Parity and Short Pregnancy Spacing Linked to Severe Morning Sickness, Indonesian Study Finds
A new study by Jumiyati, S.Tr.Keb., M.Kes., Hernah Riana, and Nurmitasari from the Institut Kesehatan dan Teknologi Bisnis Menara Bunda Kolaka, Indonesia, reports that parity and the interval between pregnancies significantly influence the risk of hyperemesis gravidarum, a severe form of nausea and vomiting during pregnancy. The research was published in 2026 in the International Journal of Contemporary Sciences (IJCS) and focuses on pregnant women receiving care at Puskesmas Wundulako in Kolaka, Southeast Sulawesi.
The findings highlight how reproductive history—particularly the number of previous births and the time gap between pregnancies—can increase the likelihood of developing hyperemesis gravidarum. The study offers new insights for maternal healthcare providers working at Indonesia’s primary healthcare centers, where early detection and preventive counseling are essential for protecting maternal health.
Hyperemesis Gravidarum Remains a Global Maternal Health Concern
Nausea and vomiting are common experiences during pregnancy, especially during the first trimester. These symptoms typically begin around the fifth or sixth week of pregnancy, peak between weeks eight and twelve, and gradually improve by the second trimester.
However, in some women the symptoms become far more severe. This condition is known as hyperemesis gravidarum, a serious pregnancy complication characterized by persistent nausea, repeated vomiting, dehydration, electrolyte imbalance, and weight loss. Without proper treatment, the condition can disrupt maternal nutrition and pose risks to both mother and fetus.
Globally, the prevalence of hyperemesis gravidarum varies widely, affecting 0.3 percent to more than 10 percent of pregnancies. In Indonesia, national health data indicate that more than 80 percent of pregnant women experience nausea and vomiting, while 12–13 percent develop hyperemesis gravidarum.
Regional data from Southeast Sulawesi Province also show consistently high rates of the condition. In Kolaka District, local health records reveal stable numbers of hyperemesis gravidarum cases in recent years, suggesting that maternal characteristics and reproductive patterns may contribute to the problem.
Community health centers, known in Indonesia as puskesmas, play a crucial role in monitoring pregnancies and detecting complications early. Understanding which maternal factors increase risk can help health workers provide better counseling and preventive care.
Study Conducted at a Primary Healthcare Facility
The research team from the Institut Kesehatan dan Teknologi Bisnis Menara Bunda Kolaka conducted a cross-sectional study using maternal health records from Puskesmas Wundulako.
The study included 80 pregnant women registered in the health center’s maternal database:
- 40 women diagnosed with hyperemesis gravidarum
- 40 women without the condition
Participants were selected using purposive sampling from the 2024 maternal health register.
The researchers focused on two maternal factors:
- Parity (number of previous births)
- Interpregnancy interval (time between pregnancies)
Parity was categorized into:
- High-risk parity: first pregnancy or more than three previous births
- Low-risk parity: two to three previous births
Interpregnancy interval was classified as:
- High risk: less than two years between pregnancies
- Lower risk: two years or more
To determine whether these factors were associated with hyperemesis gravidarum, the research team analyzed the data using Chi-square statistical tests, a common method for examining relationships between categorical variables.
Key Findings from the Kolaka Study
The analysis revealed clear relationships between maternal reproductive history and the likelihood of hyperemesis gravidarum.
Main findings include:
- Pregnant women with high-risk parity (first pregnancy or more than three births) showed a significantly higher incidence of hyperemesis gravidarum.
- Women whose pregnancies occurred less than two years after the previous birth were also more likely to experience severe nausea and vomiting.
- Both factors demonstrated statistically significant associations with the occurrence of hyperemesis gravidarum.
These results indicate that maternal physiological adaptation and recovery time between pregnancies may influence how the body responds to hormonal changes during early pregnancy.
Why Parity and Pregnancy Spacing Matter
Medical researchers have long suspected that reproductive history plays a role in pregnancy complications.
Women experiencing their first pregnancy may face a higher risk of hyperemesis gravidarum because their bodies are adapting to pregnancy-related hormonal changes for the first time. Psychological factors such as stress and anxiety may also contribute.
At the other extreme, women who have had more than three births may face increased health risks due to cumulative physical strain from repeated pregnancies.
The interval between pregnancies is another critical factor. When pregnancies occur less than two years apart, the mother’s body may not have fully recovered from the previous pregnancy and childbirth. Nutritional reserves, hormonal balance, and physical recovery can all be affected.
According to the study authors, these conditions may make pregnant women more vulnerable to complications such as severe nausea and vomiting.
As the researchers explain, Jumiyati and colleagues from the Institut Kesehatan dan Teknologi Bisnis Menara Bunda Kolaka emphasize that maternal risk factors should be carefully monitored in primary healthcare settings, particularly in regions where access to specialized hospital care may be limited.
Implications for Maternal Healthcare in Indonesia
The study offers practical insights for healthcare providers working in community clinics and maternal health programs.
Key implications include:
- Improved prenatal counseling: Women planning pregnancy should receive guidance about ideal pregnancy spacing.
- Early risk screening: Health workers can identify women with high-risk parity or short pregnancy intervals during early antenatal visits.
- Targeted monitoring: Pregnant women with these risk factors may benefit from closer observation and early treatment for nausea and vomiting.
- Family planning education: Promoting optimal birth spacing may help reduce complications during future pregnancies.
For Indonesia’s maternal health system, which relies heavily on puskesmas and midwives, such preventive strategies can significantly improve outcomes for mothers and babies.
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