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CIM
CIM - April 2001MCE - avril 2001

Determinants of the need for hospital care among women with nausea and vomiting of pregnancy

Gordana Atanackovic, MD
Jacob Wolpin, PhD
Gideon Koren, MD


Clin Invest Med 2001;24(2):90-3

[ résumé ] [PDF]


Abstract

Objectives: To characterize a cohort of pregnant women who required hospital care owing to nausea and vomiting of pregnancy (NVP) and to identify variables that could serve as predictors of the need for hospital care.

Design: A retrospective, observational study.

Methods: Between 1996 and 1997, women who suffered from NVP were invited to call the NVP Healthline at The Motherisk Program in Toronto. After obtaining verbal consent, callers were interviewed by trained counsellors through a structured questionnaire about their NVP experience in previous pregnancies. Univariate and multivariate analyses were used to identify factors that could predict the need for hospital care.

Results: In total, 3201 women were recruited;1348 (43.8%) needed hospital care (treatment in the emergency room, day unit or hospital ward). The following characteristics were significantly associated with the need for hospital care: severity of vomiting (more than 5 times a day), use of more than one antiemetic medication, being primigravid, feeling depressed, having had an obstetrician as the primary health care provider and feeling that NVP had affected the partner's daily life.

Conclusions: Several factors, including the severity of physical symptoms of NVP and psychosocial factors, are associated with the need for hospital care. In addition to treatment of physical symptoms, it is important to address other factors associated with NVP.


Résumé

Objectifs : Caractériser une cohorte de femmes enceintes ayant eu besoin de soins hospitaliers en raison de nausées et vomissements gravidiques (NVG) et définir les variables qui pourraient servir de prédicteurs du besoin de soins hospitaliers.

Conception : Étude rétrospective par observation.

Méthodes : Entre 1996 et 1997, on a invité les femmes souffrant de NVG à composer le numéro de la «NVP Healthline» du Motherisk Program de Toronto. Après avoir obtenu le consentement verbal des intéressées, des conseillers ayant reçu la formation nécessaire les ont interviewées au moyen d'un questionnaire structuré portant sur leur expérience de NVG au cours de grossesses antérieures. On a procédé à des analyses unidimensionnelles et multidimensionnelles pour définir les facteurs susceptibles de prédire le besoin de soins hospitaliers.

Résultats : On a recruté au total 3201 femmes;1348 (43,8 %) ont eu besoin de soins à l'hôpital (traitement à l'urgence, court séjour ou hospitalisation). On a établi un lien significatif entre les caractéristiques suivantes et le besoin de soins à l'hôpital : gravité des vomissements (plus de cinq fois par jour), utilisation de plus d'un antiémétique, primiparité, sentiment de dépression, obstétricien comme prestateur de soins primaires et sentiment que les NVG avaient un effet sur la vie quotidienne du partenaire.

Conclusions : On établit un lien entre plusieurs facteurs, y compris la gravité des symptômes physiques de NVG et des facteurs psychosociaux, et le besoin de soins à l'hôpital. Outre le traitement des symptômes physiques, il importe de se pencher sur d'autres facteurs associés aux NVG.


From The Motherisk Program, Division of Clinical Pharmacology and Toxicology, Department of Pediatrics and Research Institute, The Hospital for Sick Children, Toronto, Ont.

Medical subject headings: hospitalization; nausea; pregnancy; vomiting

(Original manuscript submitted Sep. 21, 2000; received in revised form Dec. 8, 2000; accepted Jan. 3, 2001)

Reprint requests to:Dr. Gideon Koren, Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, 555 University Ave., Toronto ON M5G 1X8; fax 416 813-7562, gkoren@sickkids.on.ca

© 2001 Canadian Medical Association / Association médicale canadienne