Morning Sickness or NVP: National Survey of Nurse Practitioners Points to Underreporting of Common Condition in Pregnancy

MAPLE GROVE, Minn., Feb. 27, 2012 /PRNewswire/ -- Nausea and vomiting in pregnancy (NVP) is the most common medical condition in pregnancy, affecting an estimated 70 to 85% of all pregnant women.(1) Yet in a recent national survey of more than 350 nurse practitioners (NPs), only 40% of their patients reported experiencing NVP in the last 12 months, pointing to the need for greater patient and healthcare provider dialogue about the condition.   

The survey was conducted online in November 2011 by the National Association of Nurse Practitioners in Women's Health (NPWH) and supported by Upsher-Smith Women's Health.

"NVP is a condition that affects many pregnant women.  And, contrary to popular belief, many pregnant women experience symptoms sporadically throughout the day.  Even a less severe case of NVP can detract from the joy of pregnancy and may affect a woman's general well being," said Elizabeth Kostas-Polston, PhD, APRN, WHNP-BC, NPWH Board Chair*. "Women experiencing NVP should discuss appropriate treatment strategies with their healthcare provider and not suffer in silence." 

The survey also revealed that after dietary and lifestyle changes, the top three treatment options currently being recommended include: vitamin B6, ginger and ondansetron. 

"Historically, there have been a limited number of treatment options available that are specifically designed for women suffering from NVP," said Wesley Mark Todd, MD, Senior Director Medical Affairs, Upsher-Smith Laboratories, Inc. "The survey results indicate that the top strategies identified by nurse practitioners are in alignment with recommendations put forth by The American Congress of Obstetricians and Gynecologists (ACOG).(1) ACOG recommends vitamin B6 as a first-line approach for nausea and vomiting, and suggests ginger as a non-drug option."   

Other key findings of the nurse practitioners' assessment include:

• The majority of NPs (76%) believe that NVP poses a moderate-to-severe problem for their patients.
• 70% of the respondents were unaware of the term NVP – a definition that reflects the fact that NVP can occur at any time throughout the day as opposed to the traditional "morning sickness."(2)
• More than half (56%) of NPs reported that the average NVP patient contacts their practice 3 times or more for help with their symptoms during the course of her pregnancy.
• During the past 12 months, nearly one-quarter of the NPs reported that all of their patients suffering from NVP were treated with dietary and/or lifestyle changes. 
• Nearly 80% of NPs agree that ginger/B-vitamins as a component of a prenatal supplement may help ease NVP symptoms.
• According to the survey, nurse practitioners most often recommend vitamin B6 (84%), ginger (81%) and ondansetron (79%) for patients being treated for NVP.

Survey Methodology

The research was undertaken by NPWH using an online survey conducted in November 2011.  The survey was emailed to members of NPWH.  The 17-question survey was hosted by NPWH and available online from November 8 – 15, 2011.  More than half of the respondents have been practicing for 10 years or more.

About NVP

Although commonly known as morning sickness, NVP can occur at any time throughout the day and affects 70 to 85% of pregnant women.  Approximately 50% of pregnant women experience both nausea and vomiting, while 25% experience only nausea. Studies have shown that women taking a multivitamin regularly at the time of conception were less likely to have severe cases of NVP.(1) In most cases, the condition affects women only during the first and early second trimesters, although up to 20% of women continue to have symptoms throughout pregnancy.(3)

NVP can cause significant distress in many women and can lead to feelings of anxiety about how the fetus may be affected.  Some women do not seek treatment for morning sickness because of concerns about drug therapy during pregnancy or because they don't know treatments are available.(2)  Even a less severe case of NVP can detract from the joy of pregnancy and can affect a woman's general well being.(3)

NVP Treatment Options

The treatment of NVP depends on the severity of symptoms.  Treatment options range from dietary changes and use of medications for mild to moderate NVP, to hospitalization, or total parenteral nutrition for the most severe cases of NVP.  The American Congress of Obstetricians and Gynecologists (ACOG) recommends women experiencing NVP get plenty of rest, avoid bothersome smells, eat five or six small meals a day instead of three large ones, avoid spicy and fatty foods, and eat crackers before getting out of bed in the morning.  Ginger, acupuncture and acupressure, motion sickness bands, or hypnosis may also help.(4)  First-line treatment is generally vitamin B6, which can reduce symptoms of mild to moderate nausea, or B6 and doxylamine for reducing vomiting.  If B6 and doxylamine are unsuccessful, doctors may recommend antihistamines or anti-emetics, such as promethazine, metoclopramide, or ondansetron. Ginger can be added at any time during therapy. Patients who cannot hold down food or liquids may be treated with intravenous therapy.(1)

About The National Association of Nurse Practitioners in Women's Health (NPWH)

The National Association of Nurse Practitioners in Women's Health was founded in 1980.  NPWH's mission is to assure the provision of quality health care to women of all ages by nurse practitioners.  NPWH defines quality health care to be inclusive of an individual's physical, emotional, and spiritual needs.

NPWH recognizes and respects women as decision-makers for their health care. NPWH's mission includes protecting and promoting a woman's right to make her own choices regarding her health within the context of her personal, religious, cultural, and family beliefs.

NPWH represents nurse practitioners that provide care to women in the primary care setting as well as in women's health specialty practices.

NPWH is a trusted source of information on nurse practitioner education, practice, and women's health issues.  NPWH works with a wide range of individuals and groups within nursing, medicine, and the women's health community.

About Upsher-Smith Women's Health

Upsher-Smith Laboratories, Inc. is a privately held company dedicated to improving health and advancing wellness since 1919.  Upsher-Smith demonstrates its commitment to meeting the healthcare needs of its customers through the manufacturing and marketing of consumer and prescription products.  Upsher-Smith Women's Health is committed to providing treatment options specifically designed to meet the ever-changing needs of women throughout their lives such as prenatal nutritional support, bone health and symptom relief during menopause.  For additional information, visit http://www.upsher-smith.com/products/womens-health.

* Upsher-Smith provides educational funding to NPWH.

References

1. American College of Obstetricians and Gynecologists. ACOG practice bulletin: Nausea and Vomiting of Pregnancy. Obstet Gynecol 2004;103:803–814.
2. Badell M, Ramin S, Smith J. Treatment Options for Nausea and Vomiting During Pregnancy. Pharmacotherapy. 2006;26(9):1273-1287. Accessed on 10/12/11 at www.medscape.com/viewarticle/545629.
3. Einarson A, et al. Treatment of Nausea and Vomiting in Pregnancy.  Motherisk Update. Canadian Family Physician. December 2007;53:2109-2111.
4. The American College of Obstetricians and Gynecologists.  Morning Sickness. ACOG Educational Pamphlet AP126.

SOURCE Upsher-Smith Laboratories, Inc.