Incidence and Self-Care of Nausea and Vomiting Among Pregnant Women
Attending a Maternal Clinic
Ufuoma Shalom Ahwinahwi1*
, Valentine Uche Odili2
Department of Clinical Pharmacy and Pharmacy Administration, Delta State University ; P.M.B 1, Abraka- Nigeria
2Department of Clinical Pharmacy and Pharmacy Practice, University of Benin, P.M.B 1154, Benin City- Nigeria
Article Information Received 28 May 2016
Received in revised form 27 June 2016 Accepted 29 June 2016
Nausea and vomiting (NVP) of pregnancy are common among women. The purpose of this
study was to determine the incidence of nausea and vomiting in pregnancy and the self- care
measures adopted by women attending a maternal clinic. A descriptive cross sectional study
was carried out utilizing an interviewer-administered questionnaire to consenting pregnant
women attending the maternal clinic of Central Hospital, Agbor; Delta state – Nigeria. Of the
521 gravid women included in the study, 221 (42.4%) were within the age group of 27 and 32
years and had secondary level of education 238(45.7%).The mean gravidity of the
participants was 2.68±1.54, mean gestational age at the time of the study was 24.68 weeks ±
7.40 and the mean gestational age at which nausea and vomiting were observed, and was
6.30 weeks ± 3.82. Three hundred and fifteen (60.5%) of the women experienced the symptoms of nausea and vomiting of pregnancy. Taking “bitterkola” (Garcinia kola) (22.9%) either alone or in combination with other substances was the most frequently occurring
measure to control nausea and vomiting. Other measures taken included taking “native chalk” (18.8%), Ginger (5.6%) bitter leaves (Amygdala vernonia) (7.6%), fruits (19.9%), chewing gum (4.7%), taking sweets (9.4%), taking drugs (3.7%) and rest (4.7%).Over 20%
of the study population with nausea and vomiting opined that nausea and vomiting had a
negative impact on their lives; however only 7.5% are discouraged from getting pregnant as
a result of nausea and vomiting. Use of self-care measures was associated with educational
level of the respondents (P=0.004). The rate of nausea and vomiting was high in the studied
participants and Bitterkola (Garcinia kola) was the most commonly used agent for its prevention. The respondents who experienced nausea and vomiting reported its huge
negative impact on their lives. Keywords:
Nausea and vomiting, Pregnant women Corresponding Author: E-mail : email@example.com Mob.: +2348084867230
Nausea and Vomiting (NVP) in pregnancy is common among
women who are in the first trimester of pregnancy. About seven
to eight out of every 10 pregnant women experience Nausea
and vomitting1. Historically, nausea and vomiting of pregnancy
was first recorded about four millennia ago2. Although NVP is most commonly experienced in the first trimester, quite a
number of women suffer symptoms beyond twelve weeks of
gestation1. “Morning sickness” is commonly used to describe
NVP and is defined as nausea alone or the combination of
nausea, retching and occasional vomiting in early pregnancy3 or
a collection of symptoms such as food aversions, nausea and
vomiting, which occur in women during the first trimester of
pregnancy2, however, only about 17% of pregnant women have
symptoms only in the morning4. In some pregnant women
nausea and vomiting can begin in the first two weeks or one
month of pregnancy and usually stops by the 20th week of
pregnancy6. There is a more severe form of NVP called
Hyperemesis Gravidarium (HG) which occurs in 0.5% -3% of
pregnancies7,8. HG has been reported as the most common reason for hospitalization during the first trimester9 and carries
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an increased risk for low birth weight of the foetus 10. Studies have reported that NVP is associated with favorable pregnancy
outcomes3,7. A number of maternal characteristics, including
primiparity, younger maternal age and lower educational level
have been associated with nausea and vomiting of
pregnancy8,11. Higher maternal Body Mass Index (BMI) has
been identified as a risk factor for vomiting11. A meta-analysis12
which determined the global rates of nausea and vomiting in
pregnancy, included only two studies from the African continent
gave an average rate of 64% and 32.7% for women who had
only nausea without vomiting.
NVP has been found to affect a woman's life and professional
productivity. For instance, almost half of all pregnant women
who experience nausea and vomiting believe that NVP
adversely affects their relationship with their spouse, make them
depressed13, and reduces their work efficiency such that about
a quarter of them would need to be absent from work to contend
with the symptoms14. A study of 411 pregnant women3 revealed that women without NVP had poorer outcomes of pregnancy
such as, non-viable pregnancies and low infant birth weight.
Conversely, a meta-analysis of 11 studies concluded that
women with NVP had a lower risk of miscarriage15.
Some self-care practices by women who have NVP include
actions to either alleviate or stop such unhealthy disposition and
these include their lifestyles modification, diet, drugs and other
alternative therapies used. A Jordanian study16 revealed that
women used several strategies ranging from lifestyle
modifications, diet, complementary and alternative medicines
and drugs to alleviate the symptoms of nausea and vomiting in
pregnancy. Another study revealed that half of the women who
experienced nausea used anti-emetic herbal remedies, which
included ginger, peppermint and cannabis17. Most women with
nausea and vomiting in pregnancy can successfully be
managed in a primary care setting.
Nausea and vomiting in pregnancy which is common among
pregnant women has been studied in different parts of the
world1,16,18. The management of NVP in developed countries
has also been given much consideration as seen in our
literature search. A few of such studies19, 20 have been
conducted in Nigeria; there is, however, a dearth of studies on
self-care measures in the management of NVP in Nigeria and in
the immediate locality hence this study. This study will therefore
determine the incidence of nausea and vomiting in pregnancy in
this locality and to identify measures taken by the women to
alleviate nausea and vomiting determine its association with
their level of education.
2 Materials and Methods
2.1 Study design
The study was a cross sectional descriptive study conducted
using an interviewer administered questionnaire.
2.2 Setting and population
The study was conducted at the ante-natal clinic of Central
Hospital, Agbor in Delta State. Central Hospital Agbor is a
secondary health facility, and it is one of the four central
hospitals located in the State, Pregnant women attending the
clinic at the center benefit from free-maternal care, which was
on-going in the state at the time of this research.
The population comprised pregnant women attending ante-natal
clinic at the center for a period between the 15th May 2015 and
25th July 2015. About fifty pregnant women attend the clinic on
Mondays, Tuesdays and Wednesdays with another 50 freshly
registered at the clinic every Wednesday and given an
appointment for a future date. This results in a total of about 200
women visiting the clinic weekly. A total population of 1800 was
therefore achieved in the nine weeks of the study.
2.3 Sample size calculation
The sample size was calculated using Raosoft® sample size
calculator with a population of 1800, a margin of error at 5%,
confidence level at 95% and Response distribution of 50% and
a sample size of 317 was obtained. However, 521 pregnant
women were included in the study to make up for attrition.
2.4 Data collection
The interview was conducted with the aid of a questionnaire
which was drawn after careful consideration of the study
objectives, literature search and consultations with other
researchers. It consisted of 30-items which included a
demographic section and a section on Nausea and Vomiting in
Pregnancy. The Questionnaire was pre-tested among pregnant
women who do not attend the ante-natal clinic at the study
center and appropriate adjustments were made.
The questionnaire was administered to the pregnant women
waiting to receive ante-natal care after a brief introductory talk
on the purpose of the research.
2.5 Ethical considerations
Oral informed consent was obtained from the participants
before administering the questionnaire,
Permission to undertake this study was granted by the Hospital
2.6 Data analysis
Data gathered were entered into Microsoft Excel spreadsheet,
cleaned and sorted. Thereafter, it was loaded into the Statistical
Package for Social Sciences (SPSS) version 15. Descriptive
statistics of variables were reported as either frequencies
(percentages), or mean (standard deviation) and inferential
statistics were also carried out and P˂0.05 were considered
A total of Five hundred and twenty-one pregnant women
participated in the study The majority of the respondents 221
(42.4%) were in the age group of 27 and 32 years followed by
144 (31.1%) who were within 21-26 years, other age ranges are
as shown in table 1. Four hundred and ninety-nine (95.8%)
were married and only 20 (4%) of them were single, divorced or
separated. The Ikas, 331 (63.5%) were the most frequent ethnic
group encountered. Majority of the respondents had a
secondary level education 238 (45.7%) while 229 (44.0%) had a
tertiary education. The education status of the other participants
is as depicted in table 1. The occupation of the respondents are
shown in the table 3.2, majority of them were traders 172
(33.3%) followed by artisans 90 (17.3 %).
The mean gravidity of the respondents was 2.68 ± 1.54 (range
1-10) and mean number of pregnancies to full term was 1.36 ±
1.34 (range 0-9). The mean gestational age at booking was
19.69 weeks ± 6.07 (range 4weeks - 40weeks) and mean
gestational age at the time of the study was (24.68 ± 7.40
(range 4 weeks - 42weeks). The mean gestational age at which
nausea and vomiting were observed was 6.30 weeks ± 3.82
(range 1week-28 weeks).
Majority of the women 438 (84.1%) did not have any disease
conditions while 31 (10%) reported malaria either alone or
associated with diarrhea and ulcer 31 (6%), and 13 (2.5%) had
pregnancy induced hypertension.
3.2 Incidence of nausea and vomiting
Three hundred and fifteen (61%) of the women experienced
either one or more of the following: nausea, vomiting and
excessive salivation which are symptoms of nausea and
vomiting during pregnancy (Table 2).
3.3 Measures taken to control nausea and vomiting
Measures taken by the participants to control nausea and
vomiting in pregnancy included a wide range of dietary, life style
modification and complementary and alternative medicine.
Among a total of 106 responses, Bitterkola (Garcinia kola) either used alone (8.4%) or in combination with other agents (14.5%)
was the most frequently mentioned substance taken to control
nausea and vomiting, other measures included the use of a
substance known as “native chalk” (18.8%), Ginger (5.6%),
chewing gum (4.7%) and sweets (9.4%), while some of the
participants increased their fluid intake (0.9%) and /or took
some rest (4.7%) as shown in table 3
3.4 Use of drugs in the control of NVP
Out of the 174 (33.4 %) participants who responded when
asked about drug use, 53 (30%) took drugs to alleviate nausea
and vomiting while 121 (70%) said they do not take drugs to
alleviate nausea and vomiting.
Table 1: Demographics of respondents
Characteristics Frequency (%)
Age group 15-20 18(3.5)
No Response 2 (0.4)
Marital status Single 17(3.3)
No Response 2(0.4)
Level of education No Basic Education 10(1.9)
Primary Education 36(6.9)
Tertiary Education 229(44.0)
No response 4(0.8)
Ethnicity Ika 331(63.3)
Employment Student/Apprentice 24(4.6)
Public Servant 38(7.3)
Table 2: Incidence of Nausea and Vomiting
Symptoms Frequency (%)
Nausea 11 (2.1)
Nausea and Vomiting 49(9.4)
Nausea, Vomiting and excessive
Nausea and excessive salivation 22(4.2)
Vomiting Only 38(7.3)
Vomiting and spitting 28(5.4)
Excessive salivation only 64(12.3)
No Response 2(0.4)
Of the total respondents that used drugs, 25(47.2%), 11
(20.8%), and 3 (5.7%) said drugs were prescribed by doctor,
nurse and pharmacist respectively while the others (1426.4%)
got the drugs on their own or through recommendation from friends and family members. Forty-one (77 %) of the fifty –three
persons who used drugs said they got better after using the
3.5 Impact of Nausea and vomiting on the lives of the respondents
One hundred and twenty-eight of the sample population (24.6%)
felt nausea and vomiting had prevented them from carrying out
their normal activities and 122 (23.4%) thought they lost weight
as a result of nausea and vomiting. Eighty respondents (15.4%)
said that nausea and vomiting are serious enough problem to
warrant a sick day off from work and 105 (22.1%) of them said it
affects their quality of life. However, only 39 (7.5%) of all the
participants agreed that nausea and vomiting in pregnancy can
discourage them from getting pregnant again. This is as shown
in table 4
3.6 Association between taking self-care measures and educational level
There was an association between taking self-care measures
and educational level. This is shown in table 5
This study is aimed at evaluating the incidence and self-care of
nausea and vomiting in pregnancy and its impact on the lives of
4.1 Incidence of nausea and vomiting The incidence of nausea and vomiting in pregnant women
studied was high compared to other previous studies.
Table 3: Measures taken by pregnant women to control nausea and vomiting
Measures Frequency (%)
Bitterkola alone 9((8)
Bitterkola and bitterleaf 1(0.9)
Bitterkola and fruits 4(3.7)
Bitterkloa and chewing gum 3(2.8)
Bitterkola and native chalk 4(3.7)
Bitterkola and ginger 2(1.9)
Bitterkola , native chalk and sweets 2(1.9)
Sweets (containing menthol) 7(6.6)
Native chalk 6(5.7)
Native chalk and sweets 2(1.9)
Native chalk and fruits 1(0,9)
Native chalk and ginger 1(0.9)
Native chalk and pepperfruit 1(1.9)
Native chalk , ginger and rest 1(1.9)
Bitterleaf/bitterleaf stalk 6(5.7)
Bitterleaf and chewing gum 1(1.9)
Sweets and chewing gum 5(4.7)
Fruits and sweets 2(1.9)
Fruits and chewing gum 1(1.9)
Fruits , chewing gum and biscuits 1(1.9)
Kolanut and fruits 1(1.9)
Herbal remedies 4(3.7)
Ginger and rest 1(0.9)
Ginger and chewing gum 1 (1.9)
Chewing gum 2(1.9)
Chewing gum and biscuits 1(0.9)
Sweets and Bitter lemon drink 1(0.9)
Fluid intake , fruits and rest 1(0.9)
Avoid triggers and drugs 1(0.9)
Dietary changes 2(1.9)
Drugs and sweets 1(0..9)
Ate “Ukpa” 1(0.9)
Went to the hospital 1(0.9)
The study revealed that nausea with or without vomiting was
experienced by over half of the respondents. This rates was
lower than reported in some studies1,5 and could be due to the fact that NVP is more common in whites than black women21.
Nigeria where the incidence of NVP among gravid women was 49.2%.
Table 4: The Impact of Nausea and Vomiting on the lives of the respondents
Item (N= 521) Response N (%)
Yes No Undecided
Has the nausea and vomiting disturbed you from
carrying out you normal activities? 128(15.2) 79(2.9) 15(2.9)
Do you think you have lost weight as a result of
vomiting during this pregnancy? 122(23.4) 87(16.7) 16(3.1)
Do you think nausea and vomiting is serious enough
problem to warrant sick day off from work? 80(15.4) 97(18.6) 48(9.2)
Does nausea and vomiting affect your quality of life? 115(22.1) 89(17.1) 23(4.4)
Does nausea and vomiting discourage you from getting
pregnant again? 39(7.8) 150(28.8) 37(7.1)
Table 5: Relationship between taking self-care measures and educational level
level Frequency No Yes
Primary 28 5 3 -
Secondary 149 34 55 0.004
Tertiary 127 55 47 -
4.2 Measures taken to control nausea and vomiting of pregnancy
Strikingly, among the various measures taken by the
respondents to control nausea and vomiting of pregnancy,
bitterkola (Garcinia kola) either taken alone or in combination with other agents was most frequently used, Ginger has been
widely reported as an alternative medicine agent in the control
of nausea and vomiting22. Others such as chamomile,
peppermint and cannabis have also been studied17. Ginger was
only used by a few of the respondents in the current study. This
could be because the use of ginger for nausea and vomiting
was still unknown to majority if the respondents in this study.
There were no previous studies found on the use of bitterkola in
the control and treatment of nausea and vomiting in pregnancy,
this is highly suggestive of the speculation that bitterkola could
be a common practice of traditional and herbal remedies in this
locality. The use of native chalk or Nzu as it is called locally was reported also among the study participants. In 2009, United
States Food and Drug Administration department notified
healthcare professionals and pregnant and breastfeeding
mothers to avoid consuming Nzu, a traditional African remedy
for morning sickness because of potential health risks from
high level of lead and arsenic 23.
The proportion of respondents who used drugs to control
nausea and vomiting is low when compared with a previous
study where over 60% used pharmacologic agent in treating
nausea and vomiting in pregnancy24. Most of the drugs used
were prescribed by healthcare professionals and only a few
were taken based on the recommendation of family and friends.
This this may be due to the general belief in the locality that
using drugs indiscriminately by pregnant women could cause
harm to the baby, and the belief that herbal or alternative
medicines such as bitterkola are safer.
4.3 Impact of Nausea and vomiting on the lives of pregnant women
Over 20% of the participants believed nausea and vomiting had
some negative impact on their lives as shown by weight loss,
inability to carry out their normal activities and generally their
quality of life. This corroborates the findings of other studies25,26.
However, majority of the respondents would still get pregnant
despite NVP.. This is in consonance with another study27 were over 80% of the population did not consider termination of
pregnancy due to NVP.
4.4 Association between self-care measures and educational level
There was an association between self-care measures and
educational levels of the participants. This association has not
been found in any other reports, Kresheh16 however reported an association between paid employment and using various
strategies in controlling NVP.
There was a high incidence of nausea and vomiting in the
respondents studied. Various measures taken by the women to
control nausea and vomiting included Bitterkola (Garcinia kola), Native chalk, Ginger, Drugs, Chewing gum and sweets among
others while some of the participants increased fluid intake, took
some rest or went to the hospital. An appreciable proportion of
the women perceived nausea and vomiting had a negative
impact on their lives; however, only a small proportion would not
want to get pregnant because of nausea and vomiting.
Research studies, including clinical trials should be conducted
on Bitterkola (Garcinia kola) to determine its efficacy and safety in controlling nausea and vomiting in pregnancy.
6 Conflict of Interests
7 Author’s contributions
VUO and USA conceived the study, USA and OE did the
literature review. OE and USA collected the data while VUO
carried out the statistical analyses. VUO and USA drafted the
manuscript. All authors read and approved the final manuscript.
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