Use of metoclopramide in the first trimester and risk of major congenital malformations: A systematic review and meta-analysis.

Li Sun,Yang Xi,Xiaoke Wen,Wei Zou,Angela Lupattelli

doi:10.1371/journal.pone.0257584

Abstract

BackgroundNausea and vomiting of pregnancy affects up to 80% of pregnant women, it typically occurs during the first trimester which is the most sensitive time for environmental exposures given organogenesis. Metoclopramide is an antiemetic drug used widely during NVP, but the findings of studies evaluating its safety of use in pregnancy is inconsistent. Therefore, we conducted a systematic review and meta-analysis to assess whether metoclopramide use during first trimester of pregnancy is associated with the risk of major congenital malformations.MethodsThe systematic search using database included Pubmed, Embase, Web of science, and Cochrane library. Studies written in English, comprising with an exposed group and a control group, reporting major congenital malformation as an outcome were included.ResultsSix studies assessing a total number of 33374 metoclopramide-exposed and 373498 controls infants were included in this meta-analysis. No significant increase in the rate of major congenital malformation was detected following metoclopramide use during first trimester (OR, 1.14; 95% CI, 0.93–1.38).ConclusionsMetoclopramide use during first trimester of pregnancy was not associated with the risk of major congenital malformations.

Highlights

Nausea and vomiting of pregnancy (NVP) is a common pregnancy-related medical condition that typically occur during the first trimester, affecting about 80% pregnant women [1]
All included studies investigated the risk of major congenital malformation in relation with first-trimester exposure to metoclopramide
Fiaschi et al [29] investigated the medical records (CPRD-GOLD) from England, finding that metoclopramide was the most commonly prescribed as second-line pharmacotherapy (11.6%) for NVP and that hospital admissions as well as antemetic prescribing increased continuously during 1998–2013

Summary

Introduction

Nausea and vomiting of pregnancy (NVP) is a common pregnancy-related medical condition that typically occur during the first trimester, affecting about 80% pregnant women [1]. Metoclopramide is a dopamine receptor antagonist, which works via blocking the dopamine receptor in the chemoreceptor trigger zone and depressing the vomiting center in the brain [5]. It is widely used in NVP at the situation that a treatment with vitamin B6 or antihistamine has failed. We performed a meta-analysis to provide a comprehensive assessment of the association between metoclopramide use in first trimester and major congenital malformations. To the best of our knowledge, this is the first meta-analysis exploring the risk of major congenital malformations and metoclopramide use in the first trimester.

Methods

Results

Conclusion