TY  - BOOK
AU  - Grantz, Katherine L
TI  - Association of Nausea and Vomiting During Pregnancy With Pregnancy Loss: A Secondary Analysis of a Randomized Clinical Trial
SN  - 2168-6106
PY  - 2016///
KW  - *Abortion, Spontaneous/pc [Prevention & Control]
KW  - *Anti-Inflammatory Agents, Non-Steroidal/ad [Administration & Dosage]
KW  - *Aspirin/ad [Administration & Dosage]
KW  - *Nausea/th [Therapy]
KW  - *Pregnancy Complications/th [Therapy]
KW  - *Vomiting/th [Therapy]
KW  - Adolescent
KW  - Adult
KW  - Anti-Inflammatory Agents, Non-Steroidal/ae [Adverse Effects]
KW  - Aspirin/ae [Adverse Effects]
KW  - Biomarkers/bl [Blood]
KW  - Chorionic Gonadotropin/bl [Blood]
KW  - Double-Blind Method
KW  - Female
KW  - Follow-Up Studies
KW  - Humans
KW  - Israel
KW  - Pregnancy
KW  - Pregnancy Outcome
KW  - Pregnancy Trimester, First
KW  - Pregnancy Trimester, Second
KW  - Prospective Studies
KW  - Research Design
KW  - Risk Assessment
KW  - Risk Factors
KW  - United States
KW  - MedStar Washington Hospital Center
KW  - Obstetrics and Gynecology/Maternal-Fetal Medicine
KW  - Comparative Study
KW  - Journal Article
KW  - Multicenter Study
KW  - Randomized Controlled Trial
N2  - Conclusions and Relevance: Among women with 1 or 2 prior pregnancy losses, nausea and vomiting were common very early in pregnancy and were associated with a reduced risk for pregnancy loss. These findings overcome prior analytic and design limitations and represent the most definitive data available to date indicating the protective association of nausea and vomiting in early pregnancy and the risk for pregnancy loss; Design, Setting, and Participants: A randomized clinical trial, Effects of Aspirin in Gestation and Reproduction, enrolled women with 1 or 2 prior pregnancy losses at 4 US clinical centers from June 15, 2007, to July 15, 2011. This secondary analysis was limited to women with a pregnancy confirmed by positive results of a human chorionic gonadotropin (hCG) test. Nausea symptoms were ascertained from daily preconception and pregnancy diaries for gestational weeks 2 to 8. From weeks 12 to 36, participants completed monthly questionnaires summarizing symptoms for the preceding 4 weeks. A week-level variable included nausea only, nausea with vomiting, or neither; Importance: Nausea and vomiting during pregnancy have been associated with a reduced risk for pregnancy loss. However, most prior studies enrolled women with clinically recognized pregnancies, thereby missing early losses; Main Outcomes and Measures: Peri-implantation (hCG-detected pregnancy without ultrasonographic evidence) and clinically recognized pregnancy losses; Objective: To examine the association of nausea and vomiting during pregnancy with pregnancy loss; Results: A total of 797 women (mean [SD] age, 28.7 [4.6] years) had an hCG-confirmed pregnancy. Of these, 188 pregnancies (23.6%) ended in loss. At gestational week 2, 73 of 409 women (17.8%) reported nausea without vomiting and 11 of 409 women (2.7%), nausea with vomiting. By week 8, the proportions increased to 254 of 443 women (57.3%) and 118 of 443 women (26.6%), respectively. Hazard ratios (HRs) for nausea (0.50; 95% CI, 0.32-0.80) and nausea with vomiting (0.25; 95% CI, 0.12-0.51) were inversely associated with pregnancy loss. The associations of nausea (HR, 0.59; 95% CI, 0.29-1.20) and nausea with vomiting (HR, 0.51; 95% CI, 0.11-2.25) were similar for peri-implantation losses but were not statistically significant. Nausea (HR, 0.44; 95% CI, 0.26-0.74) and nausea with vomiting (HR, 0.20; 95% CI, 0.09-0.44) were associated with a reduced risk for clinical pregnancy loss; Trial Registration: clinicaltrials.gov Identifier: NCT00467363
UR  - https://dx.doi.org/10.1001/jamainternmed.2016.5641
ER  -