Factors associated with elective termination of pregnancy among Canadian and American women with nausea and vomiting of pregnancy

Case reports have associated severe nausea and vomiting of pregnancy (NVP) with elective termination of pregnancy. Therefore, our objective was to explore the determinants of consideration of termination and actual termination of pregnancy among women with NVP. From 1996 to 1997, callers to an advertised NVP Healthline underwent a semi-structed interview. From callers who retrospectively reported on NVP in a previus pregnancy, a nested unmatched case-control study was performed. Callers were divided into three groups: those who reported having electively terminated their pregnancy due to NVP, those who considered termination due to NVP and those who never considered termination. The severity of nausea and vomiting, and frequency of psychosocial morbidity, were compared between cases and controls, and multivariate logistic regression analysis was used to determine factors independently associated with termination and/or consideration of termination of pregnancy due to NVP. Of 3201 callers with NVP, 413 women reported having considered termination of pregnancy for NVP, 108 reported termination due to NVP and 2609 reported never having considered termination for NVP. The following factors were independently associated with a woman's consideration of termination of pregnancy due to NVP: unplanned prenancy (p = 0.002), multiparity (p = 0.0001), more severe vomiting (p = 0.003), feelings of depression (p < 0.0001) and reported adverse effects of NVP on both her partner's daily life (p = 0.04) and her relationship with her partner (p = 0.003). The following factors were independently associated with actual termination of pregnancy due to NVP: unplanned pregnancy (p < 0.0001), multiparity (p = 0.03) and feelings of depression (p = 0.001). There were no significant interactions between factors. Consideration of termination, or actual termination of pregnancy, due to NVP are associated with psychosocial circumstances, which should be taken into consideration when managing these women.