Treatment Of Nausea And Vomiting Of Pregnancy Research Articles

Effects of Complementary Alternative Medicine on Hyperemesis Gravidarum: A Systematic Review

Background: Nausea and vomiting of pregnancy (NVP) is a common problem for pregnant women. Many pregnant women are worried about the side effects of pharmacological therapy, thus encouraging them to use non-pharmacological therapy. Researchers have recently paid particular attention to complementary medicine methods for the treatment of NVP. With regard to the high prevalence of NVP as well as the adverse effects of chemicals on the mother and fetus of the drug, this study focused on assessing the safety and efficacy of different non-pharmacological methods in eliminating NVP. This systematic review was carried out to assess the safety and efficacy of different non-pharmacological methods in eliminating NVP. Methods: This study used a systematic review method by conducting a literature search through the PubMed database, Cochrane library, Science direct, Proquest, and Google Scholar with publication years starting January 2011 and January 2021. Results: A total of ten articles were selected as part of the final sample according to the inclusion criteria. Of the 10 articles, 2 were about the use of ginger, 3 were about Acupuncture-moxibustion, 2 were about psychotherapy, one was about Progressive muscle relaxation, and 2 were about psychoeducation. Studies have shown a positive effect on NVP reduction; however, no side effects were reported. Conclusion: According to the results of this review, most of the methods used are effective in reducing the incidence of NVP, among which ginger and P6 acupressure can be recommended more reliably.

Тошнота и рвота беременных: влияние на качество жизни

Objective. To examine the relationship between nausea and vomiting of pregnancy (NVP) of varying severity and health-related quality of life (QoL), as well as the efficacy of improving it with the Preginor® complex. Patients and methods. A prospective cohort study enrolled 94 women at 6 to 16 weeks’ gestation with mild to moderate nausea and/or vomiting. The clinical status of patients and QoL were assessed by questionnaire before, during and after administration of Preginor® with evaluating the Pregnancy–Unique Quantification of Emesis and Nausea/PUQE index and socioeconomic status, habits, and lifestyle from specialized questionnaires. Results. Based on the total PUQE index, 69.1% of pregnant women had mild nausea and vomiting. Moderate NVP accounted for 30.9%. No cases of severe NVP that might require hospitalization were identified. In the calculation, the average PUQE score before the use of Preginor® was 6.5. By the end of treatment, the mean value of NVP index decreased by 2.2 times; 37.2% of patients had no complaints, while 55.3% only experienced mild nausea. In 7.5% of women, even with the persistence of moderate manifestations of NVP, their intensity was significantly reduced, improving the general condition of pregnant women and increasing their QoL. In some patients, the Preginor® complex could be continued for more than 1 month upon the recommendation of the attending physician. Conclusion. According to the data presented, NVP, the intensity of which can be measured by the PUQE index, has a significant impact on various aspects of women’s lives, including global QoL, day-to-day aspects, and readiness to become pregnant again. A decrease in this index during the treatment of NVP is associated with an improvement in physical and mental QoL. For this reason, the NVP-specific PUQE index can be a very useful tool in clinical practice. The use of Preginor® complex for nausea and vomiting during pregnancy, significantly alleviating these symptoms, improves patients’ quality of life and daily activities. Key words: nausea, vomiting, pregnancy, antiemetics, ginger, Preginor®, quality of life

Assessment of the management of nausea and vomiting of pregnancy (NVP) by primary care providers in Nigerian primary care settings: A descriptive study

Nigeria has one of the highest maternal morbidity and mortality rates in the world. A strategic approach to reverse this trend is timely recognition and prompt treatment of pregnancy related diseases at primary care levels. This study assessed the knowledge, attitude and treatment practices of primary care providers (PCPs) on Nausea and Vomiting of Pregnancy (NVP) at primary care settings in Osun State, south-west Nigeria. The study employed a descriptive cross-sectional design and two-stage sampling technique. Assessment of the study outcomes (level of knowledge, attitude and practice) was done using a validated questionnaire and were categorized based on performance scores. Data was collected using a pre-tested questionnaire to elicit information on socio-demographic characteristics, level of knowledge of NVP, attitudes on roles and specific tasks in caring for NVP and practices in the management of NVP. The data collected was analyzed using descriptive and inferential statistics . Bivariate analysis comprised Chi-square test on association between level of knowledge of NVP and job cadres while correlation test assessed strength of relationship between level of knowledge of NVP and years of experience. Analytical statistics considered a p < 0.05 to be statistically significant. Of the 250 PCPs enrolled into the study, only 1.2% demonstrated good knowledge of NVP and its recommended management modalities. There was a statistically significant association between the level of knowledge of PCPs and job cadres (χ 2 = 2.840, p = 0.039) while correlation showed a statistically positive relationship between level of knowledge and years of experience (r = 0.272, p = 0.001). Less than half [22 (8.8%)], [47 (18.8%)] and [3 (1.2%)] of the nurses, community workers and doctors respectively agreed NVP is a purely natural phenomenon and requires no treatment, while more than half [36 (14.4%)] of the health assistants agreed that NVP is natural and requires no treatment. Almost all the respondents had recommended pharmacological measures for the treatment of NVP during their professional practice and encountered complications with their use. The level of knowledge of NVP and its management was very low among the PCPs. An educational tool aimed at bridging the knowledge gap may lead to improved care.

Comparison of the effectiveness of ondansetron versus metoclopramide in hyperemesis gravidarum: a randomized clinical trial

Objective: Nausea and vomiting are the most common complications and the first cause of hospitalization of pregnant women in the first trimester of pregnancy. Given the maternal and fetal complications as well as the negative psychosocial and economic effects of nausea and vomiting, the present study aimed to compare the antiemetic effects of ondansetron and metoclopramide.&#x0D; Methods: The present double-blind randomized clinical trial study was conducted on 153 pregnant women with a complaint of nausea and vomiting during pregnancy referred to the obstetrics and gynecology ward. Patients were randomly divided into two metoclopramide and ondansetron groups. The outcomes of interest were nausea and vomiting, the number of used doses of the drug, and the length of hospital stay. The Pregnancy-Unique Quantification of Emesis (PUQE) questionnaire was used to assess the severity of nausea and vomiting.&#x0D; Results: The mean age was significantly higher in the metoclopramide group (28.44±6.45 vs. 25.43±5.42 years, P=0.004). On day 3, the PUQE score was significantly higher in the ondansetron group (6.60±1.10 vs. 6.56±0.88, P&lt;0.001). The decrease in the severity of nausea and vomiting was significantly higher in the ondansetron group (5.29±1.35 vs. 4.90±1.17, P=0.05) in the second day compared to the first day. In the repeated measure analysis, significant differences were found between the two treatment groups (F=7.01, P=0.009). There was no significant difference between the two groups in terms of the length of hospital stay (P&gt;0.05).&#x0D; Conclusion: In this study, ondansetron revealed more efficacy than metoclopramide on the nausea and vomiting of pregnancy (NVP) management. Ondansetron may, therefore, be considered as a safe and effective alternative for metoclopramide in the treatment of NVP.

Effects of Complementary Medicine on Nausea and Vomiting in Pregnancy: A Systematic Review.

Nausea and vomiting of pregnancy (NVP) is a common problem for pregnant women. Researchers have recently paid special attention to complementary medicine methods for the treatment of NVP. Regarding the high prevalence of NVP as well as maternal and fetal adverse effects of chemical drugs, the present study, focusing on clinical trials carried out in Iran, was conducted to assess safety and efficacy of different nonpharmacological methods in relieving NVP. This systematic review focused on randomized controlled trials (RCTs) and assessed complementary medicine on NVP for which databases including MedLib, Magiran, Iran Medex, SID, PubMed, Scopus, and Google Scholar search engines from 2000 to 2015 were searched. Those articles that gained score 3 or higher, according to Jadad criteria, were recruited for the study. In this study, 31 clinical trials assessing NVP were conducted on Iranian pregnant women. After removing ten articles, 21 articles with scores 3 and higher, according to Jedad criteria, were assessed. Out of 21 papers, 10 papers were about ginger, one was about cardamom, one was about lemon, two were about peppermint aromatherapy, six were about pericardium 6 (P6) acupressure, and one article about KID21 acupressure. Most studies have demonstrated a positive effect on reducing NVP; however, no adverse effect was reported. According to the results of this review, the majority of methods employed were effective in reducing the incidence of NVP, among which ginger and P6 acupressure can be recommended with more reliability.

A Review of Herbal Medicines for Nausea and Vomiting of Pregnancy in Traditional Persian Medicine

Nausea and vomiting of pregnancy (NVP) is one of the prevalent pregnancy complaints. This study was conducted to review the medicinal plants mentioned in Traditional Persian Med­icine (TPM) for the treatment of NVP. A literature research was conducted on a number of main references of TPM, including the books of al-Qanun fī al-Teb, Zakhireye Kharazmshahi, Tadbir-al-Habali al- Atfal al-Sabiban and Makhzan-al-Adviah. Then, medicinal plants mentioned in TPM for treatment of NVP were determined and searched in electronic databases, including PubMed and Google Scholar to find studies that confirmed their efficacy. The search terms were ‘‘vomiting’’ or ‘‘nausea’’ or “emesis” and “pregnancy” and the name of each herb. Data were collected for the years 1990–2016. The findings included 10 plants. Citrus limon (Lemon), Citrus medica L. (Citron), Cydonia oblonga (Quince), Elletaria cardamomum (Cardamom), Mentha spicata L. (Spearmint), Menatha piperita (Mint), Myristica fragrans Houtt (Nutmeg), Pistacia lentiscus Linn. (Mastic), Punica granatum L. (Pomegranate), Malus domestica Borkh (Apple), and Piper cubeba L. are the most recommended medications for NVP. There is evidence in human studies for some of these medicinal plants (Mentha Piperita L., Citrus limon, Elletaria cardamom, and Cydonia oblonga Mill). The other mentioned herbs have not been evaluated during pregnancy. There is limited evidence to safely recommend these plants for NVP. Although some human studies have suggested the antiemetic effects of TPM remedies, their safety is not sufficiently documented in modern literature. Scientific studies on these medicinal plants during pregnancy are warranted to determine their safety. [GMJ.2017;6(4):281-90] DOI: 10.22086/gmj.v0i0.809

Ondansetron Use During Pregnancy for Nausea and Vomiting and the Risk of Preterm Birth [34D

INTRODUCTION: Nausea and Vomiting of Pregnancy (NVP) is a common condition affecting up to 80% of pregnant women. Risks of adverse pregnancy outcomes associated with anti-nausea medications have not been well studied. As one of the more common drugs administered for treatment of NVP, we investigated ondansetron use and risk of preterm delivery. METHODS: These data represent a secondary analysis of maternal pregnancy and fetal outcome characteristics from the prospective Proteomic Assessment of Preterm Risk (PAPR) study (2011-2013), where 5,501 pregnant women were enrolled between 17 and 28 weeks of gestation at 11 sites in the United States. Only women who consented to remain in the PAPR repository (n=3,563) were considered eligible and used in this analysis. Potential associations between exposed and unexposed women were investigated statistically by the use of Chi square and multivariate logistic regression. RESULTS: NVP was reported by 814 (23%) women consenting to remain in the repository. In these women ondansetron exposure prior to 290/7 weeks gestation occurred in 534 (66%) who were eligible for analysis. Women taking ondansetron experienced a PTB rate of 14.6% compared to 14.1% for those who did not (unadjusted OR 1.0 95% CI 0.1-1.4). CONCLUSION: The results of this study suggest that exposure to ondansetron was not associated with increased risk of PTB. However, the sample size in this study is relatively small and future studies should be performed in order to further investigate these findings.

Nausea and vomiting of pregnancy - What's new?

Nausea and vomiting of pregnancy (NVP) is one of the most common disorders of pregnancy. The symptoms occur predominantly during the first trimester, although in a subgroup of patients they can continue throughout the entire pregnancy and can affect the woman's quality of life. A small percentage of women develop a severe form of NVP called hyperemesis gravidarum (HG) that if left untreated may lead to significant maternal morbidity and adverse birth outcomes. Overall, the morbidity in pregnant women with NVP is significant, although it tends to be underestimated. The pathogenesis of NVP remains unclear, but there is consensus that the disorder is multifactorial and that various genetic, endocrine and infectious factors may be involved. The treatment of NVP can be challenging as the optimal targets for therapy are not known. Currently, the therapy used depends on the severity of the disorder and it is focused on improving the symptoms while minimizing risks to mother and fetus. Therapies range from dietary changes, pharmacologic treatment or hospitalization with intravenous fluid replacement and nutrition therapy. The aims of this review are 1) to provide an overview of NVP, 2) to present possible links between the most important factors associated with the pathogenesis of NVP and 3) to discuss the effectiveness and safety of the pharmacologic and non-pharmacologic options available to treat this disorder.

Treatment of nausea and vomiting during pregnancy-a cross-sectional study among 712 Norwegian women.

The purposes of this study were to investigate the treatments used for nausea and vomiting of pregnancy (NVP) according to NVP severity among Norwegian women and to assess whether maternal characteristics and attitudes were related to the use of pharmacological treatment of NVP. This is a cross-sectional Web-based study. Pregnant women and mothers with children ≤1 year of age were eligible to participate. Data were collected through an anonymous online questionnaire accessible from November 10th, 2014 to January 31st, 2015. In total, 712 women were included in the study, of which 62 (8.7 %), 439 (61.7 %) and 210 (29.5 %) had mild, moderate and severe NVP, respectively, according to the Pregnancy-Unique Quantification of Emesis (PUQE) classification. A total of 277 (38.9 %) women had used one or more antiemetics, of which meclizine, closely followed by metoclopramide, was the most commonly used. Different drug utilisation patterns were found between the groups of women with mild, moderate and severe NVP. Many with moderate or severe symptoms did not use any pharmacological treatment (70.2 and 32.9 %, respectively). Sick leave was given without initiating medical treatment in 266 (62.1 %) women. The women's beliefs about medicines had an important impact on their use of medicines for NVP. A large proportion of women suffered from moderate to severe symptoms of NVP, many of whom did not receive any pharmacological treatment. Many women, who had been on sick leave due to NVP, were not prescribed medicines.

Ondansetron and pregnancy: Understanding the data.

Nausea and vomiting of pregnancy (NVP) is a common condition affecting 75% of pregnant women. NVP generally commences early in the first trimester, peaking in severity between 7 and 12 weeks and in over 90% symptoms will have abated by week 20. Thus, the time when women are most likely to have NVP and require treatment coincides with the embryonic period when there is maximum susceptibility to any teratogenic risk. Following the thalidomide tragedy of 55 years ago there is a particular awareness and sensitivity about these potential risks, especially in relation to any medication used to treat NVP. Despite several studies showing no clear benefits of ondansetron over other NVP treatments such as doxylamine, and the paucity of safety data, the off-label prescribing and use of ondansetron to treat NVP has increased significantly worldwide. Albeit based on limited human pregnancy data, ondansetron has not been associated with a significantly increased risk of birth defects or other adverse pregnancy outcomes. This review attempts to highlight some of the difficulties in interpreting the available data and the need to follow practical guidelines regarding treatment of NVP.

HPLC-DAD selective method for ginger root powder and extracts nauseastop as standarized not mutagenic ginger extract

Nausea and vomiting of pregnancy (NVP) is a common medical condition in pregnancy with significant physical and psychological morbidity. Up to 90% of women will suffer from NVP symptoms in the first trimester of pregnancy. Ginger is often advocated as beneficial for nausea and vomiting. The herb is increasingly used in western society because there is no FDA-approved medication for the treatment of NVP. The use of ginger in early pregnancy is recommended by the ACOG and the UK National Health Service but the use of standarized extract with well known actives concentration and description of the molecules contained is a must for effective results and proper dosing. For such purpose we describe a selective HPLC-DAD method for the analysis of ginger root powder and extracts for the separation and cuantification of all and every gingerols and shogaols, molecules responsables of the anti emetic activity. Moreover we compared the active content of the powder from roots and the botanical extract NAUSEASTOP. Furthermore for the first time, the Ames Test has been performed for testing the non mutagenic activity of NAUSEASTOP ginger extract and its suitability for the intake during pregnancy. Results reveals the safeness and efficacy of the extract.

The Delayed-Release Combination of Doxylamine and Pyridoxine (Diclegis®/Diclectin®) for the Treatment of Nausea and Vomiting of Pregnancy

Nausea and vomiting of pregnancy (NVP) affects up to 85 % of all pregnancies. Effective treatment can greatly improve a woman’s quality of life, reduce the risk for maternal and fetal complications, and reduce healthcare costs. Unfortunately, many women receive either no pharmacological treatment or are recommended therapies for which fetal safety and efficacy have not been established. First-line treatment of NVP, as recommended by several leading healthcare and professional organizations, is the combination of doxylamine and pyridoxine. This combination, formulated as a 10 mg/10 mg delayed-release tablet, was approved by the US Food and Drug Administration (FDA) for the treatment of NVP in April 2013 under the brand name Diclegis®, and has been on the Canadian market since 1979, currently under the brand name Diclectin®. The efficacy of Diclegis®/Diclectin® has been demonstrated in several clinical trials, and, more importantly, studies on more than 200,000 women exposed to doxylamine and pyridoxine in the first trimester of pregnancy have demonstrated no increased fetal risk for congenital malformations and other adverse pregnancy outcomes. The present review aims to present the scientific evidence on the effectiveness and fetal safety of Diclegis®/Diclectin® for the treatment of NVP to justify its use as first-line treatment for NVP.

Characteristics of women with nausea and vomiting of pregnancy who chose to continue compassionate use of placebo after a randomised trial

The placebo effect has not been characterised in pregnant women suffering from nausea and vomiting of pregnancy (NVP). Our aim was to characterise determinants of the placebo effect in women treated with placebo for NVP. We analysed data from a multicentre, double blind randomised controlled trial of Diclectin® (delayed release doxylamine and pyridoxine) vs placebo for the treatment of NVP. A total of 127 women in the placebo arm and 130 in the active arm provided evaluable data for this analysis. Women who chose to continue placebo on a compassionate basis (n = 41) had significantly better improvement in symptoms of NVP and higher Wellbeing scores than those who did not ask to continue compassionate use. Results were similar in the active drug arm. The request to continue compassionate use of either placebo or active drug could be predicted by greater improvement in symptoms of NVP during the trial period.

The Leading Concerns of American Women with Nausea and Vomiting of Pregnancy Calling Motherisk NVP Helpline

Background. Nausea and vomiting of pregnancy (NVP) is the most common medical condition of pregnancy, affecting up to 85% of expecting mothers. In the USA, there is no FDA-approved medication for the treatment of NVP. Objective. To identify the primary concerns of American women leading them to contact the Motherisk NVP Helpline and to characterize the severity of their symptoms and therapy offered in order to develop improved and customized counseling for them. Methods. We reviewed the intake forms of the American women who called the NVP Helpline from 2008 to 2012. We extracted their state of residence, demographic data, severity of NVP symptoms, and other available clinical characteristics. Results. A total of 195 forms were reviewed. Of these, 86% called for information on management of NVP with/without questions about fetal drug safety, while 14% called solely about drug safety during pregnancy/breastfeeding. The majority of women were Caucasian, in their thirties, educated, employed, married and in their second pregnancy. Of them 95% were suffering from moderate-to-severe condition with 13% having hyperemesis gravidarum. Conclusion. American women need more information on the management of NVP and on a variety of its aspects in addition to the safety and effectiveness of antiemetic medications. Their leading concern was the use of doxylamine and vitamin B6 combination for NVP treatment followed by the use of ondansetron.

Determinants of Adherence to Delayed-Release Doxylamine and Pyridoxine in Patients With Nausea and Vomiting of Pregnancy

Women often hesitate to take medications in pregnancy due to fears of perceived potential fetal damage. The authors' objective is to identify the determinants of adherence to delayed-release doxylamine-pyridoxine (Diclectin) in patients with nausea and vomiting of pregnancy (NVP). The authors performed a prespecified secondary analysis of a multicenter double-blind randomized controlled trial of Diclectin versus placebo for the treatment of NVP. Data on adherence to study medication were collected in all patients. The primary outcome of this analysis was adherence to study medication, which was determined by pill counting and patient diaries. The treatment regimen in the original trial was not fixed and depended on patient's symptoms. There was no difference in the adherence rates between subjects in the Diclectin or placebo arms of the study, so the 2 arms were analyzed as one cohort. The degree of adherence was analyzed in the various subgroups. Subsequently, a multiple linear regression model was constructed to identify predictors to adherence. Two hundred fifty-eight women were included in this analysis. There were no differences in adherence rates according to ethnicity, race, or the presence of adverse events. Gravidity, average number of prescribed tablets per day, site of enrollment, and change in NVP severity measured by the pregnancy unique-quantification of emesis score were associated with adherence. In multivariable analysis, average number of tablets per day, change in pregnancy unique-quantification of emesis, number of treatment days, site of enrollment were significantly predictive of adherence, with the former being negatively correlated. Adherence to antinauseants for NVP is affected by number of tablets prescribed per day, and treatment duration and effectiveness.

Medications used to treat nausea and vomiting of pregnancy and the risk of selected birth defects

Nausea and vomiting of pregnancy (NVP) occurs in up to 80% of pregnant women, but its association with birth outcomes is not clear. Several medications are used for the treatment of NVP; however, data are limited on their possible associations with birth defects. Using data from the National Birth Defects Prevention Study (NBDPS)-a multi-site, population-based, case-control study-we examined whether NVP or its treatment was associated with the most common noncardiac defects in the NBDPS (nonsyndromic cleft lip with or without cleft palate [CL/P], cleft palate alone [CP], neural tube defects, and hypospadias) compared with randomly selected nonmalformed live births. Among the 4524 cases and 5859 controls included in this study, 67.1% reported first-trimester NVP, and 15.4% of them reported using at least one agent for NVP. Nausea and vomiting of pregnancy was not associated with CP or neural tube defects, but modest risk reductions were observed for CL/P (adjusted odds ratio [aOR] = 0.87; 95% confidence interval [CI], 0.77-0.98) and hypospadias (aOR = 0.84; 95% CI, 0.72-0.98). Regarding treatments for NVP in the first trimester, the following adjusted associations were observed with an increased risk: proton pump inhibitors and hypospadias (aOR = 4.36; 95% CI, 1.21-15.81), steroids and hypospadias (aOR = 2.87; 95% CI, 1.03-7.97), and ondansetron and CP (aOR = 2.37; 95% CI, 1.18-4.76), whereas antacids were associated with a reduced risk for CL/P (aOR = 0.58; 95% CI, 0.38-0.89). NVP was not observed to be associated with an increased risk of birth defects; however, possible risks related to three treatments (i.e., proton pump inhibitors, steroids and ondansetron), which could be chance findings, warrant further investigation.

Optimal management of nausea and vomiting of pregnancy

Nausea and vomiting of pregnancy (NVP) is a common medical condition in pregnancy with significant physical and psychological morbidity. Up to 90% of women will suffer from NVP symptoms in the first trimester of pregnancy with up to 2% developing hyperemesis gravidarum which is NVP at its worst, leading to hospitalization and even death in extreme cases. Optimal management of NVP begins with nonpharmacological approaches, use of ginger, acupressure, vitamin B6, and dietary adjustments. The positive impact of these noninvasive, inexpensive and safe methods has been demonstrated. Pharmacological treatments are available with varying effectiveness; however, the only drug marketed specifically for the treatment of NVP in pregnancy is Diclectin(®) (vitamin B6 and doxylamine). In addition, the Motherisk algorithm provides a guideline for use of safe and effective drugs for the treatment of NVP. Optimal medical management of symptoms will ensure the mental and physical wellbeing of expecting mothers and their developing babies during this often stressful and difficult time period. Dismissing NVP as an inconsequential part of pregnancy can have serious ramifications for both mother and baby.

Determinants of women?s decision making on whether to treat nausea and vomiting of pregnancy pharmacologically

Nausea and vomiting of pregnancy (NVP) affects up to 80% of all women to some degree during their pregnancies. Diclectin (doxy lamine and pyridoxine [vitamin B6]) has been on the Canadian market for many years and is indicated as the drug of choice for the treatment of NVP. However, some women choose not to treat NVP with pharmacologic measures, perhaps due to a persistent fear of teratogenic risk. The objective of this study was to determine the factors that influence a woman's decision not to treat NVP with pharmacologic measures. Fifty-nine women recruited from the Motherisk Nausea and Vomiting Helpline completed a questionnaire. All were informed that Diclectin was considered safe for use during pregnancy. At a follow-up telephone call, 34% were not using any pharmacologic treatment, and of those who were taking the drug, 26% were using less than the recommended dose. Reasons cited for not using the medication were insufficient safety data, preference for non-pharmacologic methods, and being made to feel uncomfortable by the physician. Of the women who did use Diclectin, the most convincing reassuring information that it was safe to use came from friends and family. Many other factors play a large role in a women's decision making.

Determinants of women’s decision making on whether to treat nausea and vomiting of pregnancy pharmacologically

Nausea and vomiting of pregnancy (NVP) affects up to 80% of all women to some degree during their pregnancies. Diclectin (doxylamine and pyridoxine [vitamin B6]) has been on the Canadian market for many years and is indicated as the drug of choice for the treatment of NVP. However, some women choose not to treat NVP with pharmacologic measures, perhaps due to a persistent fear of teratogenic risk. The objective of this study was to determine the factors that influence a woman’s decision not to treat NVP with pharmacologic measures. Fifty-nine women recruited from the Motherisk Nausea and Vomiting Helpline completed a questionnaire. All were informed that Diclectin was considered safe for use during pregnancy. At a follow-up telephone call, 34% were not using any pharmacologic treatment, and of those who were taking the drug, 26% were using less than the recommended dose. Reasons cited for not using the medication were insufficient safety data, preference for non-pharmacologic methods, and being made to feel uncomfortable by the physician. Of the women who did use Diclectin, the most convincing reassuring information that it was safe to use came from friends and family. Many other factors play a large role in a women’s decision making.

Prospective comparative study of the safety and effectiveness of ginger for the treatment of nausea and vomiting in pregnancy

Objectives The primary objective of our study was to examine the safety and the secondary objective was to examine the effectiveness of ginger for nausea and vomiting of pregnancy (NVP). Study design Pregnant women who called the Motherisk Program who were taking ginger during the first trimester of pregnancy were enrolled in the study. The women were compared with a group of women who were exposed to nonteratogenic drugs that were not antiemetic medications. The women were followed up to ascertain the outcome of the pregnancy and the health of their infants. They were also asked on a scale of 0 to10 how effective the ginger was for their symptoms of NVP. Results We were able to ascertain the outcome of 187 pregnancies. There were 181 live births, 2 stillbirths, 3 spontaneous abortions, and 1 therapeutic abortion. The mean birth weight was 3542±543 g, the mean gestational age was 39±2 weeks, and there were three major malformations. There were no statistical differences in the outcomes between the ginger group and the comparison group with the exception of more infants weighing less than 2500 g in the comparison group (12 vs 3, P ≤ .001). There were a total of 66 completed effectiveness scores with the mean score of 3.3±2.9 SD. Conclusion These results suggest that ginger does not appear to increase the rates of major malformations above the baseline rate of 1% to 3% and that it has a mild effect in the treatment of NVP.