Nausea And Vomiting Of Pregnancy And Its Associations With Postpartum Depression In Pregnant Women In Wuhan

Nausea and vomiting of pregnancy(NVP)is a common symptom during pregnancy,with its severity ranging from simple nausea to hyperemesis gravidarum.Although NVP is common during pregnancy,the research on its occurrence,development and influence among Chinese population is limited.The literature shows that the incidence and severity of NVP vary with different female races / nationalities.Some studies have found that severe NVP is associated with postpartum depression(PPD),but the results of studies on the association between NVP and PPD are controversial.Studies on the association between NVP of different severity and PPD and the role of various types of NVP as risk factors for PPD are limited.Similar studies have not yet been found in the Chinese population.Based on Wuhan Healthy Baby Cohort,this study investigated the incidence and some characteristics of NVP in the first and second trimester of pregnancy among Wuhan pregnant women and discussed the relationships between different degrees of NVP in early pregnancy and postpartum depression.Part Ⅰ Nausea and vomiting of pregnancy and its characteristics Objective: To describe the prevalence of NVP(nausea and vomiting of pregnancy)during pregnancy among pregnant women in Wuhan,to explore the changes of NVP in the first two trimesters of pregnancy,and to compare the onset time of symptoms of various types of NVP in early pregnancy and the medication use of NVP.Methods: Based on Wuhan Healthy Baby Cohort,this study included 3337 pregnant women recruited in early pregnancy from May 2017 to May 2019.The data of maternal nausea and vomiting(NVP),social demographic information and pregnancy-related factors in the early and second trimester of pregnancy were collected by questionnaires.According to the questions in the original questionnaire,the NVP types of pregnant women were divided into four groups: "none","mild","moderate" and "severe".2915 subjects submitted complete questionnaires in both the first trimester and the second trimester(accounting for 87.35% of the total number of subjects in the first trimester).F test and SNK method were used to compare mean of continuous variables,and chi-square test was used to compare rate of classified variables.Results:1.The incidence of NVP in early pregnancy(n=3337)was 62.51%,while 47.2%of the second trimester population(n=2915)still had NVP.Two thousand one hundred and twenty-nine subjects(73.04% of the total 2915)had NVP in either or both of the two periods,of whom 1832(86.05% of 2129)began their symptoms in the first trimester.2.A correlation existed between the severity of NVP in the first trimester and the second trimester(P<0.0001).There was significant difference in the severity of NVP between early pregnancy and second trimester(P<0.0001).The proportion of patients without NVP in the second trimester(1539,52.8%)was higher than that in the first trimester(1083,37.2%).The proportion of mild,moderate and severe NVP in the second trimester(1063,36.5%;289,9.9% and 24,0.8% respectively)was lower than that in the first trimester(1289,44.2%;497,17.0% and 46,1.6% respectively).3.The average gestational weeks at which symptoms of mild,moderate and severe NVP began to appear in early pregnancy were 7.18±2.06,6.53±1.97 and 6.38±1.81 weeks respectively,and the gestational weeks of different types of NVP were different(P< 0.05).The results of pairwise comparison showed that there were significant differences in gestational weeks at which symptoms began between moderate and mild,severe and mild NVP in early pregnancy.4.3.64% of NVP patients in early pregnancy took medicine.The rate was much lower than those in the United States(18%)and other countries.Conclusion: NVP was a common symptom in early pregnancy,and the incidence of NVP in Wuhan was similar to that reported in previous literature.The symptoms of NVP in the first trimester were severer than those in the second trimester,while parts of NVP symptoms tended to relieve or disappear in the second trimester.Symptoms began to develop at different gestational weeks for different types of NVP,and the onset of symptoms in severe and moderate NVP was earlier than that in mild NVP.The medication rate of NVP in Wuhan was lower than that reported abroad.Part Ⅱ Associations between nausea and vomiting during pregnancy and postpartum depression Objective: To explore the relationship between NVP(nausea and vomiting of pregnancy)and PPD(postpartum depression).Methods: Based on Wuhan Healthy Baby Cohort,this study selected 1748 people who gave birth in Wuhan Women’s and Children’s Medical and Health Care Center from October 2017 to October 2019.They were invited to the hospital to complete the follow-up after delivery(one month and six months after delivery).The Edinburgh Postpartum Depression scale(EPDS)was used to evaluate postpartum depression.In this study,the critical value of 13 was used as the criterion for judging PPD(EPDS score ≥13 as depression,<13 as no depression).1572 and 938 people submitted complete EPDS questionnaires at one month and six months after delivery,respectively.The collection method of NVP data in early pregnancy is the same as that in Part Ⅰ.The basic demographic information of pregnant women and the related data of pregnancy and delivery were mainly obtained through the pregnancy questionnaires and the hospital electronic medical record system.Depression in the second trimester was evaluated by the EPDS scale in the second trimester questionnaire.The relationship between early pregnancy NVP and postpartum depression score was analyzed by generalized linear regression model,while the association between early pregnancy NVP and risk of PPD was estimated by logistic regression model.Results:1.The incidence of depression one month after delivery was 17.18%,and 13.65%at six months after delivery.2.The results of the generalized linear model showed that the EPDS scores one month after delivery of women with severe NVP in early pregnancy were 2.22(P<0.01),2.00(P<0.01)and 1.64(P<0.05)more compared with those without,with mild and with moderate NVP,respectively.The EPDS score one month after delivery of women with moderate NVP was 0.58 higher than that of women without NVP(P<0.05).Six months after delivery,the EPDS scores of women with severe NVP were1.95(P<0.05)and 1.96(P<0.05)higher than those without NVP and mild NVP,respectively.3.Univariate logistic regression analysis showed that severe NVP in early pregnancy increased the risk of PPD at one and six months postpartum.After adjusting for potential covariates,it was found that the risks of depression one month after delivery in women with severe NVP were 3.52 times(95%CI:1.43-8.64),2.49times(95%CI:1.03-6.02)and 2.56 times(95%CI:1.02-6.42)of those without,with mild and with moderate NVP,respectively.The risk of depression one month after delivery in patients with mild NVP was 1.41 times of that in women without NVP(95%CI:1.02-1.96).For six months postpartum,the relationship between the two was not statistically significant after adjusting for potential covariates.Conclusion: Severe and moderate NVP in early pregnancy increased postpartum EPDS scores one month after delivery while severe NVP of early pregnancy increased postpartum EPDS score six months after delivery.Severe and mild NVP in early pregnancy increased the risk of postpartum depression at one month.Attention should be paid to the nursing of patients with NVP symptoms during pregnancy.