Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
Laboratory of Clinical Chemistry and Haematology, Máxima Medical Centre, Veldhoven, The Netherlands.
Psychol Med. 2020 Jan;50(2):229-236. doi: 10.1017/S0033291718004105. Epub 2019 Jan 30.
The aetiology of nausea and vomiting during pregnancy (NVP) is multifactorial, but the relative contribution of biological and psychological determinants is insufficiently understood. We examined the association of human chorionic gonadotropin (hCG), thyroid hormones (thyroid-stimulating hormone and thyroxin) and psychological factors with NVP.
Blood chemistry and psychological measures were obtained in 1682 pregnant women participating in the Holistic Approach to Pregnancy and the first Postpartum Year (HAPPY) study between 12 and 14 weeks of gestation. The presence of NVP was measured using the Pregnancy-Unique Quantification of Emesis scale. Depressive symptoms were assessed using the Edinburgh Depression Scale. Multivariable logistic regression analyses were used to investigate the independent role of hCG, thyroid hormones and depression as related to NVP, adjusting for age, body mass index, education, parity, smoking status, unplanned pregnancy and history of depression.
Elevated levels of NVP were observed in 318 (18.9%) participants. High hCG levels [odds ratio (OR) = 1.47, 95% confidence interval (CI) = 1.11-1.95], elevated depressive symptoms in the first trimester (OR = 1.67, 95% CI = 1.15-2.43) and a history of depression (OR = 1.53, 95% CI = 1.11-2.11) were independently related to high NVP. Multiparity (OR = 1.47, 95% CI = 1.12-1.92) and younger age (OR = 0.91, 95% CI = 0.87-0.94) were also associated with high NVP, whereas (sub)clinical hyperthyroidism was not related to high NVP.
The current study is the first to demonstrate that a combination of hCG hormone and psychological factors are independently related to nausea and vomiting during early pregnancy.
妊娠恶心呕吐（NVP）的病因是多因素的，但生物和心理决定因素的相对贡献尚不清楚。我们研究了人绒毛膜促性腺激素（hCG）、甲状腺激素（促甲状腺激素和甲状腺素）和心理因素与 NVP 的关系。
在 12-14 孕周参加整体妊娠和产后第一年研究（HAPPY）的 1682 名孕妇中获得了血液化学和心理测量值。使用妊娠专用呕吐量度表（Pregnancy-Unique Quantification of Emesis scale）来测量 NVP 的存在。使用爱丁堡抑郁量表评估抑郁症状。多变量逻辑回归分析用于研究 hCG、甲状腺激素和抑郁与 NVP 的独立关系，调整年龄、体重指数、教育程度、产次、吸烟状况、非计划妊娠和抑郁史。
318 名（18.9%）参与者出现了较高水平的 NVP。高 hCG 水平[比值比（OR）=1.47，95%置信区间（CI）=1.11-1.95]、妊娠早期的高抑郁症状（OR=1.67，95%CI=1.15-2.43）和抑郁史（OR=1.53，95%CI=1.11-2.11）与高 NVP 独立相关。多产（OR=1.47，95%CI=1.12-1.92）和年龄较小（OR=0.91，95%CI=0.87-0.94）也与高 NVP 相关，而（亚）临床甲状腺功能亢进与高 NVP 无关。
本研究首次证明，hCG 激素和心理因素的结合与妊娠早期的恶心和呕吐独立相关。
