Nausea And Vomiting In Pregnancy Research Articles

Efficacy of Doxylamine and Pyridoxine during Pregnancy Induced Nausea and Vomiting

Introduction: Nausea and vomiting in pregnancy (NVP) is the most common medical condition of pregnancy causes a significant clinical, psychological and economic burden. Therefore, it is very important to treat this condition appropriately and effectively. The combination of Doxylamine and Pyridoxine is recommended as first-line therapy for nausea and vomiting in pregnancy. Objectives: To observe the therapeutic efficacy of combined Doxylamine and Pyridoxine for treatment of nausea and vomiting in pregnancy. Materials and Methods: An observational study was conducted on patients with nausea and vomiting in pregnancy attended the Model Family planning clinic in the Department of Obstetrics and Gynaecology, Sylhet MAG Osmani Medical College Hospital, Sylhet during the period from January 2019 to December 2019. A total 90 patients with clinically meaningful nausea vomiting (Pregnancy-Unique Quantification of Emesis [PUQE] score > 6) were selected and given 2-4 tablets each containing combined Doxylamine succinate 10 mg and Pyridoxine hydrochloride 10 mg based on a pre-specified titration protocol response to symptoms by respective physician and PUQE score was recorded in all participants before initiation of treatment and at 8th day and 15th day of treatment. In course of follow up period 7 patients were dropped out and finally 83 patients were analyzed in this study. Result: The mean PUQE score was decreased from 10.27 ± 1.76 to 7.94 ± 1.75 at 8th day and to 5.35 ± 1.47 at 15th day of treatment was significant (p<0.001). The percentage reduction of PUQE score was 23.14% at 8th day and 46.91% at 15th day of treatment. The difference was significant (p<0.001). Conclusion: Combined Doxylamine-Pyridoxine is effective and well tolerated in the treatment of nausea and vomiting in pregnancy (NVP). Medicine Today 2023 Vol.36 (1): 26-30

Validation of Sinhala and Tamil translations of the motherisk: Pregnancy unique quantification of emesis (PUQE) scoring system

Aims: Nausea and vomiting in pregnancy (NVP), where there are no other underlying causes, is one of the most common symptoms in the early part of the pregnancy. It is responsible for up to 80% of pregnant population. By using PUQE score system, it is very convenient to categorize pregnant women with nausea and vomiting come to outpatient department (OPD) or general practice into those who can manage in community setting or those who need inpatient treatments. Objectives: Validation of PUQE instrument to assess NVP and hyperemesis gravidarum (HG) women in Sri Lanka. Methods: Descriptive cross-sectional study conducted among 160 pregnant women presented to the Gynecology Unit of Teaching Hospital Anuradhapura (ATH) during three months duration. Translated self-administered PUQE questionnaire was applied to the patients with signs and symptoms with emesis in pregnancy. All study participants were undergoing clinical judgment as a confirmation test. Diagnostic test accuracy methods were used to assess criterion validity of the experimental tool. Data were analyzed by using SPSS statistical software version 25.0. Results: Study population has a mean age of 27.96 (SD 5.31). Majority of study participants were Sinhalese and according to the parity majority were primigravida pregnancies. Majority of study participants were diagnosed as NVP Stage II (N=134:53.8%) by the PUQE scoring system. According to the clinical judgment Stage II of NVP was diagnosed among 127 (79.4%) study participants. Mean score of the PUQE scale was 9.08 (SD=2.35). Reliability assessment of the PUQE scoring system was reported as an excellent level (Cronbach alpha=0.804). Five types of management strategies were detected among study participants. Significantly high percentage of study participants were given first line antiemetics and oral rehydration solutions. Calculated sensitivity of the PUQE scoring system to diagnose Stage I of NVP was 69.56% and specificity was 96.35%. Calculated sensitivity of the PUQE scoring system to diagnose Stage II of NVP was 100% and specificity was 78.78%. All pregnant women who were clinically detected as Stage II NVP patients were detected as Stage II NVP patients by the PUQE scoring system also. None of the false positives and false negatives regarding Stage II of NVP detected by the PUQE scoring system. Conclusion: First line antiemetics and oral rehydration solutions are usually used for treating pregnancy-related nausea and vomiting. Stage II NVP conditions were detected with a higher prevalence when NVP status was diagnosed clinically and with PUQE scoring system. Specificity of PUQE scoring system appeared higher while detecting NVP Stage I and for NVP Stage II, sensitivity of PUQE scoring system appeared high. For Stage III NVP, clinical judgments and PUQE scoring system values were completely compatible. Management strategies used for treating pregnancy-related hyperemesis status should be further studied. Conducting these studies at different study settings may help to achieve more successful results. Pregnancy unique quantification of emesis tool can be used to diagnose NVP status more descriptively. Also, this PUQE tool is a valid tool which can be effectively used for patient management. Application of PUQE scoring system should be published by planning and implementing staff awareness programs for both curative sector and public health sector.

Nausea, vomiting and conflict in pregnancy: The adaptive significance of Growth-Differentiation Factor 15.

Nausea and vomiting in pregnancy (NVP) is heritable, common and aversive, and its extreme, hyperemesis gravidarum (HG), can be highly deleterious to the mother and fetus. Recent influential studies have demonstrated that HG is caused predominantly by high levels of Growth-Differentiation Factor 15 (GDF15), a hormone produced by the placenta in substantial amounts. This work has led to calls for therapeutic modulation of this hormone to reduce GDF15 levels and ameliorate HG risk. I describe three main lines of evidence relevant to the hypothesis that GDF15 production is typically adaptive for the fetus, in the context of enhanced placental invasion, reduced rates of miscarriage and preterm birth and higher birth weight. These considerations highlight the medical implications of maternal-fetal conflict, in the context of tradeoffs between aversive symptoms during gestation, rare disorders of pregnancy with major adverse effects and moderate fitness-enhancing benefits to fetuses.

Helicobacter pylori Exposure in Nausea and Vomiting of Pregnancy Increases Risk of Preterm Delivery.

Hyperemesis gravidarum (HG), a severe form of nausea and vomiting in pregnancy (NVP), is a leading indication for hospitalization in the first trimester. NVP and HG are associated with Helicobacter pylori (HP) infection in non-United States cohorts. How HP exposure and NVP interact to affect metabolic disturbance and pregnancy outcomes is not known. We designed a retrospective cohort study relating HP and NVP to serum electrolyte laboratory results, preterm delivery, and infant birth weight. Single academic institution discovery and independent multi-institutional validation cohorts included pregnant subjects with an HP test result. Associations of HP, NVP, and pregnancy outcomes were assessed with odds ratio calculations, Student's t-tests, and multivariate logistic regression. Among subjects with positive HP test results, the prevalence of hyperemesis gravidarum (HG) was 0.025 (66 of 2671) and NVP was 0.27 (710 of 2671). Subjects with negative HP had prevalence of HG 0.015 (165 of 10,960) and NVP 0.22 (2392 of 10,960). History of HP exposure increased risk of NVP, including HG (odds ratio 1.3, 95% CI 1.1-1.4). Patients with HP exposure had lower serum potassium (mean difference 0.1 mEq/L) and bicarbonate (mean difference 0.3 mEq/L) during pregnancy than HP-negative patients (p < 0.01). Serum potassium was lowest in subjects with both NVP and HP exposure (mean 3.5 mEq/L [3.4-3.6], p < 0.0001). HP exposure alone carried increased risk for preterm delivery (OR 1.3 [1.1-1.4]). NVP alone increased risk of preterm delivery (OR 2.8 [2.5-3.1]) including second trimester delivery (OR 2.2 [1.7-2.8]). In multivariate analysis, HP exposure in the setting of NVP further increased risk of preterm delivery (adjusted OR 1.4 [1.0-1.9], p = 0.03). H. pylori exposure and diagnosis of NVP are individually associated with metabolic disturbances and adverse pregnancy outcomes such as preterm labor and delivery, and their combination further increases risk in US populations.

Ear Plaster Therapy as a Safe and Effective Treatment for Gestational Vomiting.

Nausea and vomiting in pregnancy (NVP) are common symptoms that often complicate early pregnancy for many women. While clinical treatments such as fasting, fluid infusion, and nutritional support are conventionally applied to manage NVP, their effectiveness varies. However, traditional ear plaster therapy offers a promising alternative that effectively relieves symptoms and poses no known risk to the development of embryos or fetuses. This therapy is known for its ease of application, cost-effectiveness, and favorable outcomes. Previous studies have demonstrated the efficacy of combining ear plaster therapy with conventional treatments in alleviating symptoms of nausea and vomiting in pregnant women, surpassing the results achieved with conventional treatment alone. The protocol presented herein describes a method to relieve NVP using round, smooth, and hard cowherb seeds applied to specific ear points. These seeds are gently rubbed onto the surface of the ear, utilizing the principles of acupressure. By stimulating the designated ear points, this procedure aims to regulate the body's energy flow and restore balance, thereby reducing the severity and frequency of NVP. The application of cowherb seeds on specific ear points is a straightforward technique that healthcare professionals can easily implement or self-administered by pregnant women under appropriate guidance. Overall, ear plaster therapy presents a safe, effective, and economical approach for managing gestational vomiting, offering women a potential solution to alleviate their discomfort during pregnancy.

Dietary Intake and Its Association with Birth Outcomes in Women with Nausea and Vomiting during the Second Trimester of Pregnancy: A Prospective Cohort Study in Japan.

Nausea and vomiting in pregnancy (NVP) is a common symptom. Although the influence of NVP during the first trimester on dietary intake and birth outcomes has been revealed, no study has focused on NVP during the second trimester. This study aimed to reveal whether NVP severity during the second trimester is associated with dietary intake, gestational weight gain (GWG), birth weight, and delivery week. Participants completed a questionnaire at 18-27 gestational weeks. NVP severity was assessed using the modified Pregnancy-Unique Quantification of Emesis and Nausea scale in the questionnaire. Dietary habits were assessed using a brief-type diet history questionnaire. In total, 825 responses were analyzed: 202 (24.5%), 135 (16.4%), and 8 (1.0%) women reported mild, moderate, and severe NVP, respectively; 480 (58.2%) women did not have NVP during the second trimester. No significant association was observed between energy and nutrient intake and no/mild and moderate/severe NVP. Women with moderate/severe NVP had lower total GWG than those with no/mild NVP (p = 0.007). There was no significant difference in low birth weight and preterm birth rates (p = 0.246 and p = 0.604). This is the first study to investigate whether NVP severity during the second trimester is associated with dietary intake and birth outcomes.

Nausea and vomiting in pregnancy

Nausea and vomiting in pregnancy (NVP) is one of the most common presenting complaints to primary care during pregnancy. Although often referred to as ‘morning sickness’ symptoms may be present at any time of the day. Hyperemesis gravidarum (HG) is the most severe presentation of NVP and can lead to hospitalisation due to dehydration and other metabolic complications. HG can lead to psychological and socioeconomic difficulties in those affected, and there also may be more long term sequalae for the developing foetus. This article aims to highlight the issues to consider when managing patients presenting with NVP and HG in primary care.

Associations between nausea and vomiting in pregnancy, disgust sensitivity, and first-trimester maternal serum free β-hCG and PAPP-A

Elevated levels of nausea and vomiting in pregnancy (NVP) and disgust sensitivity have been observed in the first trimester and both are thought to have a protective function for the mother and her fetus. Their aetiology is not clear, however, with previous studies attributing elevated NVP and disgust to various factors including endocrine changes, immunological changes, and psychological variables. To date, no study has directly assessed the relationship between disgust and NVP. Here, we prospectively collected two independent samples (S1 and S2; n1 = 201, n2 = 391) of women in the first trimester of pregnancy, who completed the Index of Nausea, Vomiting, and Retching and the Disgust Scale-Revised. We also measured free β-human chorionic gonadotropin (hCG) and pregnancy-associated plasma protein A (PAPP-A) in maternal serum. Our results did not confirm any association between NVP and disgust; in addition, they indicate that NVP and disgust may have different proximate causes. Disgust sensitivity was significantly negatively correlated with free β-hCG and (only in S1) with PAPP-A. In contrast, NVP was significantly positively associated with free β-hCG levels and (only in S1) with PAPP-A. While low hCG levels seem to be an important indicator for activation of the behavioral immune system in the first trimester, increased hCG levels play a role in stronger symptoms of NVP, a result consistent with previous studies. Levels of PAPP-A are likely part of a larger network of immunological and endocrine responses and do not appear to provide sufficient information for predicting women's NVP and disgust sensitivity.

Testing effects of partner support and use of oral contraception during relationship formation on severity of nausea and vomiting in pregnancy

BackgroundA recent study focusing on dietary predictors of nausea and vomiting in pregnancy (NVP) found that women with higher levels of partner support, and those who had used oral contraception (OC) when they met the father, both tended to report less severe NVP compared with previous non-users or those with less supportive partners. We provide a further test of these factors, using a large sample of women from four countries who retrospectively scored their NVP experience during their first pregnancy.MethodsWe recruited women who had at least one child to participate in a retrospective online survey. In total 2321 women completed our questionnaire including items on demographics, hormonal contraception, NVP, and partner support. We used general linear models and path analysis to analyse our data.ResultsWomen who had used OC when they met the father of their first child tended to report lower levels of NVP, but the effect size was small and did not survive adding the participant’s country to the model. There was no relationship between NVP and partner support in couples who were still together, but there was a significant effect among those couples that had since separated: women whose ex-partner had been relatively supportive reported less severe NVP. Additional analyses showed that women who were older during their first pregnancy reported less severe NVP, and there were also robust differences between countries.ConclusionsThese results provide further evidence for multiple influences on women’s experience of NVP symptoms, including levels of perceived partner support.

Nausea and Vomiting during Early Pregnancy among Chinese Women and Its Association with Nutritional Intakes

Nausea and vomiting in pregnancy (NVP) is one of the most common uncomfortable symptoms of women in early pregnancy. A total of 303 Chinese pregnant women from 10 urban cities in their first trimester were recruited in this study to collect their sociodemographic characteristics and their NVP occurrence. Their dietary nutrient and food intakes were also collected by a 24 h dietary recall and a semi-quantitative food frequency questionnaire (SFFQ). Using the univariate analysis and multiple linear regression analysis to estimate the correlation between NVP and dietary intake, we found that 255 (84.1%) pregnant women experienced NVP during their first trimester. The intake of energy, protein, fat, vitamin A, thiamin, riboflavin, vitamin E, phosphorus, potassium, iron and zinc was lower in women with NVP than in those with no NVP. Additionally, women with NVP were more likely to have insufficient intake of protein, riboflavin, calcium, phosphorus and selenium. In terms of specific food groups, the average daily intake of mushrooms, algae, nuts and seeds, meat, eggs and dairy products in the NVP group was lower. Women in the severe NVP group even had insufficient gestational weight gain. We should pay more attention to women who experience nausea and vomiting during pregnancy and provide them with targeted nutritional support.

Evaluation of nausea and vomiting in the first trimester on the risk of adverse birth outcomes and the contribution of genetic polymorphisms: a pilot prospective study.

To evaluate the impact of Nausea and Vomiting in Pregnancy (NVP) on the risk of Preterm Birth (PTB) and Low Birth Weight (LBW), and explore the effect of geneticpolymorphisms on the severity of NVP. A prospective study was conducted. Participants' experience of NVP prior to 12 gestational weeks were evaluated by a Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scale. 11 Single Nucleotide Polymorphisms (SNPs) loci located in growth differentiation factor 15 (GDF15) and leucine-rich repeat containing 25 (LRRC25) gene of chr19p13.11 and intergenic region of chr4q12 were genotyped, which were implicated as genetic risk factors for NVP. Logistic regression models were applied to determine the effect of NVP in the first trimesteron the risk of PTB and LBW, and genetic polymorphisms on the risk of NVP. Among 413 pregnant women, the incidence of nausea and vomiting was 85.5% (n = 353) in the first trimester, including 38.7% (n = 160) mild vomiting, 42.6% (n = 176) moderate vomiting and 4.1% (n = 17) severe vomiting.33 were PTB, 20 were LBW. Compared with pregnant women without NVP, women with mild, moderate or severe NVP in the first trimester were not associated with the risk of PTB and LBW. Besides, the polymorphisms of 11 SNPs loci were not associated with the risk of NVP. Our study indicated that symptoms of nausea and vomitingin the first trimester were not significantly associated with PTB and LBW, and there were also no associations between GDF15 and LRRC25 polymorphisms and NVP.

Ondansetron use in nausea and vomiting during pregnancy: A descriptive analysis of prescription patterns and patient characteristics in UK general practice.

AimsThe objective of this study was to describe ondansetron drug utilization patterns during pregnancy to treat nausea and vomiting in pregnancy (NVP). Moreover, we aimed to describe the maternal factors associated with NVP and antiemetic use.MethodsThe data consist of pregnancies with a live birth(s) within an IMRD‐UK registered GP practice. Descriptive statistics were used to investigate patterns of ondansetron use in pregnancy and to describe maternal characteristics associated with NVP and antiemetic drug utilization. We differentiate first‐ from second‐line use during pregnancy using antiemetic prescription pathways.ResultsThe dataset included 733 633 recorded complete pregnancies from 2005 to 2019. NVP diagnosis and ondansetron prescription prevalence increased from 2.7% and 0.1% in 2005 to 4.8% and 2.5% in 2019 respectively. Over the period 2015–2019, the most common oral daily dosages were 4 mg/d (8.5%), 8 mg/d (37.1%), 12 mg/d (37.5%) and between 16 and 24 mg/d (16.9%). Prescription of ondansetron was initiated during the first trimester of pregnancy in 40% of the cases and was moderately used as a first‐line therapy (2.8%), but preferred choice of second‐line therapy. Women with mental health disorders, asthma and/or prescribed folic acid were more likely to experience NVP and use antiemetics in pregnancy than their counterparts.ConclusionThis study confirms that ondansetron is increasingly used off‐label to treat NVP during pregnancy, also in the first trimester and before other prescription antiemetics have been prescribed. Several maternal comorbidities and folic acid use were more common among women experiencing NVP and using antiemetics, including ondansetron.

THE RELATIONSHIP OF SOCIAL SUPPORT WITH THE DEGREE OF NAUSEA AND VOMITING IN PREGNANCY

Abstract Background : At the beginning of a pregnancy the mother experiences various processes of transition or adaptation regarding changes in herself, so that she really needs support from her environment. Lack of social support can worsen the physiological complaints of pregnant women including Nausea and Vomiting in Pregnancy (NVP). Complaints of nausea and vomiting can affect the mother in carrying out daily activities, affect the mother's social situation with the environment and cause stress. Therefore, it is important to research the relationship between social support and the degree of nausea and vomiting in first and second-trimester pregnant women. Method : This research method is observational analytic with cross sectional research design. Sampling used the total sampling method with the criteria of pregnant women who had complaints of nausea and vomiting. Collecting data using primary data using a 24-hour PUQE questionnaire that measures the duration and frequency of nausea and vomiting and the MSPSS questionnaire measuring social support. The data collected were analyzed using the Spearman test (p&lt;0.15). Results : Out of 47 respondents, 34 pregnant women (72.3%) received high social support. Besides that, 24 out of 47 respondents (51.1%) experienced moderate degree of NVP. In this study, there were no respondents who experienced severe degree of NVP. Spearman test analysis results obtained p= 0.833 or p&gt;0.15. Conclusion : There is no relationship between social support with NVP in first and second trimester of pregnancy.

Effectiveness of Ginger in Treating Nausea and Vomiting of Pregnancy

Nausea and vomiting in pregnancy (NVP) is one of the common main complaint in pregnancy. NVP can be a significant burden to the patient, make a decrease in quality of life, pregnancy threatening or even worse can lead to nutritional loss and death. NVP diagnosed when in first trimester of pregnancy and the other possible cause of NVP is excluded. Management of NVP is included maintaining hydration, nutrition, and lifestyle modification. Also avoiding the smells, food, or activity that can cause nause are necessary. There are some methods to treat NVP including pharmalogical or non-pharmalogical. The non-pharmalogical approach is change nutritional habits, lifestyle and medications. Several pharmalogical agents that can be used to relief the symptoms of NVP are pyridoxine, anti- histamines, metoclopramide, pyridoxine/doxylamine, promethazine and metoclopramide. Some patients also want to try more “natural” medications for NVP like ginger. The pharmacological activity is thought to stand in the pungent principles (gingerols and shogaols) and volatile oils (sesquiterpenes and monoterpenes). The true mechanism of action of ginger is probable to be a gastric effect, to increase tone and peristaltic due to anticholinergic and antiserotonin act. Ginger acts straight to the digestive tract and avoids the CNS side effects common to centrally acting antiemetics. Ginger is available in capsule or syrup form or in candy, cookies, beer, tinctures, teas, sodas, and jam. Nowadays, true dosing is available only if one uses standardized extracts; however, women may choose to use another form of ginger.

The effect of a pharmacist consultation on pregnant women\u2019s quality of life with a special focus on nausea and vomiting: an intervention study

BackgroundMaternal wellbeing and quality of life (QOL) are increasingly being recognized as important for healthy pregnancies. The aim of this study was to investigate the impact of a pharmacist consultation on pregnant women’s QOL focusing on nausea and vomiting in pregnancy (NVP), and patient satisfaction.MethodsFor this intervention study in 14 community pharmacies, women in early pregnancy were recruited and assigned to a pharmacist consultation (intervention) or standard care (control). The consultation aimed to address each woman’s concerns regarding medications and pregnancy-related ailments. Data were collected through online questionnaires at baseline (Q1) and during the second trimester (Q2). The intervention group completed an additional satisfaction questionnaire after the consultation was completed. The primary outcome was the impact of the intervention on the Quality of Life Scale (QOLS) scores between the first and second trimesters. The impact of the intervention was assessed by linear regression, and secondary analyses were performed to assess effect modification by NVP.ResultsOf the 340 women enrolled in the study, we analyzed data for 245. Half (170/340) of the original participants were allocated to the intervention group, of whom 131 received the pharmacist consultation. Most women (75%, 78/96) reported that the consultation was useful to a large/very large extent. The consultation had no overall impact on QOLS scores between the first and the second trimesters compared with standard care (adjusted β: 0.7, 95% CI: -2.1, 3.4). The impact of the intervention on QOLS was greater amongst women with moderate/severe NVP (adjusted β: 3.6, 95% CI: -0.6, 7.7) compared to those with no/mild NVP (adjusted β: -1.4, 95% CI: -5.1, 2.2) (interaction term study group*NVP severity, p = 0.048).ConclusionsThe pregnant women highly appreciated the pharmacist consultation, but the intervention did not affect their QOL scores compared with standard care. Future studies should further explore the effect of a pharmacist consultation specifically for NVP and on other outcomes such as use of health care services and medication use in pregnancy.Trial registrationRetrospectively registered in ClinicalTrials.gov (identifier: NCT04182750, registration date: December 2, 2019).

Effect of Accu Tens with Accu Band on Nausea, Vomiting, Retching and Quality of Life in Early Pregnancy

Background: Nausea and vomiting are basic human preventive reflexes against the absorption of toxins, as well as responses to correct stimuli. They are often used together, although each phenomenon should be assessed separately.1 Nausea and vomiting in pregnancy (NVP) is repeatedly experienced in early pregnancy, most frequently between 6 and 12 weeks.its important to find out Accu tens and bands and related techniques have potential for nonpharmacologic relief of nausea and vomiting in pregnancy Methodology: Subjects were randomized into two groups. 124 subjects of above 18 years old subjects were recruited in each group. Accu (TENS) Transcutaneous Electrical Nerve Stimulation with accu band at P6 point or Neiguan acupuncture point of dominant hand was administered to experimental group while control group was subjected to placebo (TENS) Transcutaneous Electrical Nerve Stimulation with Accu band on dorsum of wrist joint. Both the groups received interventions for 5 days in a week for 3 weeks. The outcome of study assessed by Rhodex index,Nausea Vomiting of Pregnancy Quality of Life (NVPQOL) questionnaire, which was assessed before treatment and after treatment session regimen. Result: Rhodex index scores shows that there is comparison between group A and group B mean value of group A and group B 18.61 and 12.29 respectively. The t-value were 6.66 and p<0.0001. NVPQOL scores shows that there is comparison between group A and group B mean value of group A and group B 115.23 and 80.58 respectively. The t-value were 7.25 and p<0.0001. Conclusion: The results obtained from this study showed that the Accu TENS with Accu band can be easy to perform, least expensive, feasible and most efficient management strategy for reducing nausea, vomiting and retching, weight gain and enhancing the quality of life of individuals with early pregnancy.

The safety of early pregnancy exposure to granisetron

ObjectiveCurrent guidelines suggest that granisetron is an optional treatment for nausea and vomiting in pregnancy (NVP) despite lack of evidence to support fetal safety. We aimed to determine the association between early pregnancy exposure to granisetron and fetal/neonatal outcomes. DesignMedical records of patients treated for NVP during the first and second trimester between June 2013 to September 2015 were reviewed. Patients were asked to participate in the study by answering a detailed questionnaire regarding newborn’s health and complementary data. Pregnancy outcomes of patients exposed to granisetron were compared with those of patients who were not exposed to granisetron. Results100 Granisetron exposed pregnancies were compared with 108 granisetron unexposed pregnancies. Exposure to granisetron occurred in the first trimester in 88 patients (94 fetuses). Maternal characteristics, history of anomalies in first degree relatives, co-exposure to other substances and extent of prenatal sonographic surveillance were comparable between both groups. Miscarriage rate was significantly lower among granisetron exposed patients compared to controls (0 vs 5.5 %, respectively, p = 0.03). Three major malformations were identified prenatally or postnatally in each of the groups (2.77 % Vs 2.83 %, p = 1). The rate of major malformations was similar between exposed and unexposed fetuses even after excluding second trimester exposure (3.2 % vs. 2.83 %, respectively p = 1). Mean gestational age at delivery, mean newborn weight and incidence of small for gestation age, were not significantly different between the groups. ConclusionGranisetron exposure was not associated with increased risk for minor or major fetal anomalies. This study provides preliminary reassurance regarding the safety of in-utero exposure to granisetron.

Hyperemesis gravidarum

Nausea and vomiting in pregnancy (NVP), or morning sickness, is the most common symptom experienced by pregnant women and affects 80% of pregnancies. NVP occurs across a spectrum, ranging from mild to severe, with hyperemesis gravidarum (HG) representing the most extreme form. HG is a complication of pregnancy affecting 1% of pregnancies, and if left untreated can cause maternal and fetal morbidity and mortality. Early treatment of NVP in primary care can prevent progression to HG. This article aims to help GP trainees understand the natural history of HG and provides a framework for its assessment and management.

Clinical management of nausea and vomiting in pregnancy and hyperemesis gravidarum across primary and secondary care: a population‐based study

To assess how nausea and vomiting in pregnancy (NVP) and hyperemesis gravidarum (HG) are managed and treated across primary and secondary care. Population-based pregnancy cohort. Medical records (CPRD-GOLD) from England. 417028 pregnancies during 1998-2014. Proportions of pregnancies with recorded NVP/HG diagnoses, primary care treatment, and hospital admissions were calculated. Multinomial logistic regression was employed to estimate adjusted relative risk ratios (aRRRs) with 99% confidence intervals (CIs) for the association between NVP/HG management paths and maternal characteristics. NVP/HG diagnoses, treatments, and hospital admissions. Overall prevalence of clinically recorded NVP/HG was 9.1%: 2.1% had hospital admissions, 3.4% were treated with antiemetics in primary care only, and 3.6% had only recorded diagnoses. Hospital admissions and antiemetic prescribing increased continuously during 1998-2013 (trend P<0.001). Younger age, deprivation, Black/Asian/mixed ethnicity, and multiple pregnancy were associated with NVP/HG generally across all levels, but associations were strongest for hospital admissions. Most comorbidities had patterns of association with NVP/HG levels. Among women with NVP/HG who had no hospital admissions, 49% were prescribed antiemetics, mainly from first-line treatment (21% prochlorperazine, 15% promethazine, 13% cyclizine) and metoclopramide (10%). Of those admitted, 38% had prior antiemetic prescriptions (34% first-line, 9% second-line, 1% third-line treatment). Previous focus on hospital admissions has greatlyunderestimated the NVP/HG burden. Although primarycare prescribing has increased, most women admitted to hospital have no antiemetics prescribed before this. An urgent call is made to assess whether admissions could be prevented with better primary care recognition and timely treatment. The NVP/HG burden is increasing over time and management optimisation should be high priority to help reduce hospital admissions.

Trends in marijuana use among pregnant women with and without nausea and vomiting in pregnancy, 2009–2016

BackgroundCross-sectional studies indicate an elevated prevalence of prenatal marijuana use in women with nausea and vomiting in pregnancy (NVP). However, it is unknown whether differences in marijuana use by NVP status have persisted over time as marijuana becomes more acceptable and accessible and prenatal use increases overall. We compared trends in prenatal marijuana use by NVP status in the first trimester of pregnancy using data from Kaiser Permanente Northern California’s (KPNC) large healthcare system. MethodsThe sample comprised KPNC pregnant women aged ≥12 who completed a self-administered questionnaire on marijuana use and a urine toxicology test for cannabis during standard prenatal care from 2009 to 2016. The annual prevalence of marijuana use via self-report or toxicology by NVP status was estimated using Poisson regression with a log link function, adjusting for sociodemographics and parity. We tested for linear trends and differences in trends by NVP. ResultsOf 220,510 pregnancies, 38,831 (17.6%) had an NVP diagnosis. Prenatal marijuana use was elevated each year among women with NVP. The adjusted prevalence of use increased significantly from 2009 to 2016 at an annual rate of 1.086 (95%CI = 1.069–1.104) among women with NVP, from 6.5% (95%CI = 5.7%–7.2%) to 11.1% (95%CI = 0.2%–12.0%), and 1.069 (95%CI = 1.059–1.080) among women without NVP, from 3.4% (95%CI = 3.2%–3.7%) to 5.8% (95%CI = 5.5%–6.1%). Trends did not vary by NVP status. DiscussionThe prevalence of prenatal marijuana use has remained elevated over time among women with NVP. Clinicians should ask pregnant patients about their reasons for marijuana use and treat NVP with evidence-based interventions.