Document Type : Original Article


1 Department of Midwifery, School of Nursing and Midwifery, Evidence‑Based Care Research Center, Mashhad University of Medical Sciences, Mashhad

2 Department of Midwifery, School of Nursing and Midwifery, Esfahan University of Medical Sciences, Esfahan, Iran


INTRODUCTION: Nausea and vomiting in pregnancy is the most common medical complication in
the first trimester of pregnancy. That associated with a wide range of physical and mental symptoms
for the patient and his family and can affect the quality of life of women’s life. In addition, the training
to improve knowledge, in adjusting diet and lifestyle, and leading to decrease nausea and vomiting.
Due to the positive characteristics of training using the small groups, this study was applied with the
objective of “The effect of small group teaching on quality of life in pregnant women with nausea
and vomiting.”
METHODS: This study was applied based on intervention, on 59 nulliparous women with nausea
and vomiting who referred to obstetrics ward of selected health and treatment centers in Neishaboor
County. The training was presented by a researcher in group intervention in 8 sessions, each 45–30 min
in small groups (3 groups 10 members). The control group received routine care. The study
instruments (nausea and vomiting of pregnancy quality of life questionnaire) and (modified‑PUGE)
form. The results were analyzed using the Wilcoxon test, Mann–Whitney, and t‑test.
RESULTS: Research units were no statistically significant difference of personal data, at the beginning
of the study, and before intervention, was not differences between the mean change scores of
postpartum stress disorder in two groups (P = 0/192). While the mean quality of life score in the
intervention and control groups was statistically significant difference after intervention (P = 0.001).
Quality of life score in the intervention group had statistically significant difference before and after
the intervention (P = 0.001).
CONCLUSION: Training in the intervention group with small group strategies has more effective in
comparison to conventional training of nausea and vomiting.


1. Bustos M, Venkataramanan R, Caritis S. Nausea and vomiting of
pregnancy – What’s new? Auton Neurosci 2017;202:62‑72.
2. Mitchell‑Jones N, Gallos I, Farren J, Tobias A, Bottomley C,
Bourne T, et al. Psychological morbidity associated with
hyperemesis gravidarum: A systematic review and meta‑analysis.
BJOG 2017;124:20‑30.
3. Heitmann K, Solheimsnes A, Havnen GC, Nordeng H, Holst L.
Treatment of nausea and vomiting during pregnancy‑a
cross‑sectional study among 712 norwegian women. Eur J Clin
Pharmacol 2016;72:593‑604.
4. Einarson TR, Piwko C, Koren G. Quantifying the global rates of
nausea and vomiting of pregnancy: A meta analysis. J Popul Ther
Clin Pharmacol 2013;20:e171‑83.
5. Koren G. Safety considerations surrounding use of treatment
options for nausea and vomiting in pregnancy. Expert Opin Drug
Saf 2017;16:1227‑34.
6. Heitmann K, Nordeng H, Havnen GC, Solheimsnes A, Holst L.
The burden of nausea and vomiting during pregnancy: Severe
impacts on quality of life, daily life functioning and willingness
to become pregnant again – Results from a cross‑sectional study.
BMC Pregnancy Childbirth 2017;17:75.
7. Heitmann K, Svendsen HC, Sporsheim IH, Holst L. Nausea
in pregnancy: Attitudes among pregnant women and general
practitioners on treatment and pregnancy care. Scand J Prim
Health Care 2016;34:13‑20.
8. Bai G, Korfage IJ, Groen EH, Jaddoe VW, Mautner E, Raat H,
et al. Associations between nausea, vomiting, fatigue and
health‑related quality of life of women in early pregnancy: The
generation R study. PLoS One 2016;11:e0166133.
9. Goodwin TM, Ramin SM. Practice Bulletin summary No. 153:
Nausea and Vomiting of Pregnancy. Lippincott Philadelphia,
PA, USA: Williams and Wilkins; 2015.
10. Clark S, Hughes B, McDonald SS. The impact of nausea and
vomiting of pregnancy on quality of life: Report of a national
consumer survey and recommendations for improving care.
Obstet Gynecol Surv 2013;68:S1‑10.
11. MatthewsA, HaasDM, O’Mathúna DP, DowswellT. Interventions
for nausea and vomiting in early pregnancy. Cochrane Database
Syst Rev 2015;1 (3):CD007575.
12. Khavandi Zadeh Aghdam S, Mahfozi B. Studing efficacy of
medicine compressive (sea‑band) biscuit for nausea and vomitin.
Magzine Islam Azad Univ Ardebil 2005:39:43.
13. ACOG practice bulletin no 189 summary: Nausea and vomiting
of pregnancy. Obstet Gynecol 2018;131:190‑3.
14. Liu MC, Kuo SH, Lin CP, Yang YM, Chou FH, Yang YH, et al.
Effects of professional support on nausea, vomiting, and quality
of life during early pregnancy. Biol Res Nurs 2014;16:378‑86.
15. Tan A, Lowe S, Henry A. Nausea and vomiting of pregnancy:
Effects on quality of life and day‑to‑day function. Aust N Z J
Obstet Gynaecol 2018;58:278‑90.
16. Oshvandi KH, Adineh Fathabadi M, Falahi Nia GH, Dadras F,
Mahjob H. Studing effects of education in small groups on
electrolits serum in hemodyalisis pationts. Hamedan Nurs
Midwifery J 2011;18:5.
17. Aalaa M, Peimani M, Gharib M. Teaching and learning in small
groups. Magiran Med Educ 2014;13:72‑83.
18. Ghavam‑Nasiri MR, Heshmati Nabavi F, Anvari K,
Habashi Zadeh A, Moradi M, Neghabi G, et al. The effect of
individual and group self‑care education on quality of life in
patients receiving chemotherapy: A randomized clinical trial.
Iran J Med Educ 2012;11:874‑84.
19. Moradi Lakeh M, Taleb AM, Saeidi M. Application effective
and using safety ginger for reduce nausea and vomiting in early
pregnancy. Issue Payesh 2008;7:345‑54.
20. Lacasse A, Rey E, Ferreira E, Morin C, Bérard A. Nausea and
vomiting of pregnancy: What about quality of life? BJOG
21. A group of writers. Country Guide of Providing Obstetric Services
in Children and Mother‑Friendly Hospitals. Tehran: Charsoye
Honar; 2010.
22. Lacasse A, Rey E, Ferreira E, Morin C, Bérard A. Validity of
a modified pregnancy‑unique quantification of emesis and
nausea (PUQE) scoring index to assess severity of nausea and
vomiting of pregnancy. Am J Obstet Gynecol 2008;198:71.e1‑7.
23. Chung YH, Tsai ST, Liu MC, Chou FH. Testing the reliability and
validity of the Taiwan health‑related quality of life for nausea and
vomiting during pregnancy scale. Hu Li Za Zhi 2017;64:45‑55.
24. Abedian Z, Abbaszadeh N, Latifnejad Roudsari R, Shakeri MT.
The effect of telephone support on the severity of nausea and
vomiting in the first trimester of pregnancy in the primiparous
women. The Iranian Journal of Obstetrics, Gynecology and
Infertility. 2014;17(118):18‑29.
25. Lacasse A, Bérard A. Validation of the nausea and vomiting of
pregnancy specific health related quality of life questionnaire.
Health Qual Life Outcomes 2008;6:32.
26. Chou FH, Avant KC, Kuo SH, Fetzer SJ. Relationships between
nausea and vomiting, perceived stress, social support, pregnancy
planning, and psychosocial adaptation in a sample of mothers:
A questionnaire survey. Int J Nurs Stud 2008;45:1185‑91.
27. Golmakani N, Soltani M, Ghayour Mobarhan M, Mazloum SR.
Evaluation of the effects of an educational intervention based
on the Ottawa nutritional guideline on health‑related quality of
life in pregnant women with nausea and vomiting. J Midwifery
Reprod Health 2017;5:873‑81.
28. Tol A, Pourreza A, Rahimi Foroshani A, Tavassoli E. Assessing the
effect of educational program based on small group on promoting
knowledge and health literacy among women with type 2 diabetes
referring to selected hospitals affiliated to Tehran University of
Medical Sciences. Razi J Med Sci 2013;19:10‑9.
29. Ghanbari S, Majlessi F, Ghaffari M, Mahmoodi Majdabadi M.
Evaluation of health literacy of pregnant women in urban health
centers of Shahid Beheshti Medical University. Daneshvar.
30. Wood H, McKellar LV, Lightbody M. Nausea and vomiting
in pregnancy: Blooming or bloomin’ awful? A review of the
literature. Women Birth 2013;26:100‑4