Distinct temperament and character traits in patients with hyperemesis gravidarum

Modification of the association between nausea and vomiting of pregnancy and anxiety by personality trait during early pregnancy: A longitudinal study of Japanese pregnant women

AIM

This study aimed to elucidate whether personality traits modify the relationship between nausea and vomiting of pregnancy (NVP) and anxiety, stratified by three pregnancy periods: 5-8 weeks, 9-12 weeks, and 13-20 weeks.

METHODS

This longitudinal study was conducted from August 2018 to February 2019 at a perinatal outpatient unit in a general hospital. We included 153 pregnant women aged ≥20 years and under 20 weeks of gestation at their first prenatal visit. They completed the Index of Nausea, Vomiting, and Retching, and the State-Trait Anxiety Inventory (STAI) to measure anxiety in terms of both trait (STAI-T) and state anxiety (STAI-S), and retook them at follow-up checkups for a maximum of three times.

RESULTS

Using longitudinal data until 20 weeks' gestation, changes in NVP and trait anxiety were significantly associated with changes in state anxiety independently, with trait anxiety being more strongly involved than the change in NVP. This tendency was pronounced in the high-trait anxiety group with STAI-T scores of ≥45. Cross-sectional analyses by gestational week showed similar results in the low-trait anxiety group (STAI-T < 45). In the high-trait anxiety group, only trait anxiety was significantly associated with state anxiety up to 12 weeks gestation. However, only NVP was significantly associated with state anxiety after 13 weeks.

CONCLUSIONS

Pregnant women who tend to be anxious temperamentally may have other factors that cause anxiety besides nausea immediately after the discovery of pregnancy. Understanding personality traits may help reduce anxiety in pregnant women.

[Expert consensus from the College of French Gynecologists and Obstetricians: Management of nausea and vomiting of pregnancy and hyperemesis gravidarum]

OBJECTIVE

To determine the management of patients with 1st trimester nausea and vomiting and hyperemesis gravidarum.

METHODS

A panel of experts participated in a formal consensus process, including focus groups and two Delphi rounds.

RESULTS

Hyperemesis gravidarum is distinguished from nausea and vomiting during pregnancy by weight loss≥5 % or signs of dehydration or a PUQE score≥7. Hospitalization is proposed when there is, at least, one of the following criteria: weight loss≥10%, one or more clinical signs of dehydration, PUQE (Pregnancy Unique Quantification of Emesis and nausea) score≥13, hypokalemia<3.0mmol/L, hyponatremia<120mmol/L, elevated serum creatinine>100μmol/L or resistance to treatment. Prenatal vitamins and iron supplementation should be stopped without stopping folic acid supplementation. Diet and lifestyle should be adjusted according to symptoms. Aromatherapy is not to be used. If the PUQE score is<6, even in the absence of proof of their benefit, ginger, pyridoxine (B6 vitamin), acupuncture or electrostimulation can be used, even in the absence of proof of benefit. It is proposed that drugs or combinations of drugs associated with the least severe and least frequent side effects should always be chosen for uses in 1st, 2nd or 3rd intention, taking into account the absence of superiority of a class over another to reduce the symptoms of nausea and vomiting of pregnancy and hypermesis gravidarum. To prevent Gayet Wernicke encephalopathy, Vitamin B1 must systematically be administered for hyperemesis gravidarum needing parenteral rehydration. Patients hospitalized for hyperemesis gravidarum should not be placed in isolation (put in the dark, confiscation of the mobile phone or ban on visits, etc.). Psychological support should be offered to all patients with hyperemesis gravidarum as well as information on patient' associations involved in supporting these women and their families. When returning home after hospitalization, care will be organized around a referring doctor.

CONCLUSION

This work should contribute to improving the care of women with hyperemesis gravidarum. However, given the paucity in number and quality of the literature, researchers must invest in the field of nausea and vomiting in pregnancy, and HG to identify strategies to improve the quality of life of women with nausea and vomiting in pregnancy or hyperemesis gravidarum.

Somatic complaints in early adulthood predict the developmental course of compassion into middle age

OBJECTIVE

The aim of the present study was to investigate (i) whether somatic complaints predict the developmental course of compassion in adulthood, and (ii) whether this association depends on alexithymic features.

METHODS

The participants came from the population-based Young Finns study (N = 471-1037). Somatic complaints (headache, stomachache, chest pain, backache, fatigue, exhaustion, dizziness, heartburn, heartbeat, and tension) were evaluated with a self-rating questionnaire in 1986 when participants were aged between 18 and 24 years. Compassion was assessed with the Compassion Scale of the Temperament and Character Inventory (TCI) in 1997, 2001, and 2012. The data were analyzed using growth curve models.

RESULTS

We obtained a significant compassion-age interaction (B = -0.137, p = .02) and a compassion-age squared interaction (B = 0.007, p = .006), when predicting the course of somatic complaints. Specifically, in participants without frequent somatic complaints, compassion steadily increased with age in adulthood. In participants with frequent somatic complaints, however, compassion remained at a lower level until the age of 40 years, then started to increase, and achieved the normal level of compassion approximately at the age of 50 years. The association between somatic complaints and compassion over age was found to be independent of alexithymic features. The analyses were adjusted for a variety of covariates (age, gender, use of health care in childhood, depression in childhood, parental socioeconomic factors, parental care-giving practices, stressful life events, parental alcohol intoxication, and participants' socioeconomic factors in adulthood).

CONCLUSION

Frequent somatic complaints may predict delayed development of compassion in adulthood. This association was found to be independent of alexithymic features.