Morning Sickness Impact Study

Impact Study

Morning Sickness Impact Study...(c) 2001

Miriam Erick, M.S. R.D. CDE.

Dept. of Nutrition, Brigham and Women's Hospital, Boston

Total disability from morning sickness is unknown. To gain perspective, we collaborated with the Boston Parents’ Paper (BPP) to assess the problem from the client perspective. We received 122 responses over a 3 month period, from the paper and Internet versions of a questionnaire which appeared August 1998, which was also posted on Dietitian.com. The NVP (nausea and vomiting of pregnancy) economic impact study was approved by the Brigham and Women’s IRB committee. (Legacy 98-09258/ Assurance No. M-1049, Protocol # 1999-P- 003137/1). Women evaluated therapies from acupuncture, acupressure, Chinese herbs, massage therapy, homeopathy, ginger, cinnamon, lemon aroma therapy, olfactory reduction, psychiatric intervention, relaxation, prescription medications and intravenous hydration. We inquired for salary and sick time losses and zip code. Marital status, income, education and gestational age were omitted due to space restriction.

Discussion:

NVP affects approximately 75% of all pregnancies, (1) averaging 17.3 weeks (2). Some degree of NVP appears to protect the fetus. Brandes found a fetal loss of 86.0 per 1000 in women with no NVP while fetal loss was 49.1 per 1000 in sick women (3). Consistent negative results are difficult to demonstrate, however smaller infants are reported (4) (5) (6). Growth restriction can be mitigated by aggressive intravenous hydration, electrolyte correction, and anti-emetic therapy. (7) A correlation between weight loss, lost work, and reduced birth weight exists (8). In the UK, 8.6 million hours of paid employment and 5.8 million hours of house work lost due to NVP has been reported (9). In Australia, 20% of women had NVP until delivery (10), while in a racially mixed group of South African women only 5% were ill until delivery (11). The latter statistic is similar to morbidity reported in the US (12). Gadsby evaluated work losses of 363 women in the UK and found 73% lost an average of 62 hours of work time (13). Direct health care costs noted in a community hospital in Pennsylvania were $186,000, for an average $2900 per woman per hospitalization (14). Nationally, an estimated $130M in direct health care costs is assigned to NVP (15).

In our study, 106 women had singleton pregnancies, eight were the result of IVF (in vitro fertilization) 7 with twins and one with triplets. Data was analyzed with Microsoft Access and Microsoft Excel. The rating scale to assess therapy efficacy was a convention of the study originator and is as follows:

0= did not try

1= adverse reaction

2= effective 80% any time used

3= effective 60% any time used

4= effective 40% any time used

5= effective 1-2 times only

6= effective morning only

7= effective afternoon only

8= effective night time only

9= seemed to be effective with other treatments, please explain

10= ineffective

Findings:

The total salary loss was $316,212 or an average of $2,591.90. Of the 122 women, 43 women (35.2%) reported significant disability, which resulted in $7,353.77 loss per sick woman (Tables 1 and 2). Of the women reporting salary loss, sixteen percent (n=20) used disability, which could not be assigned a monetary value.

The number of women reporting nausea was 121/122 with computed to 11.8 hr/day of nausea. Forty-five women (36.8%) classified their nausea as “constant”. We arbitrarily assigned a value of 16 hours as the definition of “constant” assuming 8 hours of sleep per day. Ninety-nine women had an average of 7 vomiting episodes per day. The number retching episodes was 9.7 per day per respondent. (Retching is also referred to as “dry heaves”.) A cumulative 12,892 hours of sick time was reported which averaged 105.6 hours per respondent. The sicker women reported more time losses -- or 204.63 hours per respondent. Whether women used benefit and vacation time is not known. Women were aggressively pursuing nausea relief, averaging 6.29 remedies/each. Outside economic losses, 38% of women stated family size was limited because of NVP. Eighteen women contemplated abortion, while two subjects (1.6%) actually terminated. Nine women were hospitalized for dehydration.

The reported client-initiated termination statistic in our study is similar to that reported by Mazzoto of 1.5 % (8). The women in their study who aborted vomited an average of 9.3 times day vs. 6.5 times of day of women who considered abortion but did not follow through. The abortion group, 17 of 1100 women, had fewer hospitalizations, experienced an average weight loss of 5.9 kg and an average of 20 days work loss. Ten of 17 were offered dimenhydrinate (Dramamine) which was effacious in only 2 of 10 cases. One woman found Compazine (procholoro- perazine) effective. The two who opted for termination had vomiting episodes of 15 and 20-30 times per day, weight losses of 12 and 5-7 kgs each respectively, and disabilities affecting 4 months of graduate studies and 1 month of paid employment respectively. One woman lost consciousness three times.

Two women aborting in our study reported different profiles. Woman A did not report salary sacrifice while Woman B reported $40,000 loss. Both women reported “constant nausea”. Woman A reported 160 hours of sick time and emetic events averaging 4 per day with 5 episodes of retching. Woman A used crackers, ginger root and tablets, sea bands, and smell reduction. Woman B reported 1080 hours of sick time, 20 episodes of emesis per day with 10 episodes of retching. Woman B employed Compazine, ondantstron, Reglan, Bendectin, droperidol, relaxation techniques, massage therapy, psychotherapy, chewable vitamins, cinnamon, Emetrol, smell reduction, sea bands, acupuncture, acupressure, lemons, crackers, ginger root and tablets, potato chips, raspberry tea, home intravenous therapy, vitamin B6 and reported hospital admissions and intravenous nutrition.

Tables 3-5 show therapies utilized; alternative and adjunctive, prescription, and over-the-counter or folkloric suggestions. Table 6 summarizes efficacy per client perception.

Our survey indicates a significant psycho-social and economic morbidity associated with NVP. We suggest a more comprehensive, multi-centered study to assess the total costs of this pregnancy problem.

To view the tables associated with this study select the following link:

Morning Sickness Impact Study - Tables

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