles, California, USA. Multivariable statistical methods were employed to control for the potential confounding effects of age, ethnicity, occupation, and anti-emetic use on pregnancy outcome. The analyses indicated that vomiting was associated with decreased risk of miscarriage (adjusted odds ratio 0.18, 95% CI 0.06 to 0.53); women with nausea but no vomiting had a miscarriage risk equal to that in the sample overall. Among the subsample of women with signs of threatened miscarriage, those who had experienced vomiting had a decreased risk of miscarriage (10.3% vs 31.7% in the subsample). No statistically significant association was observed between nausea and vomiting of pregnancy and other pregnancy outcomes (perinatal mortality, fetal anomalies, neonatal anthropometric measures).
Article
To study the problem of nausea and vomiting in early pregnancy an epidemiological survey was undertaken, obtaining information from 500 consecutive antenatal patients. Seventy-six percent of women complained of symptoms during the first trimester, and in only 27% had the symptoms resolved by the twelfth week. Job efficiency was markedly impaired. Women who suffered nausea premenstrually, or on the oral contraceptive pill, were much more likely to develop symptoms, lending credence to a hormonal etiology for the condition.
Article
: The relationship of nausea during pregnancy with pregnancy outcome was studied using information from a post-pregnancy survey of a sample of women in a cohort of 7,767 pregnancies. Seventy-one percent of women were nauseated at some time during pregnancy. Nausea was unrelated to race and education. Younger women and those of higher parity were significantly (p < 0.05) more likely to be nauseated than older women and primiparas. The percentage of women nauseated during pregnancy was 70.1 in those who delivered a boy and 73.3 in those who delivered a girl, a difference that was not statistically significant (X2= 1.8, df 1, p = 18). The relative risks of spontaneous abortion and of ectopic pregnancy were significantly (p < 0.01) increased in women who were not nauseated at all during pregnancy, but there was no significant association of freedom from nausea with increased or decreased risk of stillbirth, congenital anomaly, or intrauterine growth retardation (IUGR). Twelve percent of women whose pregnancy lasted two or more trimesters had nausea throughout pregnancy. The relative risks of IUGR and of major and minor congenital anomaly were elevated in women with persistent nausea, although the elevations in risk were small and not statistically significant. Information about nausea of pregnancy may be useful in counseling pregnant women. It may help guide the evaluation of patients in whom ectopic pregnancy is a possibility, particularly where ultrasound is not available. If nausea is a biological marker for good placental function, better delineation of its physiologic basis might contribute to our understanding of variations in placental function and could result in development of a tool for monitoring it.
Article
The pattern of nausea and/or vomiting of pregnancy were investigated in a group of 414 predominantly white, upper middle-class women in Albany, New York; patterns were ascertained before their eighty-eighth day of gestation and followed up to the end of pregnancy. Of these, 89.4% reported at least some symptoms. This frequency is higher than reported previously, perhaps in part because extensive attempts were made in this study to ascertain symptoms. The incidence of vomiting was about 55%. Women with no symptoms of nausea and/or vomiting of pregnancy experienced a significantly greater proportion of nonviable pregnancy outcomes (fetal death). Increased intake of niacin during the first trimester was associated with decreased infant birth weight. This may be the result of quicker fetal maturation due to increased levels of protein intake.
Article
In this article the immunologic, clinical, and epidemiologic evidence for altered host susceptibility to infection during pregnancy is reviewed in an attempt to determine general principles that can be applied to interpret the wide range of information available and that can be utilized for epidemiologic analysis and study design. Gestational changes in immunity are related to the maternal history of infection during pregnancy. Primary infections are distinguished from recurrent infections, and the different patterns of recurrent infection in pregnancy are defined. This classification system is then used to interpret a wide range of data. The impact of infection in pregnancy on the offspring is discussed in relation to vertical transmission and pregnancy immune status: in pregnant women the clearance, if not the incidence, of infection is similar to that in nonpregnant women; maternal susceptibility to infection alters early in gestation (at less than 12 weeks); the degree of maternal recovery from early gestational infection affects vertical transmission rates; there are few data on how patterns of infection with the major tropical parasites during pregnancy relate to vertical transmission.
Article
Factors associated with early pregnancy vomiting were investigated in 9098 first-trimester registrants in the Collaborative Perinatal Project. Vomiting in the absence of hyperemesis or gastroenteritis was noted in 56% of all women, and was more common among primigravidas (P = .002), younger women (P less than .001), women with less than 12 years of education (P less than .001), nonsmokers (P less than .001), and women weighing 77.1 kg (170 lb) or more (P = .003). Adjustment for confounders did not change these associations. Women reporting vomiting were less likely to experience miscarriage or stillbirth (P = .002) and delivery before 37 weeks' gestation (P = .004), but there was no difference in infant birth weight between mothers with and without vomiting (P = .48). Women who vomit in one pregnancy are more likely to vomit in subsequent pregnancies than are comparable women who did not vomit.
Article
The hypothesis that pregnancy sickness has evolved to expel dietary toxins (PROFET, 1988; 1992; HOOK, 1976) is critically reviewed. Instead it is proposed that pregnancy sickness and mastalgia have evolved to reduce frequency of sexual intercourse in early pregnancy. Reduction in coital frequency during the first trimester has often been documented. Uterine motility during sexual excitement contrasts with lack of spontaneous myometrial activity in the first trimester, except when uterine cramping sometimes occurs as a result of intercourse. Such cramping would be expected to increase the chances of spontaneous abortion.
Article
During gestation, the immune system is challenged with establishing tolerance to the partial allograft represented by the paternal contribution to the fetal genome. That fact that cell-mediated immunity is decreased while T-cell-dependent immunoglobin production remains intact or is increased is generally accepted. This latter phenomenon can be placed in teleological perspective in terms of providing passive immunity to the fetus. T-cell lineages that diverge based on function and cytokine production have been identified. Pregnancy is associated with a relative increase in Th2-associated immunity, characterized by increased production of the cytokines IL-4 and IL-10. These changes occur concomitantly with increased immunoglobulin production and decreased Th1 immunity. IL-2 and interferon secretion characterize Th1 immunity, facilitating allograft rejection. These changes in Th1 and Th2 have implications for the clinical course of a several autoimmune diseases that may complicate pregnancy and the postpartum period.
Article
Pregnancy has commonly been viewed as a cooperative interaction between a mother and her fetus. The effects of natural selection on genes expressed in fetuses, however, may be opposed by the effects of natural selection on genes expressed in mothers. In this sense, a genetic conflict can be said to exist between maternal and fetal genes. Fetal genes will be selected to increase the transfer of nutrients to their fetus, and maternal genes will be selected to limit transfers in excess of some maternal optimum. Thus a process of evolutionary escalation is predicted in which fetal actions are opposed by maternal countermeasures. The phenomenon of genomic imprinting means that a similar conflict exists within fetal cells between genes that are expressed when maternally derived, and genes that are expressed when paternally derived. During implantation, fetally derived cells (trophoblast) invade the maternal endometrium and remodel the endometrial spiral arteries into low-resistance vessels that are unable to constrict. This invasion has three consequences. First, the fetus gains direct access to its mother's arterial blood. Therefore, a mother cannot reduce the nutrient content of blood reaching the placenta without reducing the nutrient supply to her own tissues. Second, the volume of blood reaching the placenta becomes largely independent of control by the local maternal vasculature. Third, the placenta is able to release hormones and other substances directly into the maternal circulation. Placental hormones, including human chorionic gonadotropin (hCG) and human placental lactogen (hPL), are predicted to manipulate maternal physiology for fetal benefit. For example, hPL is proposed to act on maternal prolactin receptors to increase maternal resistance to insulin. If unopposed, the effect of hPL would be to maintain higher blood glucose levels for longer periods after meals. This action, however, is countered by increased maternal production of insulin. Gestational diabetes develops if the mother is unable to mount an adequate response to fetal manipulation. Similarly, fetal genes are predicted to enhance the flow of maternal blood through the placenta by increasing maternal blood pressure. Preeclampsia can be interpreted as an attempt by a poorly nourished fetus to increase its supply of nutrients by increasing the resistance of its mother's peripheral circulation.
Article
Pregnancy is traditionally viewed as a harmonious collaboration between mother and fetus. From this perspective, viviparity poses a series of problems that maternal and fetal genes work together to solve and the many complications of pregnancy are interpreted as evidence of the malfunctioning of an evolved system or of the failure of natural selection to achieve an adaptive goal. This view fails to recognize aspects of genetic conflict that lie at the heart of gestation. At least three interrelated sources of conflict can be identified: (i) conflict between genes expressed in the mother and genes expressed in the fetus/placenta (parent-offspring conflict); (ii) conflict between maternally-derived and paternally-derived genes within the fetal genome (genomic imprinting); and (iii) conflict between maternal genes that recognize themselves in offspring and the rest of the maternal genome (gestational drive).
Article
This study sought to evaluate maternal characteristics and pregnancy outcomes among women with hyperemesis gravidarum. We performed a retrospective analysis of pregnancy records of obstetric admissions during a 6-year period. Women treated as out-patients for hyperemesis were also identified. Hyperemesis was defined as excessive nausea and vomiting resulting in dehydration, extensive medical therapy, and/or hospital admission. Statistical analysis was by t-test and chi square. We identified 193 women (1.5%) who developed hyperemesis among 13,053 women. Racial status, marital status, age, and gravidity were similar between the hyperemesis patients and the general population. However, there were less women with hyperemesis who were para 3 or greater. Forty-six women (24%) required hospitalization for hyperemesis, mean hospital stay 1.8 days, range 1-10 days. One patient required parenteral nutrition, two had yeast esophagitis, none had HIV infection, psychiatric pathology or thyroid disease. Pregnancy outcomes between hyperemesis patients and the general population were similar for mean birth weight, mean gestational age, deliveries less than 37 weeks, Apgar scores, perinatal mortality or incidence of fetal anomalies. Our incidence of hyperemesis (1.5%) is similar to that of other published reports. Women with hyperemesis have similar demographic characteristics to the general obstetric population, and have similar obstetric outcomes.
Article
We report the correlation between total hours of nausea in early pregnancy, as a continuous variable, and various factors in women's obstetric and personal histories. Positive correlations for increased nausea were found with heavier placentae (p = 0.005), non-smoking status (p = 0.004), women with nausea in previous pregnancies (p = 0.005), and women whose mothers experienced trouble with nausea in their pregnancies (p = 0.001). 17 other factors did not relate to pregnancy nausea at the p < 0.01 level.
Article
To determine the relative risk for major malformations associated with antihistamine (H1 blockers) exposure in the first trimester of pregnancy, a literature search of all studies examining the association between antihistamines and major malformations for the period 1960 to 1991 was conducted, followed by meta-analysis. Odds ratio was calculated using the Mantel-Haenszel method. Twenty-four controlled studies met the inclusion criteria with more than 200,000 participating women. The summary odds ratio of major malformations associated with antihistamines taken during the first trimester was 0.76 (95% CI: 0.60-0.94). This analysis indicates that H1 blockers used mainly for morning sickness during the first trimester do not increase the teratogenic risk in humans and may, in fact, be associated with a protective effect. More study is needed to verify the possibility that by preventing vomiting, antihistamines may ensure better metabolic conditions to the fetus and thus may reduce some birth defects. Alternatively, it is possible that pregnancies characterized by vomiting are associated with better outcome due to other reasons, such as hormonal status or placental function. Women suffering from morning sickness which is not controlled by nonpharmacological methods can safely use antihistamines.
Article
NVP is a spectrum of disorders ranging from the physiologically typical mild to moderate nausea and vomiting that is usually self-limited, to the pathologic, intractable symptoms of hyperemesis gravidarum that are associated with metabolic and electrolyte disturbances and weight loss. Up to 90% of pregnant women experience NVP. The pathogenesis remains poorly understood with multifactorial theories proposed combining both biologic and psychological factors. Diagnosing this syndrome is straightforward, but other organic sources should be excluded when symptoms are severe or prolonged. The overall prognosis is excellent for typical NVP, but whether hyperemesis gravidarum increases the risk to the fetus is controversial. Initial management should be conservative, including reassurance of the transient nature of the symptoms and the good prognosis, in addition to dietary modifications. Pharmacologic therapy is reserved for patients with persistent symptoms and is appropriate after discussion of the risks and benefits with informed consent. Alternative treatments, including psychotherapy and other nonpharmacologic modalities, are less proven but potentially safe and effective, thus providing additional therapeutic options. In refractory cases, nutritional supplementation becomes life-saving for both the mother and the fetus. Therapeutic abortion is a rare and last resort, to be used only when maternal life is threatened.
Article
Food aversion learning has attracted widespread interest because it is a highly adaptive, powerful type of learning with both practical and theoretical ramifications. It has features that make it unusual and robust when compared with other learning paradigms. It has relevance to human problems in that it is likely to contribute to food choice and appetite problems in certain clinical situations. And the robustness of this learning makes it a promising model for neurobiologists interested in understanding neural mechanisms of plasticity. This review provides a broad overview of these aspects of taste aversion learning and points to areas where questions remain and additional research is needed.
Article
The consequences of foodborne illness can be particularly devastating during pregnancy because both the woman and her fetus are at risk. Escalated production of progesterone during pregnancy leads to down-regulation of cellular (cell-mediated) immune functions. Many foodborne pathogens (and other pathogens) are intracellular pathogens, and infections caused by these pathogens are controlled by cell-mediated immunity. The pregnancy-induced decrease in cell-mediated immune functions leads to increased susceptibility of the pregnant woman to certain infections. Hepatitis E virus, Coxiella burnetii, Listeria monocytogenes, and Toxoplasma gondii are intracellular pathogens that have a predilection for the maternal-fetal unit and may induce serious disease in the mother and/or fetus. In the United States, T. gondii and L. monocytogenes are the most important foodborne pathogens in pregnancy, and these organisms can induce death or grave disease in the fetus and newborn. The pregnant woman, in order to protect herself and her fetus from the consequences of foodborne illness, must practice a high standard of food hygiene and personal cleanliness.
Article
Cooking is a human universal that must have had widespread effects on the nutrition, ecology, and social relationships of the species that invented it. The location and timing of its origins are unknown, but it should have left strong signals in the fossil record. We suggest that such signals are detectable at ca. 1.9 million years ago in the reduced digestive effort (e.g., smaller teeth) and increased supply of food energy (e.g., larger female body mass) of early Homo erectus. The adoption of cooking required delay of the consumption of food while it was accumulated and/or brought to a processing area, and accumulations of food were valuable and stealable. Dominant (e.g., larger) individuals (typically male) were therefore able to scrounge from subordinate (e.g., smaller) individuals (typically female) instead of relying on their own foraging efforts. Because female fitness is limited by access to resources (particularly energetic resources), this dynamic would have favored females able to minimize losses to theft. To do so, we suggest, females formed protective relationships with male co-defenders. Males would have varied in their ability or willingness to engage effectively in this relationship, so females would have competed for the best food guards, partly by extending their period of sexual attractiveness. This would have increased the numbers of matings per pregnancy, reducing the intensity of male intrasexual competition. Consequently, there was reduced selection for males to be relatively large. This scenario is supported by the fossil record, which indicates that the relative body size of males fell only once in hominid evolution, around the time when H. erectus evolved. Therefore we suggest that cooking was responsible for the evolution of the unusual human social system in which pair bonds are embedded within multifemale, multimale communities and supported by strong mutual and frequently conflicting sexual interest.
Article
A distinction should be made between genetic aspects of schizophrenia and familial aspects. Genetic aspects of the disease have been reviewed and found to be deficient in many respects. Until recent years, familial factors were assumed to be psychological in origin, but this assumption is now discredited. Research efforts should focus on familial factors that are biological, especially infectious agents that may be transmitted within the family. Most infectious agents are influenced by predisposing genes. The etiology of schizophrenia, then, may turn out to involve biological familial infectious agents that are influenced by susceptibility genes governing the infectious process and the clinical expression of the disease.
Article
Nausea and emesis in early pregnancy is a common phenomenon affecting between 50% and 70% of pregnant women, but little is known about the etiology and possible function of this common and often incapacitating condition. Morning sickness has been reported to have a positive effect on pregnancy outcome and is associated with a decreased risk of miscarriage, preterm birth, low birth weight (LBW), and perinatal death. Both human and animal studies have shown that reduced energy intakes in early pregnancy are associated with increased placental weight. Based on evidence from the literature, a hypothesis is proposed that suggests a functional role for the nausea and emesis of pregnancy in stimulating early placental growth. It is suggested that morning sickness, resulting from secretion of hCG and thyroxine, reduces maternal energy intake. As a result, maternal levels of the anabolic hormones, insulin, and insulin growth factor-1 (IGF-1) are lowered. By suppressing maternal tissue synthesis in early pregnancy, we propose that nausea and vomiting in pregnancy helps ensure that nutrient partitioning favors the developing placenta. Evidence is also presented that suggests there may be a positive relationship between morning sickness and preconceptional body mass index (BMI), such that women who are underweight will experience less severe symptoms of morning sickness compared with women with normal preconceptional BMIs.
Nausea and vomiting of pregnancy Maternal and fetal outcomes in hyperemesis gravidarum
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Reproductive immunosuppression and diet: an evolutionary perspective on pregnancy sickness and meat consumption [plus commentaries]
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Fessler DMT. Reproductive immunosuppression and diet: an evolutionary perspective on pregnancy sickness and meat consumption [plus commentaries]. Curr Anthropol 2002;43:19-61.
Pregnancy sickness and embryo quality Number 5 Sherman and Flaxman S197 Deutsch JA. Pregnancy sickness as an adaptation to concealed ovulation
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