Heinrichs LeRoy
Department of Gynecology and Obstetrics, Stanford University School of Medicine, CA 94305-5466, USA.
Am J Obstet Gynecol. 2002 May;186(5 Suppl Understanding):S215-9. doi: 10.1067/mob.2002.123053.
The experience of women was sought about nausea and vomiting, its relation to olfaction, its occurrence among pregnant women with anosmia, and the potential association of hyperemesis gravidarum and migraine headache.
We performed a community-based study with a physician/patient-directed questionnaire, and a retrospective analysis of hospital records.
Nearly all women (n = 163 parous women) experience nausea (98%) and vomiting (97%). The highest frequency causes of nausea and vomiting were "food poisoning" (65%), "flu" (58%), pregnancy (54%), and offensive odors (52%); vomiting occurred as frequently as nausea for the first 2 causes, and one half as often for the latter causes. Most women reported that the pain experienced during vomiting exceeded that of parturition. Among 9 women with hypogonadotropic anosmia with advanced reproductive technology-induced pregnancies, 2 experienced nausea and vomiting, one from "food poisoning." Among 37 women with migraine headache, 10 (27%) had experienced hyperemesis gravidarum, and among 16 who experienced hyperemesis gravidarum, 5 (37%) had migraine headaches.
The frequency of nausea and vomiting, caused most often by nonpregnancy-related triggers, is high among women. In a small sample of women with congenital anosmia, nausea and vomiting of pregnancy occurred in only 1 pregnancy, suggesting that olfaction is a highly selected trigger for nausea and vomiting of pregnancy. The shared nausea and vomiting experience of hyperemesis gravidarum and migraine headache among women suggests a common mechanism, possibly based on allelic variations within the DRD2 (dopaminergic receptor) gene. Because olfactory receptors, odor types, and MHC antigens are closely integrated, and because olfactory stimuli often incite episodes of pregnancy, nausea, and vomiting, hyperemesis gravidarum, and migraine headache, these genes and their products invite further scrutiny. The pregnancy-conserving effect of PNV and the MHC antigen overlap in couples with recurrent abortion are important clues possibly relating olfaction, MHC antigens, and reproductive success or failure.
了解女性恶心和呕吐的经历、其与嗅觉的关系、在嗅觉缺失的孕妇中的发生情况，以及妊娠剧吐与偏头痛之间的潜在关联。
我们开展了一项基于社区的研究，采用医生/患者导向的问卷，并对医院记录进行回顾性分析。
几乎所有女性（163名经产妇）都经历过恶心（98%）和呕吐（97%）。恶心和呕吐的最常见原因是“食物中毒”（65%）、“流感”（58%）、妊娠（54%）和难闻气味（52%）；前两种原因导致呕吐的频率与恶心相同，后两种原因导致呕吐的频率是恶心的一半。大多数女性报告称，呕吐时的疼痛超过了分娩时的疼痛。在9名因先进生殖技术导致妊娠的低促性腺激素性嗅觉缺失女性中，2人经历了恶心和呕吐，其中1人是因“食物中毒”。在37名偏头痛女性中，10人（27%）曾经历过妊娠剧吐，在16名经历过妊娠剧吐的女性中，5人（37%）患有偏头痛。
女性中恶心和呕吐的发生率很高，最常见的原因是与妊娠无关的诱因。在一小部分先天性嗅觉缺失的女性样本中，仅1例妊娠出现了妊娠恶心和呕吐，这表明嗅觉是妊娠恶心和呕吐的高度特异性诱因。女性中妊娠剧吐和偏头痛都存在恶心和呕吐的经历，提示可能存在共同机制，可能基于DRD2（多巴胺能受体）基因内的等位基因变异。由于嗅觉受体、气味类型和MHC抗原紧密相关，且嗅觉刺激常引发妊娠、恶心、呕吐、妊娠剧吐和偏头痛发作，这些基因及其产物值得进一步研究。妊娠恶心呕吐的妊娠保护作用以及反复流产夫妇中MHC抗原的重叠是可能将嗅觉、MHC抗原与生殖成败相关联的重要线索。
