The effect of heartburn and acid reflux on the severity of nausea and vomiting of pregnancy.
BACKGROUND
Heartburn (HB) and acid reflux (RF) in the nonpregnant population can cause nausea and vomiting; therefore, it is plausible that in women with nausea and vomiting of pregnancy (NVP), HB/RF may increase the severity of symptoms.


OBJECTIVE
To determine whether HB/RF during pregnancy contribute to increased severity of NVP.


METHODS
A prospectively collected cohort of women who were experiencing NVP and HB, RF or both (n=194) was studied. The Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scale and its Well-being scale was used to compare the severity of the study cohort's symptoms. This cohort was compared with a group of women experiencing NVP but no HB/RF (n=188). Multiple linear regression was used to control for the effects of confounding factors.


RESULTS
Women with HB/RF reported higher PUQE scores (9.6+/-2.6) compared with controls (8.9+/-2.6) (P=0.02). Similarly, Well-being scores for women experiencing HB/RF were lower (4.3+/-2.1) compared with controls (4.9+/-2.0) (P=0.01). Multiple linear regression analysis demonstrated that increased PUQE scores (P=0.003) and decreased Well-being scores (P=0.005) were due to the presence of HB/RF as opposed to confounding factors such as pre-existing gastrointestinal conditions/symptoms, hyperemesis gravidarum in previous pregnancies and comorbidities.


CONCLUSIONS
The present cohort study is the first to demonstrate that HB/RF are associated with increased severity of NVP. Managing HB/RF may improve the severity of NVP.
The Motherisk Program, The Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada.
Simerpal Kaur
SK
Gill
Caroline
C
Maltepe
Gideon
G
Koren
D016022:Case-Control Studies; D015984:Causality; D015897:Comorbidity; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000453:epidemiology*; D006356:Heartburn / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D048968:Morning Sickness / Q000175:diagnosis / Q000453:epidemiology*; D009864:Ontario / Q000453:epidemiology; D011247:Pregnancy; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires