51
|
Laitinen L, Nurmi M, Kulovuori N, Koivisto M, Ojala E, Rautava P, Polo-Kantola P. Usability of Pregnancy-Unique Quantification of Emesis questionnaire in women hospitalised for hyperemesis gravidarum: a prospective cohort study. BMJ Open 2022; 12:e058364. [PMID: 35589345 PMCID: PMC9121481 DOI: 10.1136/bmjopen-2021-058364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Pregnancy-Unique Quantification of Emesis (PUQE) questionnaire is mainly used in outpatient care to assess the severity of nausea and vomiting of pregnancy (NVP). Our aim was to evaluate the usability of the Finnish-translated PUQE in hospitalised women with hyperemesis gravidarum (HG). DESIGN Prospective cohort study. SETTING University hospital in Finland. PARTICIPANTS Ninety-five women admitted due to HG for at least overnight. PRIMARY AND SECONDARY OUTCOME MEASURES Categorised and continuous PUQE scores, physical and mental quality of life (QoL) and urine ketones at admission and at discharge, analysing the first admission and readmissions separately. RESULTS The most common PUQE categories at admission were 'moderate' and 'severe', whereas at discharge they were 'mild' and 'moderate'. Likewise, continuous PUQE scores improved between admission and discharge (p<0.0001). At admission, women rating worse physical QoL (first admission adjusted OR (AOR) 1.09; 95% CI 1.03 to 1.16; readmissions AOR 1.13; 95% CI 1.02 to 1.25) and women with ketonuria of +++ (first admission AOR 16.00; 95% CI 1.44 to 177.82) fell into higher PUQE score category. On discharge day, women with better physical QoL had lower PUQE score category (first admission AOR 0.94; 95% CI 0.91 to 0.98; readmissions AOR 0.93; 95% CI 0.90 to 0.97). The results between physical QoL and continuous PUQE scores were similar. Concerning readmissions, better mental QoL was associated with lower PUQE score category at discharge (AOR 0.93; 95% CI 0.89 to 0.97). As for continuous PUQE score, worse mental QoL was associated with higher score at admission (readmissions, p=0.007) and better mental QoL with lower score at discharge (readmissions, p=0.007). CONCLUSIONS PUQE scores reflected alleviation of NVP severity in women hospitalised due to HG. Further, the decrease in PUQE score was associated with improved physical QoL and partly also with improved mental QoL. We therefore suggest PUQE as a complementary instrument for inpatient setting.
Collapse
Affiliation(s)
- Linda Laitinen
- Central Finland Health Care District, Department of Obstetrics and Gynecology, Jyväskylä, Finland
- Department of Obstetrics and Gynecology, University of Turku Faculty of Medicine, Turku, Finland
| | - Miina Nurmi
- Department of Obstetrics and Gynecology, University of Turku Faculty of Medicine, Turku, Finland
- Department of Public Health, University of Turku Faculty of Medicine, Turku, Finland
| | | | - Mari Koivisto
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Elina Ojala
- Department of Obstetrics and Gynecology, Turku University Hospital (TYKS), Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku Faculty of Medicine, Turku, Finland
- Clinical Research Centre, Turku University Hospital (TYKS), Turku, Finland
| | - Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, University of Turku Faculty of Medicine, Turku, Finland
- Department of Obstetrics and Gynecology, Turku University Hospital (TYKS), Turku, Finland
| |
Collapse
|
52
|
Slattery J, Quinten C, Candore G, Pinheiro L, Flynn R, Kurz X, Nordeng H. Ondansetron use in nausea and vomiting during pregnancy: a descriptive analysis of prescription patterns and patient characteristics in UK general practice. Br J Clin Pharmacol 2022; 88:4526-4539. [PMID: 35483963 PMCID: PMC9545331 DOI: 10.1111/bcp.15370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/01/2022] [Accepted: 04/03/2022] [Indexed: 11/26/2022] Open
Abstract
Aims The 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. Methods The 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. Results The 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. Conclusion This 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.
Collapse
Affiliation(s)
- Jim Slattery
- Data Analytics TaskforceEuropean Medicines AgencyAmsterdamThe Netherlands
| | - Chantal Quinten
- Data Analytics TaskforceEuropean Medicines AgencyAmsterdamThe Netherlands
| | - Gianmario Candore
- Data Analytics TaskforceEuropean Medicines AgencyAmsterdamThe Netherlands
| | - Luis Pinheiro
- Data Analytics TaskforceEuropean Medicines AgencyAmsterdamThe Netherlands
| | - Robert Flynn
- Data Analytics TaskforceEuropean Medicines AgencyAmsterdamThe Netherlands
- Medicines Monitoring UnitUniversity of DundeeDundeeUK
| | - Xavier Kurz
- Data Analytics TaskforceEuropean Medicines AgencyAmsterdamThe Netherlands
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural SciencesUniversity of OsloOsloNorway
- Department of Child Health and DevelopmentNorwegian Institute of Public HealthOsloNorway
| |
Collapse
|
53
|
Punal N, Prasad S, Haque A, Lei J, Santiago G. Hyperemesis Gravidarum Complicated by Wernicke's Encephalopathy: A Case Report. Cureus 2022; 14:e24009. [PMID: 35547424 PMCID: PMC9089282 DOI: 10.7759/cureus.24009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 11/17/2022] Open
Abstract
Wernicke's encephalopathy (WE) is a rare neurologic disease caused by a deficiency in thiamine (B1). It is characterized by features of altered mental status, cerebellar dysfunction, and ophthalmoplegia. Most often, cases are attributed to long-term alcohol use; however, rarer causes have been described in the literature. In this article, we describe a case of WE caused by hyperemesis gravidarum in a 19-year-old female with no known medical history.
Collapse
Affiliation(s)
- Natalie Punal
- Department of Internal Medicine, University of Illinois at Chicago, Chicago, USA
| | - Supritha Prasad
- Department of Internal Medicine, University of Illinois at Chicago, Chicago, USA
| | - Afsara Haque
- Department of Medicine, University of Illinois at Chicago, Chicago, USA
| | - Justin Lei
- Department of Medicine, University of Illinois at Chicago, Chicago, USA
| | - Gaia Santiago
- Department of Medicine, University of Illinois at Chicago, Chicago, USA
| |
Collapse
|
54
|
Nijsten K, Jansen LAW, Limpens J, Finken MJJ, Koot MH, Grooten IJ, Roseboom TJ, Painter RC. Long-term health outcomes of children born to mothers with hyperemesis gravidarum: a systematic review and meta-analysis. Am J Obstet Gynecol 2022; 227:414-429.e17. [PMID: 35367190 DOI: 10.1016/j.ajog.2022.03.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Hyperemesis gravidarum is characterized by severe nausea and vomiting in pregnancy, frequently resulting in severe maternal nutritional deficiency. Maternal undernutrition is associated with adverse offspring health outcomes. Whether hyperemesis gravidarum permanently affects offspring health remains unclear. This review aimed to evaluate the effects of maternal hyperemesis gravidarum on offspring health. DATA SOURCES MEDLINE and Embase were searched from inception to September 6, 2021. STUDY ELIGIBILITY CRITERIA Studies reporting on health at any age beyond the perinatal period of children born to mothers with hyperemesis gravidarum were included. METHODS Two reviewers independently selected studies and extracted data. The Newcastle-Ottawa Quality Assessment Scale was used to assess risk of bias. We conducted a narrative synthesis and meta-analysis where possible. In meta-analyses with high heterogeneity (I2>75%), we did not provide a pooled odds ratio. RESULTS Nineteen studies were included in this systematic review (n=1,814,785 offspring). Meta-analysis (n=619, 2 studies: 1 among adolescents and 1 among adults) showed that hyperemesis gravidarum was associated with anxiety disorder (odds ratio, 1.74; 95% confidence interval, 1.04-2.91; I2, 0%) and sleep problems in offspring (odds ratio, 2.94; 95% confidence interval, 1.25-6.93; I2, 0%). Hyperemesis gravidarum was associated with testicular cancer in male offspring aged up to 40 years on meta-analysis (5 studies, n=20,930 offspring), although heterogeneity was observed on the basis of a wide 95% prediction interval (odds ratio, 1.60; 95% confidence interval, 1.07-2.39; I2, 0%; 95% prediction interval, 0.83-3.08). All 6 studies reporting on attention deficit (hyperactivity) disorder and autism spectrum disorder reported an increase among children of mothers with hyperemesis gravidarum in comparison with children of unaffected mothers. Meta-analysis showed high heterogeneity, precluding us from reporting a pooled odds ratio. Most studies reporting on cognitive and motor problems found an increase among hyperemesis gravidarum-exposed children. One study investigated brain structure and found smaller cortical volumes and areas among children from hyperemesis gravidarum-affected pregnancies than among those from unaffected pregnancies. Studies evaluating anthropometry and cardiometabolic disease risk of hyperemesis gravidarum-exposed children had inconsistent findings. CONCLUSION Our systematic review showed that maternal hyperemesis gravidarum is associated with small increases in adverse health outcomes among children, including neurodevelopmental disorders, mental health disorders, and possibly testicular cancer, although evidence is based on few studies of low quality.
Collapse
Affiliation(s)
- Kelly Nijsten
- Department of Obstetrics and Gynecology, Amsterdam Reproduction & Development, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Larissa A W Jansen
- Department of Obstetrics and Gynecology, Amsterdam Reproduction & Development, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Obstetrics and Gynecology, Amphia Hospital, Breda, the Netherlands
| | - Jacqueline Limpens
- Medical Library, Research Support, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Martijn J J Finken
- Department of Paediatric Endocrinology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marjette H Koot
- Department of Obstetrics and Gynecology, Amsterdam Reproduction & Development, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Iris J Grooten
- Department of Obstetrics and Gynecology, Amsterdam Reproduction & Development, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Tessa J Roseboom
- Department of Obstetrics and Gynecology, Amsterdam Reproduction & Development, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Rebecca C Painter
- Department of Obstetrics and Gynecology, Amsterdam Reproduction & Development, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
55
|
Morrison MA, Chung Y, Heneghan MA. Managing hepatic complications of pregnancy: practical strategies for clinicians. BMJ Open Gastroenterol 2022; 9:bmjgast-2021-000624. [PMID: 35292523 PMCID: PMC8928321 DOI: 10.1136/bmjgast-2021-000624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/12/2022] [Indexed: 12/17/2022] Open
Abstract
Liver disorders specific to pregnancy are rare but can have potentially serious consequences for mother and fetus. Pregnancy-related liver disorders are the most common cause of liver disease in otherwise healthy pregnant women and pose a challenge to physicians because of the need to take into account both maternal and fetal health. A good knowledge of these disorders is necessary as prompt diagnosis and appropriate management results in improved maternal and fetal outcomes. This review will focus on pregnancy-specific disorders and will aim to serve as a guide for physicians in their diagnosis, management and subsequent monitoring.
Collapse
Affiliation(s)
| | - Yooyun Chung
- Institute of Liver Studies, King's College Hospital, London, UK
| | | |
Collapse
|
56
|
Blake Gornall A, Hutchinson AM, Redley B. Clinician perspectives of pregnant women's participation in antiemetic decision-making: A qualitative study. Nurs Health Sci 2022; 24:54-64. [PMID: 35174947 DOI: 10.1111/nhs.12930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/30/2022] [Accepted: 02/07/2022] [Indexed: 11/30/2022]
Abstract
This study explored clinician perceptions of women's participation in decision-making about antiemetic treatments during pregnancy, and the suitability of the five Choosing Wisely questions to increase women's involvement. The qualitative interpretive descriptive design used semi-structured interviews to capture data. Participants were six obstetricians and six midwives experienced in providing care for pregnant women seeking support for nausea and vomiting at a single private, obstetrician-led maternity health service in Australia. Thematic analysis revealed four themes that captured clinician perspectives about women's participation in decision-making about antiemetic treatments: (i) information gathering; (ii) developing an understanding; (iii) using knowledge; and (iv) making decisions. Clinician attitudes and perspectives, as well as their self-reported styles of communication and negotiation, influenced how they engaged with women during decision-making. While unfamiliar with the five Choosing Wisely questions, almost all participants considered them potentially useful, but for other clinicians. Strategies to actively involve women in decision-making about antiemetics were inconsistently used. The five Choosing Wisely questions may provide a useful tool for clinicians, but further research is needed to better understand women's perspectives and clinician-related barriers to shared decision-making.
Collapse
Affiliation(s)
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia.,Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia.,Monash Health, Clayton, Victoria, Australia
| | - Bernice Redley
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia.,Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia.,Monash Health, Clayton, Victoria, Australia
| |
Collapse
|
57
|
Hu M, Zhou Y, Xue M, Ren Y, Li S, Wang R, Qi L, Zeng L, Liu Z, Qian W, Yang J, Zhou X, Chen L, Zhang X. The prevalence and correlates of peripartum depression in different stages of pregnancy during COVID-19 pandemic in China. BMC Pregnancy Childbirth 2022; 22:114. [PMID: 35148708 PMCID: PMC8832077 DOI: 10.1186/s12884-022-04428-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/26/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Peripartum depression in and after pregnancy are common, reported by 11.9% of women worldwide, and the proportion was even higher during the outbreak of coronavirus disease 2019 (COVID-19). We aimed to investigate the prevalence and risk factors of peripartum depression under the influence of COVID-19 in China. METHODS Using a cross-sectional design, 2026 pregnant and postpartum women residing in Beijing, Wuhan, and Lanzhou of China were recruited from February 28 to April 9, 2020. The Patient Health Questionnaire-9 was used to assess their depressive symptoms. The women were divided into four subgroups based on pregnancy stage, and a binary logistic regression analysis was conducted on each subgroup. RESULTS Under the influence of COVID-19, the prevalence rate of peripartum depression among Chinese women was 9.7%. It was 13.6, 10.8, 7.9 and 7.3% in the first, second, third trimester and puerperium, respectively. Regression analysis showed that the influence of current pregnancy status on movement (Mild vs. No, aORs were 3.89, P < 0.001, 2.92, P = 0.003, 1.58, P = 0.150 in the three trimesters, respectively; Severe vs. No, aORs were 13.00, 20.45, 5.38 in the three trimesters, respectively, all P < 0.05), and worries and fears about childbirth (aORs were 2.46, 2.96, 2.50 in the three trimesters, respectively, all P < 0.05) were associated with depression throughout pregnancy. CONCLUSIONS The prevalence rate of peripartum depression during the COVID-19 outbreak in China was not higher than usual. The influence of current pregnancy status on movement, as well as worries and fears about childbirth were independent risk factors for peripartum depression throughout pregnancy during COVID-19. The stage of pregnancy should be considered when implementing interventions.
Collapse
Affiliation(s)
- Manji Hu
- Shanghai Pudong New Area Mental Health Centre, Shanghai, China
| | - Yongjie Zhou
- Department of Psychiatric Rehabilitation, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Mei Xue
- Qingdao Mental Health Center, Qingdao University, Qingdao, China
| | - Yali Ren
- Department of Medical Affairs, Liyuan Hospital of Tongji Medical College, Huazhong University of Science and Technology, 39 Yanhu Road, Wuchang District, Wuhan, 430077, Hubei, China.
| | - Shen Li
- Department of Psychiatry, College of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Ruoxi Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ling Qi
- School of Health Science and Nursing, Wuhan Polytechnic University, Wuhan, China
| | - Lingyun Zeng
- Department of Psychiatric Rehabilitation, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Zhengkui Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Wei Qian
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Jiezhi Yang
- Shenzhen Health Development Research Center, Shenzhen, China
| | - Xin Zhou
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China
| | - Lijuan Chen
- School of Literature, Journalism & Communication, South-Central University for Nationalities, Wuhan, China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| |
Collapse
|
58
|
Paulus WE, Lindemann J, Friebe-Hoffmann U. HNO-ärztliche Krankheitsbilder in der Schwangerschaft – welche Medikamente sind zulässig? HNO 2022; 70:239-248. [DOI: 10.1007/s00106-021-01144-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 11/30/2022]
|
59
|
Abd El-Hadi HR, Eltanany BM, Zaazaa HE, Eissa MS. HPLC-DAD approach for determination of pyridoxine HCl and doxylamine succinate in pure and pharmaceutical dosage forms: A green stability-indicating assay method. Microchem J 2022. [DOI: 10.1016/j.microc.2021.106982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
60
|
Nassif MS, Costa ICP, Ribeiro PM, Moura CDC, Oliveira PED. Integrative and complementary practices to control nausea and vomiting in pregnant women: a systematic review. Rev Esc Enferm USP 2022; 56:e20210515. [PMID: 36300661 PMCID: PMC10123954 DOI: 10.1590/1980-220x-reeusp-2021-0515en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 08/23/2022] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVE to synthesize the evidence available in the literature on the effects of integrative and complementary practices in nausea and vomiting treatment in pregnant women. METHOD a systematic review, reported according to PRISMA and registered in PROSPERO. The search for studies was carried out in 11 databases. To assess risk of bias in randomized clinical trials, the Cochrane Collaboration Risk of Bias Tool (RoB 2) was used. RESULTS the final sample consisted of 31 articles, divided into three categories: aromatherapy, phytotherapy and acupuncture. It was observed that aromatherapy with lemon essential oil, ginger capsules, pericardial 6 point acupressure were the interventions that proved to be effective. Less than half of studies reported adverse effects, with mild and transient symptoms predominating. Most articles were classified as "some concern" in risk of bias assessment. CONCLUSION the three most effective interventions to control gestational nausea and vomiting were aromatherapy, herbal medicine and acupuncture, with significant results in the assessment of individual studies.
Collapse
|
61
|
Nassif MS, Costa ICP, Ribeiro PM, Moura CDC, Oliveira PED. Práticas integrativas e complementares para controle de náuseas e vômitos em gestantes: revisão sistemática. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2021-0515pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
RESUMO Objetivo: sintetizar as evidências disponíveis na literatura sobre os efeitos das práticas integrativas e complementares no tratamento de náusea e vômito em gestantes. Método: revisão sistemática, relatada conforme o PRISMA e registrada no PROSPERO. A busca pelos estudos foi realizada em 11 bases/bancos de dados. Para avaliação do risco de viés dos ensaios clínicos randomizados, utilizou-se a ferramenta Cochrane Collaboration Risk of Bias Tool (RoB 2). Resultados: a amostra final foi composta por 31 artigos, divididos em três categorias: aromaterapia, fitoterapia e acupuntura. Observou-se que a aromaterapia com óleo essencial de limão, cápsulas de gengibre, acupressão no ponto pericárdio 6 foram as intervenções que se provaram eficazes. Menos da metade dos estudos relatou efeitos adversos, sendo que predominaram sintomas de leve intensidade e transitórios. A maioria dos artigos foi classificada como “alguma preocupação” na avaliação do risco de viés. Conclusão as três intervenções mais eficazes para controle de náusea e vômito gestacional foram aromaterapia, fitoterapia e acupuntura, com resultados significativos na avaliação dos estudos individuais.
Collapse
|
62
|
Coulm B. [Nausea and vomiting in pregnancy: A place for ondansetron?]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2021; 49:947-950. [PMID: 34700033 DOI: 10.1016/j.gofs.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Indexed: 06/13/2023]
Abstract
Although there is no recommendation in France relating to the treatment of nausea and vomiting of pregnancy, there are some in other countries, where ondansetron, widely used, appears to be an effective second-line treatment option behind doxylamine/vitamin B6 association and metoclopramide. However, based on some recent publication suggesting an increased risk of orofacial clefts and congenital heart defects in fetuses exposed in utero to ondansetron in the 1st trimester of pregnancy, the European Medicines Agency now states that this drug should not longer be used during this period. This 2019 decision is controversial and whether ondansetron can be used in pregnant women with severe vomiting during pregnancy is still in question.
Collapse
Affiliation(s)
- B Coulm
- DMU ESPRIT (épidémiologie et biostatistique, santé publique, pharmacie, pharmacologie, recherche, information médicale, thérapeutique et médicaments), centre de référence sur les agents tératogènes (CRAT), GHU, Sorbonne université, AP-HP, site Trousseau, 26, avenue Docteur-Netter, 75571 Paris cedex 12, France.
| |
Collapse
|
63
|
Şahin B, Özçetinkaya Erdoğan S, Cura Şahin G, Karlı P, Kara OF, Hatırnaz Ş, Tinelli A. Nausea and vomiting during pregnancy: a possible correlation with obsessive compulsive disorder and alexithymia. J OBSTET GYNAECOL 2021; 42:929-934. [PMID: 34693875 DOI: 10.1080/01443615.2021.1960492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The possible correlation between nausea and vomiting during pregnancy (NVP) with obsessive-compulsive disorder (OCD) and alexithymia were examined in this cross-sectional study. A cohort of pregnant women at the first trimester of pregnancy experiencing NVP were divided into three groups, according to severity (mild, moderate and severe) with the Pregnancy Unique Quantification of Emesis and Nausea (PUQE) test. The Maudsley Obsessive Compulsive Disorder Scale (MOCQ) and the Toronto Alexithymia Scale (TAS-20) were applied. Scores of scales were compared in all three groups, and the relationship between NVP severity and OCD and alexithymia was evaluated. On the 110 enrolled pregnant women, 42 had mild, 36 had moderate and 32 had severe NVP. Pregnant women with mild NVP had lower MOCQ scores than those with severe NVP (p = .010). Total scores of TAS-20 were higher among subjects with greater NVP severity (p < .001). PUQE scores were demonstrated significant correlations with MOCQ and total and subsection scores of the TAS-20, regardless of NVP groups. Study results showed that women with more pronounced OCD and/or alexithymia can experience somatic complaints, such as NVP, particularly intense in their first trimester of pregnancies. For this reason, psychotherapy in addition to medical treatments could be recommended to pregnant women with severe NVP.Impact statementWhat is already known on this subject? NVP is a condition experienced by most women, particularly in the first trimester of pregnancy, which can be affected by the psychosomatic condition of the pregnant woman.What do the results of this study add? The severity of nausea and vomiting according to PUQE test were significantly associated with OCD and alexithymia presence in pregnant women during their first trimester period.What are the implications of these findings for clinical practice and/or further research? These findings might demonstrate the symptoms of NVP are correlated to OCD, as well as alexithymia. Longitudinal studies are required to demonstrate the clear causal relationship between NVP and psychiatric symptoms as in OCD and in alexithymia.
Collapse
Affiliation(s)
- Banuhan Şahin
- Gynecology and Obstetrics Department, Amasya University Sabuncuoglu Serefeddin Training and Research Hospital, Amasya, Turkey
| | - Serap Özçetinkaya Erdoğan
- Psychiatry Department, Amasya University Sabuncuoglu Serefeddin Training and Research Hospital, Amasya, Turkey
| | | | - Pervin Karlı
- Gynecology and Obstetrics Department, Amasya University Sabuncuoglu Serefeddin Training and Research Hospital, Amasya, Turkey
| | - Osman Fadıl Kara
- Gynecology and Obstetrics Department, Amasya University Sabuncuoglu Serefeddin Training and Research Hospital, Amasya, Turkey
| | - Şafak Hatırnaz
- Gynecology and Obstetrics Department, IVF Unit, Medicana International Hospital, Samsun, Turkey
| | - Andrea Tinelli
- Obstetrics and Gynecology Department, Veris delli Ponti Hospital, Scorrano, Lecce, Italy.,Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Vito Fazzi Hospital, Lecce, Italy.,Faculty of Biological and Medical Physics, Phystech BioMed School, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russia
| |
Collapse
|
64
|
Sajdeya R, Brown JD, Goodin AJ. Perinatal Cannabis Exposures and Autism Spectrum Disorders. Med Cannabis Cannabinoids 2021; 4:67-71. [PMID: 34676352 DOI: 10.1159/000515871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/13/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ruba Sajdeya
- Consortium for Medical Marijuana Clinical Outcomes Research, University of Florida, Gainesville, Florida, USA.,Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Joshua D Brown
- Consortium for Medical Marijuana Clinical Outcomes Research, University of Florida, Gainesville, Florida, USA.,Department of Pharmaceutical Outcomes & Policy, Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Amie J Goodin
- Consortium for Medical Marijuana Clinical Outcomes Research, University of Florida, Gainesville, Florida, USA.,Department of Pharmaceutical Outcomes & Policy, Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| |
Collapse
|
65
|
Vabre C, Araujo M, Damase-Michel C, Hurault-Delarue C, Lacroix I. Initial data on the safety of metopimazine during pregnancy and the risk of major birth defects and pregnancy loss - An observational study using the EFEMERIS database. Therapie 2021; 77:405-412. [PMID: 34756562 DOI: 10.1016/j.therap.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/09/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Metopimazine is an anti-emetic drug used to treat nausea and vomiting of pregnancy. However, no animal or clinical data are available regarding its safety in pregnant women. The aim of this study was, therefore, to assess the risk of birth defects and pregnancy loss associated with the use of metopimazine during pregnancy in a population-based cohort study. METHODS The study focused on the EFEMERIS database including the prescription and dispensation of drugs for pregnant women in Haute-Garonne, France, between July 2004 and December 2017. This was an observational, retrospective, comparative study. Pregnancy loss and major birth defects were compared between women exposed to metopimazine during pregnancy and those with no exposure using multivariate logistic regression and Cox proportional risk models. RESULTS Among 135,574 pregnant women, 11,402 (8.2%) were exposed to metopimazine during pregnancy, mostly in the first trimester (more than 70% of women). No association was found between major birth defects and exposure to metopimazine in the first trimester of pregnancy (ORa=[95% CI]=1.06 [0.92-1.23]). Pregnancy loss was negatively associated with metopimazine use during pregnancy (HRa [95% CI]=0.80 [0.72-0.88]), taking into account major potential confounders. Comparable rates were recorded between women exposed to metopimazine and those unexposed to the drug in terms of prematurity (6.7% vs. 6.4%), low birth weight (6.2% vs. 6.2%) and small for gestational age (1.2% vs. 1.4%). CONCLUSION This study illustrates the wide use of metopimazine during pregnancy in France although no studies on efficacy or safety in pregnant women are available. The results of this study do not indicate any teratogenic effect or an increased risk of pregnancy loss of metopimazine.
Collapse
Affiliation(s)
- Clémentine Vabre
- REGARDS Network, Medical and Clinical Pharmacology Laboratory, Toulouse University Hospital Centre, INSERM UMR 1295, Toulouse Faculty of Medicine, 37, allées Jules Guesde, 31000 Toulouse, France.
| | - Mélanie Araujo
- REGARDS Network, Medical and Clinical Pharmacology Laboratory, Toulouse University Hospital Centre, INSERM UMR 1295, Toulouse Faculty of Medicine, 37, allées Jules Guesde, 31000 Toulouse, France
| | - Christine Damase-Michel
- REGARDS Network, Medical and Clinical Pharmacology Laboratory, Toulouse University Hospital Centre, INSERM UMR 1295, Toulouse Faculty of Medicine, 37, allées Jules Guesde, 31000 Toulouse, France
| | - Caroline Hurault-Delarue
- REGARDS Network, Medical and Clinical Pharmacology Laboratory, Toulouse University Hospital Centre, INSERM UMR 1295, Toulouse Faculty of Medicine, 37, allées Jules Guesde, 31000 Toulouse, France
| | - Isabelle Lacroix
- REGARDS Network, Medical and Clinical Pharmacology Laboratory, Toulouse University Hospital Centre, INSERM UMR 1295, Toulouse Faculty of Medicine, 37, allées Jules Guesde, 31000 Toulouse, France
| |
Collapse
|
66
|
Bruun MR, Ernst A, Arendt LH, Ramlau-Hansen CH, Brix N. Nausea During Pregnancy and Timing of Pubertal Development in Sons and Daughters: A Population-Based Cohort Study. Clin Epidemiol 2021; 13:895-905. [PMID: 34621134 PMCID: PMC8491783 DOI: 10.2147/clep.s324805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The objective of this study was to explore whether maternal nausea in pregnancy, a potential surrogate marker of endogenous estrogen levels, was associated with age at attaining pubertal milestones in sons and daughters. MATERIALS AND METHODS The study included a total of 14,612 boys and girls born in 2000-2003, from the Danish National Birth Cohort. Information on nausea was reported by mothers during pregnancy in telephone interviews scheduled around gestational week 12 and 30. Their children were invited every six months from 11 years of age until 18 years of full maturation to provide information on current pubertal status. Pubertal milestones included pubic hair, axillary hair and acne for both sexes, besides genital development, voice break and first ejaculation for boys, and breast development and menarche for girls. Mean monthly differences in age at attaining several pubertal milestones for boys and girls were estimated according to duration of nausea in the first trimester (0, 1-6, 7-11, 12 weeks). Further, we explored whether duration of nausea in the first two trimesters (0, 1-8, 9-15 or 16-28 weeks) and severity (measured by co-existence of vomiting and weight loss) were associated with pubertal timing. RESULTS Neither maternal nausea in the first trimester nor duration or severity of nausea in the first two trimesters were associated with pubertal timing. CONCLUSION Our study does not support the hypothesis that nausea in pregnancy - as a surrogate marker of endogenous estrogen levels - is associated with age at attaining pubertal milestones in children.
Collapse
Affiliation(s)
- Mette Rahbek Bruun
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Andreas Ernst
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Linn Håkonsen Arendt
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Regional Hospital Horsens, Horsens, Denmark
| | | | - Nis Brix
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
67
|
Sun L, Xi Y, Wen X, Zou W. Use of metoclopramide in the first trimester and risk of major congenital malformations: A systematic review and meta-analysis. PLoS One 2021; 16:e0257584. [PMID: 34543335 PMCID: PMC8452057 DOI: 10.1371/journal.pone.0257584] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/03/2021] [Indexed: 01/11/2023] Open
Abstract
Background Nausea 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. Methods The 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. Results Six 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). Conclusions Metoclopramide use during first trimester of pregnancy was not associated with the risk of major congenital malformations.
Collapse
Affiliation(s)
- Li Sun
- Department of Pharmacy, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Yang Xi
- Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Institute of Clinical Pharmacy, Central South University, Changsha, Hunan, China
- * E-mail:
| | - Xiaoke Wen
- Department of Pharmacy, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Wei Zou
- Department of Pharmacy, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| |
Collapse
|
68
|
Abstract
Hypnosis, the induction of a naturally relaxed state of mind and body, is most commonly practiced by pregnant women in preparation for the childbirth experience. A literature review was performed to assess the effects of hypnosis before, during and after pregnancy. The majority of data is extracted from case series and low-quality studies thereby limiting the acceptability of hypnosis for various pregnancy related conditions. A few well-designed studies show that self-hypnosis may be beneficial for mitigating labor pain and fear of childbirth. Women can safely pursue hypnotherapy during pregnancy; however, high quality trials are needed to demonstrate its complete efficacy.
Collapse
Affiliation(s)
- Shilpa Babbar
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Missouri-Kansas City, Children's Mercy Kansas City, Kansas City, Missouri
| | | |
Collapse
|
69
|
A Case of Treatment-Refractory Hyperemesis Gravidarum Responsive to Adjunctive Mirtazapine in a Patient With Anxiety Comorbidity and Severe Weight Loss. J Clin Psychopharmacol 2021; 40:509-512. [PMID: 32773493 DOI: 10.1097/jcp.0000000000001268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
70
|
Hyperemesis gravidarum is associated with increased rates of termination of pregnancy and suicidal ideation: results from a survey completed by >5000 participants. Am J Obstet Gynecol 2021; 224:629-631. [PMID: 33713683 DOI: 10.1016/j.ajog.2021.03.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 11/23/2022]
|
71
|
Association of nausea and vomiting of pregnancy with infant growth in the first 24 months of life. Arch Gynecol Obstet 2021; 304:429-438. [PMID: 34019157 DOI: 10.1007/s00404-021-06046-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE We aimed to investigate the association of maternal nausea and vomiting during pregnancy (NVP) with infant growth in the first 24 months of life and compare the effect of fetal gender. METHODS This prospective cohort study was conducted in Zhoushan Maternal and Child Health Hospital, Zhejiang, from 2011 to 2018. 1942 pairs of singleton newborns and their mothers were selected as participants. Main outcomes were gestational weight gain (GWG), birth outcomes (birthweight and gestational age) and infant growth [weight, height, weight/height-for-age Z score (WAZ/HAZ), the weight gain during childhood]. The associations of NVP with birth outcomes and infant growth at children's age of 1, 3, 6, 12, 18, and 24 months were analyzed by multivariable regression models. RESULTS Of the 1942 women, 1395 had NVP at first trimester (T1) and among them, 210 still experienced NVP at second trimester (T2). Compared with women without NVP, women experienced severe NVP at T1 were related with lower total GWG. Mild and moderate NVP at T1 were negatively associated with lower birthweight among women with male infants. Female infants exposed to maternal NVP at T1, especially for severe degree, were showed greater weight, WAZ, height, HAZ, and weight gain after 1 year old (at age of 12, 18, 24 months). No association between maternal NVP and infant growth was observed among male infants. CONCLUSION Exposure to NVP at T1 was, respectively, associated with lower GWG. Favorable influence of NVP at T1 on infant growth was observed among female offspring.
Collapse
|
72
|
Tan GN, Tan PC, Hong JGS, Kartik B, Omar SZ. Rating of four different foods in women with hyperemesis gravidarum: a randomised controlled trial. BMJ Open 2021; 11:e046528. [PMID: 33986063 PMCID: PMC8126296 DOI: 10.1136/bmjopen-2020-046528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate four foods in women with hyperemesis gravidarum (HG) on their agreeability and tolerability. DESIGN Prospective, randomised, within-subject cross-over trial. SETTING Single-centre, tertiary, university hospital in Malaysia. PARTICIPANTS 72 women within 24-hour of first admission for HG who were 18 years or above, with confirmed clinical pregnancy of less than 16 weeks' gestation were recruited and analysed. Women unable to consume food due to extreme symptoms, known taste or swallowing disorder were excluded. INTERVENTIONS Each participant chewed and swallowed a small piece of apple, watermelon, cream cracker and white bread in random order and was observed for 10 min after each tasting followed by a 2 min washout for mouth rinsing and data collection. OUTCOME MEASURES Primary outcome was food agreeability scored after 10 min using an 11-point 0-10 Visual Numerical Rating Scale (VNRS). Nausea was scored at baseline (prior to tasting) and 2 and 10 min using an 11-point VNRS. Intolerant responses of gagging, heaving and vomiting were recorded. RESULTS On agreeability scoring, apple (mean±SD 7.2±2.4) ranked highest followed by watermelon (7.0±2.7) and crackers (6.5±2.6), with white bread ranked lowest (6.0±2.7); Kruskal-Wallis H test, p=0.019. Apple had the lowest mean nausea score and mean rank score, while white bread had the highest at both 2 and 10 min; the Kruskal-Wallis H test showed a significant difference only at 10 min (p=0.019) but not at 2 min (p=0.29) in the ranking analyses. The intolerant (gagged, heaved or vomited) response rates within the 10 min study period were apple 3/72 (4%), watermelon 7/72 (10%), crackers 8/72 (11%) and white bread 12/72 (17%): χ2 test for trend p=0.02. CONCLUSION Sweet apple had the highest agreeability score, the lowest nausea severity and intolerance-emesis response rate when tasted by women with HG. White bread consistently performed worst.
Collapse
Affiliation(s)
- Gi Ni Tan
- Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur, Malaysia
| | - Peng Chiong Tan
- Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Balaraman Kartik
- Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Zawiah Omar
- Obstetrics and Gynaecology, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
73
|
Hsiao HF, Thomas A, Kay-Smith C, Grzeskowiak LE. Pregnant women report being denied medications to treat severe nausea and vomiting of pregnancy or hyperemesis gravidarum - findings from an Australian online survey. THE AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY 2021; 61:616-620. [PMID: 33984156 DOI: 10.1111/ajo.13359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/28/2021] [Accepted: 03/17/2021] [Indexed: 11/29/2022]
Abstract
We conducted an online survey of 249 Australian women who currently or previously experienced severe nausea and vomiting of pregnancy (NVP) or hyperemesis gravidarum (HG) and examined their experiences in being denied medications during pregnancy. One in four women reported being denied medications for NVP/HG, which most commonly involved doxylamine and encounters with community pharmacists. Women's experiences reflected that lack of awareness of guidelines and unfavourable risk-benefit assessments appeared to be key barriers to facilitating medication access. Approaches towards identifying and effectively addressing barriers to the provision of effective treatments for severe NVP and HG are urgently needed.
Collapse
Affiliation(s)
- Han-Fang Hsiao
- SA Pharmacy, Flinders Medical Centre, SA Health, Adelaide, South Australia, Australia
| | - Alicia Thomas
- SA Pharmacy, Flinders Medical Centre, SA Health, Adelaide, South Australia, Australia
| | | | - Luke E Grzeskowiak
- SA Pharmacy, Flinders Medical Centre, SA Health, Adelaide, South Australia, Australia.,College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia.,Adelaide Medical School, Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| |
Collapse
|
74
|
Varela P, Deltsidou A. Hyperemesis gravidarum and neonatal outcomes: A systematic review of observational studies. Taiwan J Obstet Gynecol 2021; 60:422-432. [PMID: 33966723 DOI: 10.1016/j.tjog.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2020] [Indexed: 11/16/2022] Open
Abstract
Hyperemesis gravidarum (HG) is associated with adverse somatic and psychological effects. The impact of HG on neonatal outcomes is debatable given that disagreeing research results have appeared. The objective of this study was to systematically review, according to the PRISMA guidelines, and synthesize the available evidence from observational studies on the relationship between HG and neonatal outcomes. The PubMed, Scopus, and Science Direct databases were systematically reviewed, with the last search carried out in April 2020. The quality of the studies was estimated using the Newcastle-Ottawa Scale (NOS) for non-randomized studies. The databases search yielded 516 studies 15 of which (n = 112.372 HG cases) matched eligibility criteria while the majority of the studies were of moderate quality (n = 12). We observed heterogeneity among the studies regarding the definition of HG and characteristics of the samples. The results of this systematic review suggest that it is still uncertain whether HG has an adverse impact on neonatal outcomes, fact that requires more studies to be conducted.
Collapse
Affiliation(s)
- Pinelopi Varela
- General Hospital of Athens ''Alexandra'', Department of Midwifery, University of West Attica, Athens, Greece.
| | - Anna Deltsidou
- Department of Midwifery, University of West Attica, Athens, Greece
| |
Collapse
|
75
|
Bazargani F, Iliadis SI, Elenis E. Mode of conception in relation to nausea and vomiting of pregnancy: a nested matched cohort study in Sweden. Sci Rep 2021; 11:9039. [PMID: 33907266 PMCID: PMC8079670 DOI: 10.1038/s41598-021-88575-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 04/05/2021] [Indexed: 11/30/2022] Open
Abstract
Nausea and vomiting of pregnancy (NVP) is a common condition reported however inconclusively among pregnancies after assisted conception. The study objective was thus to explore whether NVP is associated to mode of conception or other in vitro fertilization (IVF)-related variables. This nested matched cohort study, originating from the BASIC-project, was conducted at the Uppsala University Hospital in Sweden between 2010 and 2016. IVF pregnancies (n = 210) and age and parity-matched women with spontaneous pregnancies (n = 420) comprised the study sample. The study outcome was self-reported NVP at gestational week 17. IVF treatment and pregnancy data were obtained after scrutinization of the medical records. NVP with or without medications was not associated with mode of conception (chi-square test, p = 0.889), even after adjusting for potential confounders. In a subgroup analysis among IVF pregnancies, NVP without medication was more frequently seen in the group who received cleavage stage embryos vs blastocysts (chi-square test, p = 0.019), exhibiting a marginally significant but strongly increased effect even after adjustment [crude RRR 3.82 (95% CI 1.23–11.92) and adjusted RRR 3.42 (95% CI 0.96–12.11)]. No difference in the rate of NVP with or without medication between women that underwent fresh and frozen/thawed embryo transfers as well as IVF or ICSI was observed. Conception through IVF is not associated with NVP. Transfer of a blastocyst may decrease the risk of developing NVP and further, large-scale prospective studies are required to validate this finding.
Collapse
Affiliation(s)
- Farnaz Bazargani
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. .,Reproduction Centre, Women's Clinic, Uppsala University Hospital, 751 85, Uppsala, Sweden.
| | - S I Iliadis
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Reproduction Centre, Women's Clinic, Uppsala University Hospital, 751 85, Uppsala, Sweden
| | - E Elenis
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Reproduction Centre, Women's Clinic, Uppsala University Hospital, 751 85, Uppsala, Sweden
| |
Collapse
|
76
|
Original article: is the protective association between hyperemesis gravidarum and birth defects biased by pregnancy termination? Ann Epidemiol 2021; 59:10-15. [PMID: 33798708 DOI: 10.1016/j.annepidem.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE We assessed whether the protective association between hyperemesis gravidarum and birth defects could be due to selection bias from exclusion of pregnancy terminations. METHODS We designed a cohort study of 2,115,581 live births in Canada, 1990-2016. The main exposure measure was hyperemesis gravidarum. The main outcome measure included any birth defect at delivery. We estimated risk ratios (RR) and 95% confidence intervals (CI) for the association of hyperemesis gravidarum with birth defects in log-binomial regression models, and assessed the extent of selection bias through correction factors. RESULTS Hyperemesis gravidarum was associated with 0.88 times the risk of birth defects in models not corrected for bias (95% CI 0.82-0.94). Correction for selection bias suggested that if screening for birth defects was associated with 1.33 times the chance of detecting birth defects and having a pregnancy termination, there would be no association with hyperemesis gravidarum. If ultrasound was associated with 2.00 times the chance of detecting birth defects and 1.50 times the risk of pregnancy termination, hyperemesis gravidarum would be associated with 1.27 times the risk of birth defects (95% CI 1.18-1.35). CONCLUSIONS The protective association between hyperemesis gravidarum and birth defects in previous studies may be due to selection bias.
Collapse
|
77
|
Lemon LS, Bodnar LM, Garrard W, Venkataramanan R, Platt RW, Marroquin OC, Caritis SN. Ondansetron use in the first trimester of pregnancy and the risk of neonatal ventricular septal defect. Int J Epidemiol 2021; 49:648-656. [PMID: 31860078 DOI: 10.1093/ije/dyz255] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Literature is divided regarding the risk of neonatal ventricular septal defect (VSD) associated with first trimester ondansetron use in pregnancy. METHODS We evaluated the risk of VSD associated with first trimester exposure to intravenous or oral ondansetron in 33 677 deliveries at Magee-Womens Hospital in Pittsburgh, PA (2006-2014). Using log-binomial regression, we evaluated the risk: (1) in the full cohort, (2) using propensity score designs with both matching and inverse probability weighting and (3) utilizing clustered trajectory analysis evaluating the role of dose. Sensitivity analyses assessed the association between ondansetron and all recorded birth defects in aggregate. RESULTS A total of 3733 (11%) pregnancies were exposed to ondansetron in the first trimester (dose range: 2.4-1008 mg). Ondansetron was associated with increased risk of VSD with risk ratios ranging from 1.7 [95% confidence interval (CI) 1.0-2.9] to 2.1 (95% CI 1.1-4.0) across methods. Risks correspond to one additional VSD for approximately every 330 pregnancies exposed in the first trimester. The association was dose-dependent with increased risk in women receiving highest cumulative doses compared with lowest doses [adjusted risk ratio: 3.2 (95% CI 1.0-9.9)]. The association between ondansetron and congenital malformations was diluted as the outcome included additional birth defects. CONCLUSIONS First trimester ondansetron use is associated with an increased risk of neonatal VSD potentially driven by higher doses. This risk should be viewed in the context of risks attributable to severe untreated nausea and vomiting of pregnancy.
Collapse
Affiliation(s)
- Lara S Lemon
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, PA, USA.,Department of Clinical Analytics, University of Pittsburgh Medical Centers, PA, USA
| | - Lisa M Bodnar
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, PA, USA.,Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, USA
| | - William Garrard
- Department of Clinical Analytics, University of Pittsburgh Medical Centers, PA, USA
| | - Raman Venkataramanan
- Department of Pharmaceutical Science, School of Pharmacy, University of Pittsburgh, PA, USA.,Department of Pathology, University of Pittsburgh, PA, USA
| | - Robert W Platt
- Departments of Pediatrics and Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Canada
| | - Oscar C Marroquin
- Department of Clinical Analytics, University of Pittsburgh Medical Centers, PA, USA.,Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, USA
| | - Steve N Caritis
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, PA, USA
| |
Collapse
|
78
|
Iskender Ö, Kaplan S. The association between quality of life and complementary and alternative medicine use in pregnant women with hyperemesis gravidarum. J Obstet Gynaecol Res 2021; 47:2005-2013. [PMID: 33754438 DOI: 10.1111/jog.14759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 02/17/2021] [Accepted: 03/10/2021] [Indexed: 11/30/2022]
Abstract
AIM This study investigated the association between quality of life and complementary and alternative medicine (CAM) use in pregnant women with hyperemesis gravidarum in Turkey. METHODS This cross-sectional descriptive study was conducted between October 2017 and July 2018 in Turkey. The sample consisted of 240 pregnant women with hyperemesis gravidarum. Data were collected using a Demographic Information Form, the Index of Nausea, Vomiting, Retching, and the 36-item Short-Form Health Survey. RESULTS The majority (84.2%) of participants stated that they used CAM, mostly "biologically based therapies" (97.5%). They were most satisfied with the "mental and physical treatments" (3.71 ± 1.74). Participants who did not use CAM had a higher quality of life "emotional role" than those who used CAM (p = 0.038). However, there were no statistically significant differences in the other quality of life subscale scores between the two groups. CONCLUSION There is limited evidence for the association between quality of life and CAM use in pregnant women with hyperemesis gravidarum in Turkey. Therefore, more evidence-based research is warranted to evaluate the association between CAM use and quality of life in pregnant women with hyperemesis gravidarum.
Collapse
Affiliation(s)
- Özlem Iskender
- Hacettepe University Hospitals, Obstetrics Service, Ankara, Turkey
| | - Sena Kaplan
- Nursing Department, Ankara Yıldırım Beyazıt University Faculty of Health Sciences, Ankara, Turkey
| |
Collapse
|
79
|
Plaze M, Attali D, Prot M, Petit AC, Blatzer M, Vinckier F, Levillayer L, Chiaravalli J, Perin-Dureau F, Cachia A, Friedlander G, Chrétien F, Simon-Loriere E, Gaillard R. Inhibition of the replication of SARS-CoV-2 in human cells by the FDA-approved drug chlorpromazine. Int J Antimicrob Agents 2021; 57:106274. [PMID: 33387629 PMCID: PMC7772996 DOI: 10.1016/j.ijantimicag.2020.106274] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/14/2020] [Accepted: 12/20/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Urgent action is needed to fight the ongoing coronavirus disease 2019 (COVID-19) pandemic by reducing the number of infected cases, contagiousness and severity. Chlorpromazine (CPZ), an antipsychotic from the phenothiazine group, is known to inhibit clathrin-mediated endocytosis and has antiviral activity against severe acute respiratory syndrome coronavirus-1 (SARS-CoV-1) and Middle East respiratory syndrome coronavirus. The aim of this in-vitro study was to test CPZ against SARS-CoV-2 in monkey and human cells. MATERIALS AND METHODS Monkey VeroE6 cells and human alveolar basal epithelial A549-ACE2 cells were infected with SARS-CoV-2 in the presence of various concentrations of CPZ. Supernatants were harvested at day 2 and analysed by quantitative reverse transcription polymerase chain reaction (RT-qPCR) for the presence of SARS-CoV-2 RNA. Cell viability was assessed in non-infected cells. RESULTS CPZ was found to have antiviral activity against SARS-CoV-2 in monkey VeroE6 cells, with a half maximal inhibitory concentration (IC50) of 8.2 µM, half maximal cytotoxic concentration (CC50) of 13.5 µM, and selectivity index (SI) of 1.65. In human A549-ACE2 cells, CPZ was also found to have anti-SARS-CoV-2 activity, with IC50 of 11.3 µM, CC50 of 23.1 µM and SI of 2.04. DISCUSSION Although the measured SI values are low, the IC50 values measured in vitro may translate to CPZ dosages used in routine clinical practice because of the high biodistribution of CPZ in lungs and saliva. Also, the distribution of CPZ in brain could be of interest for treating or preventing neurological and psychiatric forms of COVID-19. CONCLUSIONS These preclinical findings support clinical investigation of the repurposing of CPZ, a drug with mild side effects, in the treatment of patients with COVID-19.
Collapse
Affiliation(s)
- Marion Plaze
- GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte-Anne, Service Hospitalo-Universitaire, Pôle Hospitalo-Universitaire Paris 15, Paris, France; Université de Paris, Paris, France
| | - David Attali
- GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte-Anne, Service Hospitalo-Universitaire, Pôle Hospitalo-Universitaire Paris 15, Paris, France; Université de Paris, Paris, France; Physics for Medicine Paris, INSERM, ESPCI Paris, CNRS, PSL Research University, Université Paris Diderot, Sorbonne Paris Cite, Paris, France
| | - Matthieu Prot
- Institut Pasteur, G5 Evolutionary Genomics of RNA Viruses, Paris, France
| | - Anne-Cécile Petit
- GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte-Anne, Service Hospitalo-Universitaire, Pôle Hospitalo-Universitaire Paris 15, Paris, France; Institut Pasteur, Experimental Neuropathology Unit, Paris, France
| | - Michael Blatzer
- Institut Pasteur, Experimental Neuropathology Unit, Paris, France
| | - Fabien Vinckier
- GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte-Anne, Service Hospitalo-Universitaire, Pôle Hospitalo-Universitaire Paris 15, Paris, France; Université de Paris, Paris, France
| | - Laurine Levillayer
- Institut Pasteur, Functional Genetics of Infectious Diseases Unit, Paris, France
| | - Jeanne Chiaravalli
- Institut Pasteur, Chemogenomic and Biological Screening Core Facility, C2RT, Paris, France
| | - Florent Perin-Dureau
- Fondation Rothschild, Department of Anaesthesiology, ASMR-II Consulting, Regstem, Paris, France
| | - Arnaud Cachia
- Université de Paris, Laboratoire de Psychologie du développement et de l'Education de l'Enfant, CNRS, Paris, France; Université de Paris, Institut de Psychiatrie et Neurosciences de Paris, INSERM, Paris, France
| | | | - Fabrice Chrétien
- Université de Paris, Paris, France; Institut Pasteur, Experimental Neuropathology Unit, Paris, France; GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte-Anne, Service de Neuropathologie, Paris, France
| | | | - Raphaël Gaillard
- GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte-Anne, Service Hospitalo-Universitaire, Pôle Hospitalo-Universitaire Paris 15, Paris, France; Université de Paris, Paris, France; Institut Pasteur, Experimental Neuropathology Unit, Paris, France.
| |
Collapse
|
80
|
van Gelder MMHJ, Nordeng H. Antiemetic Prescription Fills in Pregnancy: A Drug Utilization Study Among 762,437 Pregnancies in Norway. Clin Epidemiol 2021; 13:161-174. [PMID: 33664595 PMCID: PMC7924249 DOI: 10.2147/clep.s287892] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/20/2021] [Indexed: 12/28/2022] Open
Abstract
Objective To determine antiemetic prescription fill patterns during pregnancy in Norway, with special focus on the use of ondansetron and recurrent use in subsequent pregnancies. Methods We conducted a population-based registry study based on data from the Medical Birth Registry of Norway linked to the Norwegian Prescription Database for 762,437 pregnancies >12 gestational weeks ending in live or non-live births between 2005 and 2017. Prescription fills of medications used for nausea and vomiting of pregnancy were summarized in treatment pathways to determine drug utilization patterns. Logistic regression analyses were used to estimate associations between maternal and pregnancy characteristics and antiemetic prescription fills. Results The prescription fill rate for antiemetic medication during pregnancy was 7.6%. However, prescription fill rates were 35.5% in the second pregnancy after filling an antiemetic prescription in the first pregnancy and 53.5% for women who filled antiemetic prescriptions in the previous 2 pregnancies. Among pregnancies with antiemetic prescription fills, 62.2% were dispensed metoclopramide, 28.2% meclizine, and 17.2% promethazine. First-line treatment started with monotherapy in 97.4% of these pregnancies, which was the only treatment received in 78.7%. Prescriptions for ondansetron were filled in 0.3% of pregnancies, with 76.9% being initially filled in the first trimester. Ondansetron as first-line prescription medication and/or use in the first trimester was associated with proxies for more severe nausea and vomiting of pregnancy, including a diagnosis of hyperemesis gravidarum, multiple gestations, a higher obstetric comorbidity index, and concomitant use of medication for gastroesophageal reflux disease and nervous system medications. Women who filled an antiemetic prescription in their first pregnancy were less likely to have subsequent pregnancies than women who did not fill an antiemetic prescription in their first pregnancy (OR 0.93, 95% CI 0.90–0.96). Conclusion Complex patterns of antiemetic prescription fills in pregnancy may mirror the challenge of optimal management of nausea and vomiting of pregnancy in clinical practice, especially for women with severe symptoms.
Collapse
Affiliation(s)
- Marleen M H J van Gelder
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud REshape Innovation Center, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
81
|
Abstract
Vitamin B6, a cofactor in many biochemical reactions in the cells of living organisms, is an essential coenzyme for various catabolic and anabolic processes. Although vitamin B6 deficiency in young healthy women with a balanced diet is thought to be unusual, it can be seen with certain medications, health conditions, and dietary deficits, as well as aging. Vitamin B6 deficiency is associated with a variety of ill health effects, and correction of deficiency is considered beneficial. Women particularly are affected by unique health issues that are part of the array of disorders potentially alleviated through vitamin B6 supplementation.
Collapse
|
82
|
Eltanany BM, Abd El-Hadi HR, Zaazaa HE, Eissa MS. In vitro analytical dissolution profiling of antiemetic delayed release tablets in two different dissolution media: Validated spectrophotometric methods versus reported HPLC. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2021; 246:119013. [PMID: 33049467 DOI: 10.1016/j.saa.2020.119013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/11/2020] [Accepted: 09/23/2020] [Indexed: 06/11/2023]
Abstract
The combination of pyridoxine HCl (PYR) and doxylamine succinate (DOX) was proved to be effective and safe acting as the first line of pregnancy medication for vomiting and nausea under a trade name; Vomibreak® delayed release tablets. This combination has been available in the Egyptian market since 2016. Dissolution study is a meaningful tool that represents a predictor of output because the rate controlling steps in any drug's absorption is the rate of discharging from its medicinal formulation. Generally, the dissolution test of all delayed release tablets is operated at two stages: first the acid stage then the buffer stage. In our work, the acid stage was performed in 0.1 N hydrochloric acid (0.1 M HCl) and the buffer one was in 0.2 M sodium phosphate buffer (0.2 M Na-PB), pH = 6.8, according to FDA guidelines. In present work, for the first time, this binary mixture was quantitatively determined by applying four spectrophotometric methods. PYR was directly determined by zero order spectra method (D0) at 291.0 nm in the range 2.0-26.0 μg/mL in the acid stage and at 325.0 nm in the range 5.0-35.0 μg/mL in the buffer stage, where DOX show no interference in both cases. However, DOX was determined by three methods, namely, Dual wavelength (DW), Ratio difference (RD) and Derivative ratio (DD1). DD1 was the chosen method for determination of DOX in the two-phase dissolution study of Vomibreak® tablets at 249.0 nm in the range 2.0-44.0 μg/mL and 273.0 nm in the range 5.0-100.0 μg/mL in acid and buffer phases, respectively. All of the suggested methods were tested in compliance with ICH guidelines, where all methods were found to be reliable, reproducible, and selective. A statistical comparison was computed between two analytical techniques of critical importance in the development of two media dissolution profile: proposed UV- spectrophotometric and reported HPLC methods where no significant difference was found. Difference (ƒ1) and similarity (ƒ2) factors were calculated for PYR and DOX and shown that ƒ1 was 1.490 and 1.654 and ƒ2 was 94.431 and 92.396 for PYR and DOX, respectively.
Collapse
Affiliation(s)
- Basma M Eltanany
- Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, 11562 Kasr El-Aini St., Cairo, Egypt.
| | - Heidi R Abd El-Hadi
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Egyptian Russian University, Badr City, Cairo, Egypt
| | - Hala E Zaazaa
- Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, 11562 Kasr El-Aini St., Cairo, Egypt
| | - Maya S Eissa
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Egyptian Russian University, Badr City, Cairo, Egypt
| |
Collapse
|
83
|
Piccini A, Tulha A, da Silva SLA, Michelutti LDBC, Carvalho LC, Botelho S. The Brazilian version of the Health-Related Quality of Life Questionnaire for Nausea and Vomiting of Pregnancy: translation, cross-cultural adaptation and reliability - an observational cross-sectional study. SAO PAULO MED J 2021; 139:147-155. [PMID: 33825770 PMCID: PMC9632511 DOI: 10.1590/1516-3180.2020.0430.r1.08122020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/08/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Health-Related Quality of Life Questionnaire for Nausea and Vomiting of Pregnancy (NVPQOL) is a validated questionnaire assessing quality of life among pregnant women with nausea and vomiting. OBJECTIVE To translate, cross-culturally adapt and evaluate the reliability of the NVPQOL. DESIGN AND SETTING Observational cross-sectional study developed in a public university in Brazil. METHODS The translation, synthesis of translations, back-translation, expert committee, pre-testing and validation were carried out, resulting in a Portuguese-language version. The internal consistency, intra-rater and test-retest reliability and correlation between the total score of the Portuguese-language version of the NVPQOL and the domains of the World Health Organization Quality of Life-bref questionnaire were considered in the data analysis. RESULTS The instrument went through the process with testing on 104 pregnant women. Strong internal consistency (Cronbach's α: 0.95), strong intra-rater and test-retest reliability (P < 0.0; intraclass correlation coefficient: 0.89; confidence interval: 0.791-0.945) and strong correlation between the total score of the Portuguese-language version of the NVPQOL and the physical health domain of the World Health Organization Quality of Life-bref questionnaire (P < 0.01; R = -0.8) were observed. CONCLUSION The NVPQOL was translated, cross-culturally adapted and validated for the Portuguese language with satisfactory psychometric properties for assessing quality of life, especially in relation to physical health, among pregnant women with symptoms of nausea and vomiting in the first trimester of pregnancy.
Collapse
Affiliation(s)
- Adriana Piccini
- MSc. Physiotherapist, Postgraduate Program on Rehabilitation Sciences, Motor Science Institute, Federal University of Alfenas (UNIFAL-MG), Alfenas (MG), Brazil.
| | - Amanda Tulha
- BSPT. Physiotherapist, Physiotherapy Course, Motor Science Institute, Federal University of Alfenas (UNIFAL-MG), Alfenas (MG), Brazil.
| | - Sílvia Lanziotti Azevedo da Silva
- PhD. Professor, Faculty of Medicine/Department of Collective Health, Federal University of Juiz de Fora (UFJF), Juiz de Fora (MG), Brazil; Professor, Postgraduate Program on Rehabilitation Sciences, Motor Science Institute, Federal University of Alfenas (UNIFAL-MG), Alfenas (MG), Brazil.
| | - Luciana de Barros Cavalcanti Michelutti
- BSc. Professor, School of Medicine, Federal University of Alfenas (UNIFAL-MG), Alfenas (MG), Brazil; Master's Student, Postgraduate Program on Rehabilitation Sciences, Motor Science Institute, Federal University of Alfenas (UNIFAL-MG), Alfenas (MG), Brazil.
| | - Leonardo César Carvalho
- PhD. Physiotherapist and Professor, Postgraduate Program on Rehabilitation Sciences, Motor Science Institute, Federal University of Alfenas (UNIFAL-MG), Alfenas (MG), Brazil.
| | - Simone Botelho
- PhD. Physiotherapist, Professor and Coordinator, Postgraduate Program on Rehabilitation Sciences, Motor Science Institute, Federal University of Alfenas (UNIFAL-MG), Alfenas (MG), Brazil; Professor and Researcher, Postgraduate Program on Surgical Science, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas (SP), Brazil.
| |
Collapse
|
84
|
Damkier P, Kaplan YC, Shechtman S, Diav-Citrin O, Cassina M, Weber-Schoendorfer C. Ondansetron in pregnancy revisited: Assessment and pregnancy labelling by the European Medicines Agency (EMA) & Pharmacovigilance Risk Assessment Committee (PRAC). Basic Clin Pharmacol Toxicol 2020; 128:579-582. [PMID: 33275828 DOI: 10.1111/bcpt.13541] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 01/30/2023]
Abstract
Ondansetron is an effective antiemetic that is being widely used as a second-line treatment option for severe nausea and vomiting of pregnancy in accordance with clinical guidelines. The safety of ondansetron during pregnancy has-following publication of controversial and seemingly contradictory results-been subject to considerable academic turmoil, specifically with respect to the risk of congenital cardiac malformations and oral cleft. In July 2019, the European Medicines Agency (EMA) Pharmacovigilance Risk Assessment Committee (PRAC) released an updated, comprehensive assessment report on the use of ondansetron in the first trimester. The ensuing Summary of Product Characteristics (SmPC) was updated in November 2019 with important changes to section on "Fertility, pregnancy and lactation." The SmPC now states that ondansetron should not be used in the first trimester of pregnancy. ENTIS, The European Network of Teratology Information Services, believes that the implementation of this regulatory step-which has important clinical consequences-is insufficiently substantiated and is not serving the interest of pregnant women with severe nausea and vomiting. Herein, we discuss the underlying evidence and argue the case against the EMA decision.
Collapse
Affiliation(s)
- Per Damkier
- Department of Clinical Biochemistry & Pharmacology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Yusuf Cem Kaplan
- Terafar - Izmir Katip Celebi University Teratology Information, Training and Research Center, Izmir, Turkey
| | - Svetlana Shechtman
- The Israeli Teratology Information Service, Ministry of Health, Jerusalem, Israel
| | - Orna Diav-Citrin
- The Israeli Teratology Information Service, Ministry of Health, and the Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Matteo Cassina
- Clinical Genetics Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Corinna Weber-Schoendorfer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Pharmacovigilance Institute for Embryotoxicology, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| |
Collapse
|
85
|
Yan R, Zhan J, Liu G, Li C, Cai P, Chen Y, Cao H. A comparison of the efficacy and safety of traditional Chinese medicine external treatment for the hyperemesis gravidarum: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2020; 99:e23019. [PMID: 33157951 PMCID: PMC7647590 DOI: 10.1097/md.0000000000023019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The symptoms of frequent nausea and vomiting, inability to eat, and fluid imbalance caused by hyperemesis gravidarum (HG) seriously impact the quality of life of pregnant women. In some serious cases, it is even necessary to terminate the pregnancy, and threatens the life of the pregnant woman. A great many of studies have proved that HG can be effectively treated by traditional Chinese medicine (TCM) external treatment. Nevertheless, its relative effectiveness and safety haven't yet been confirmed because of the variety of TCM external treatment. Therefore, we will use the method of network meta-analysis to verify the effectiveness and safety of different types of TCM external treatment for the HG. METHODS In this study, English and Chinese literatures that meet the requirements will be searched in EMBASE, PubMed, Cochrane Library, Web of Science, CnKI, VIP, Wanfang, and CBM. Regardless of whether blinding is used or not, all randomized controlled trials (RCTs) using TCM external treatment for the HG will be included. Then, Stata 16.0 will be used to conduct a series of pairwise meta-analysis. WinBUGS 1.4.3 and Stata 16.0 will be used to conduct Bayesian network meta-analysis to evaluate the relative results of different TCM external treatments for the HG. The quality included in the study will be evaluated through the classification of Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS This study will evaluate the effectiveness and safety of TCM external treatment for the HG according to the primary and secondary outcomes, and we rank different kinds of TCM external treatments in accordance with effectiveness. The primary outcomes are the intensity of nausea and vomiting. Secondary outcomes include quality of life, adverse outcome of pregnant women, adverse outcome of fetal, duration of hospitalization and so on. CONCLUSION This study will provide more convincing and detailed information of TCM external treatment for the HG, and the reference value for clinical treatment. INPLASY REGISTRATION NUMBER INPLASY 202090089.
Collapse
Affiliation(s)
- Rugen Yan
- The First Clinical College, Shandong University of Traditional Chinese Medicine
| | - Junyi Zhan
- The First Clinical College, Shandong University of Traditional Chinese Medicine
| | - Gongxue Liu
- The First Clinical College, Shandong University of Traditional Chinese Medicine
| | - Changzhong Li
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province
| | - Pingping Cai
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province
| | - Yin Chen
- Xuyi County Hospital of Chinese Medicine, Xuyi, Jiangsu Province, China
| | - Huanze Cao
- The First Clinical College, Shandong University of Traditional Chinese Medicine
| |
Collapse
|
86
|
Pecriaux C. [Interest of vitamin b6 for treatment of nausea and/or vomiting during pregnancy]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:840-843. [PMID: 32961339 DOI: 10.1016/j.gofs.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Indexed: 06/11/2023]
Abstract
In France there is no official recommendation for the drug management of nausea and vomiting during pregnancy. In the USA, Canada and Australia, vitamin B6 is officially recommended in the treatment of mild to moderate pregnancy sickness and vomiting. Indeed, some studies have shown some effectiveness of oral vitamin B6, most often in combination with doxylamine, in comparison with a placebo. In addition, the harmlessness of oral vitamin B6 during pregnancy has been established for doses up to 40-60mg/day, mainly in combination with doxylamine (40mg/40mg). Thus, in France, as in other countries, vitamin B6 could be integrated into the therapeutic arsenal of mild to moderate nausea and vomiting during pregnancy according to the following dosage schedule: oral intake of 10mg four times a day of a compounded preparation of vitamin B6, alone or in combination with doxylamine.
Collapse
Affiliation(s)
- C Pecriaux
- Centre de référence sur les agents tératogènes (CRAT), DMU ESPRIT (Épidémiologie et biostatistique, santé publique, pharmacie, pharmacologie, recherche, information médicale, thérapeutique et médicaments), GHU AP-HP Sorbonne université, Site Trousseau 26 avenue Dr Netter, 75571 Paris cedex 12, France.
| |
Collapse
|
87
|
Regodón Wallin A, Tielsch JM, Khatry SK, Mullany LC, Englund JA, Chu H, LeClerq SC, Katz J. Nausea, vomiting and poor appetite during pregnancy and adverse birth outcomes in rural Nepal: an observational cohort study. BMC Pregnancy Childbirth 2020; 20:545. [PMID: 32943001 PMCID: PMC7499900 DOI: 10.1186/s12884-020-03141-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 07/28/2020] [Indexed: 01/17/2023] Open
Abstract
Background Nausea and vomiting are experienced by a majority of pregnant women worldwide. Previous studies have yielded conflicting results regarding their impact on birth outcomes and few studies have examined this relationship in settings with limited resources. We aimed to determine the effect of nausea, vomiting and poor appetite during pregnancy on birth outcomes in rural Nepal. Methods Observational cohort study using data collected in two randomized, community-based trials to assess the effect of influenza immunization during pregnancy on reproductive and respiratory outcomes among pregnant women and their offspring. Pregnant women in Sarlahi District, Nepal were recruited from 2011 to 2013. Exposure was defined as nausea, vomiting or poor appetite at any point during pregnancy and by trimester; symptoms were recorded monthly throughout pregnancy. Adverse outcomes were low birth weight (LBW), preterm birth and small for gestational age (SGA). Adjusted relative risks (aRR) with 95% CIs are reported from Poisson regressions with robust variance. Results Among 3,623 pregnant women, the cumulative incidence of nausea, vomiting or poor appetite was 49.5% (n = 1793) throughout pregnancy and 60.6% (n = 731) in the first trimester. Significantly higher aRRs of LBW and SGA were observed among women experiencing symptoms during pregnancy as compared to symptom free women (LBW: aRR 1.20; 95% CI 1.05 1.28; SGA: aRR 1.16; 95% CI 1.05 1.28). Symptoms in the first trimester were not significantly associated with any of the outcomes. In the second trimester, we observed significantly higher aRRs for LBW and SGA (LBW: aRR 1.17; 95% CI 1.01 1.36; SGA: aRR 1.16; 95% CI 1.05 1.29) and a significantly lower aRR for preterm birth (aRR 0.75; 95% CI 0.59 0.96). In the third trimester, we observed significantly higher aRRs for LBW and SGA (LBW: aRR 1.20; 95% CI 1.01 1.43; SGA: aRR 1.14; 95% CI 1.01 1.29). Conclusions Symptoms of nausea, vomiting or poor appetite during pregnancy are associated with LBW, SGA and preterm birth in a setting with limited resources, especially beyond the first trimester. Trial registration Prospectively registered at ClinicalTrials.gov on Dec 17, 2009 (NCT01034254).
Collapse
Affiliation(s)
- Amanda Regodón Wallin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room W5009, 21203-2105, Baltimore, MD, USA.
| | - James M Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | - Luke C Mullany
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Janet A Englund
- Seattle Children's Research Institute, University of Washington, Seattle, WA, USA
| | - Helen Chu
- Department of Medicine, University of Washington, WA, Seattle, USA
| | - Steven C LeClerq
- Nepal Nutrition Intervention Project, Sarlahi, Kathmandu, Nepal.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room W5009, 21203-2105, Baltimore, MD, USA
| |
Collapse
|
88
|
Ferrante E, Trimboli M, Petrecca G, Allegrini F, Ferrante MM, Rubino F. Management of Spontaneous Intracranial Hypotension During Pregnancy: A Case Series. Headache 2020; 60:1777-1787. [DOI: 10.1111/head.13942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/11/2020] [Accepted: 06/24/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Enrico Ferrante
- Neurology Department AOR San Carlo Potenza Italy
- Neurology Department Alto Vicentino Hospital – AULSS 7 Pedemontana Santorso Italy
| | - Michele Trimboli
- Neurology Department AOR San Carlo Potenza Italy
- Department of Medical and Surgical Sciences Institute of Neurology AOU Mater Domini – Magna Græcia University Catanzaro Italy
| | - Giuseppe Petrecca
- Anesthesiology and Intensive Care Department AOR San Carlo Potenza Italy
| | | | | | - Fabio Rubino
- Palliative Care and Pain Management Department ASST Valtellina Sondrio Italy
| |
Collapse
|
89
|
MacDuffie KE, Kleinhans NM, Stout K, Wilfond BS. Protection Versus Progress: The Challenge of Research on Cannabis Use During Pregnancy. Pediatrics 2020; 146:S93-S98. [PMID: 32737240 DOI: 10.1542/peds.2020-0818r] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2020] [Indexed: 11/24/2022] Open
Abstract
A central tension in pediatric research ethics arises from our desire to protect children from harm while also allowing progress toward discoveries that could improve child health. A prime example of this tension is research on a controversial yet increasingly common practice: the use of cannabis by women to treat nausea and vomiting of pregnancy. Studies of cannabis use in pregnancy face a combination of ethical hurdles because of the inclusion of pregnant women and involvement of a schedule I controlled substance. Given the growing need for research on the safety and efficacy of cannabis for nausea and vomiting of pregnancy, we reflect on the multiple historical contexts that have contributed to the challenge of studying cannabis use during pregnancy and make a case for the ethical rationale for such research.
Collapse
Affiliation(s)
- Katherine E MacDuffie
- Departments of Speech and Hearing Sciences,
- Seattle Children's Hospital, Treuman Katz Center for Pediatric Bioethics, Seattle, Washington; and
| | | | | | - Benjamin S Wilfond
- Seattle Children's Hospital, Treuman Katz Center for Pediatric Bioethics, Seattle, Washington; and
- Pediatrics, School of Medicine, University of Washington, Seattle, Washington
| |
Collapse
|
90
|
Huybrechts KF, Hernández-Díaz S, Bateman BT. Contextualizing Potential Risks of Medications in Pregnancy for the Newborn-the Case of Ondansetron. JAMA Pediatr 2020; 174:747-748. [PMID: 32478805 DOI: 10.1001/jamapediatrics.2020.1325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sonia Hernández-Díaz
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Brian T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
91
|
Plaze M, Attali D, Petit AC, Blatzer M, Simon-Loriere E, Vinckier F, Cachia A, Chrétien F, Gaillard R. Repurposing chlorpromazine to treat COVID-19: The reCoVery study. L'ENCEPHALE 2020; 46:169-172. [PMID: 32425222 PMCID: PMC7229964 DOI: 10.1016/j.encep.2020.05.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/11/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The ongoing COVID-19 pandemic has caused approximately 2,350,000 infections worldwide and killed more than 160,000 individuals. In Sainte-Anne Hospital (GHU PARIS Psychiatrie & Neuroscience, Paris, France) we have observed a lower incidence of symptomatic forms of COVID-19 among patients than among our clinical staff. This observation led us to hypothesize that psychotropic drugs could have a prophylactic action against SARS-CoV-2 and protect patients from the symptomatic and virulent forms of this infection, since several of these psychotropic drugs have documented antiviral properties. Chlorpromazine (CPZ), a phenothiazine derivative, is also known for its antiviral activity via the inhibition of clathrin-mediated endocytosis. Recentin vitro studies have reported that CPZ exhibits anti-MERS-CoV and anti-SARS-CoV-1 activity. METHODS In this context, the ReCoVery study aims to repurpose CPZ, a molecule with an excellent tolerance profile and a very high biodistribution in the saliva, lungs and brain. We hypothesize that CPZ could reduce the unfavorable course of COVID-19 infection among patients requiring respiratory support without the need for ICU care, and that it could also reduce the contagiousness of SARS-CoV-2. For this purpose, we plan a pilot, multicenter, randomized, single blind, controlled, phase III therapeutic trial (standard treatment vs. CPZ+standard treatment). CONCLUSION This repurposing of CPZ for its anti-SARS-CoV-2 activity could offer an alternative, rapid strategy to alleviate infection severity. This repurposing strategy also avoids numerous developmental and experimental steps, and could save precious time to rapidly establish an anti-COVID-19 therapy with well-known, limited and easily managed side effects.
Collapse
Affiliation(s)
- M Plaze
- GHU PARIS Psychiatrie & Neurosciences, site Sainte-Anne, Service Hospitalo-Universitaire, Pôle Hospitalo-Universitaire Paris 15, Paris, France; Université de Paris, Paris, France.
| | - D Attali
- GHU PARIS Psychiatrie & Neurosciences, site Sainte-Anne, Service Hospitalo-Universitaire, Pôle Hospitalo-Universitaire Paris 15, Paris, France; Université de Paris, Paris, France; Physics for Medicine Paris, Inserm, ESPCI Paris, CNRS, PSL Research University, Univ Paris Diderot, Sorbonne Paris Cite, Paris, France
| | - A-C Petit
- GHU PARIS Psychiatrie & Neurosciences, site Sainte-Anne, Service Hospitalo-Universitaire, Pôle Hospitalo-Universitaire Paris 15, Paris, France; Institut Pasteur, Experimental Neuropathology Unit, Paris, France
| | - M Blatzer
- Institut Pasteur, Experimental Neuropathology Unit, Paris, France
| | - E Simon-Loriere
- Institut Pasteur, G5 Evolutionary Genomics of RNA Viruses, Paris, France
| | - F Vinckier
- GHU PARIS Psychiatrie & Neurosciences, site Sainte-Anne, Service Hospitalo-Universitaire, Pôle Hospitalo-Universitaire Paris 15, Paris, France; Université de Paris, Paris, France
| | - A Cachia
- Université de Paris, Institut de Psychiatrie et Neurosciences de Paris, INSERM, Paris, France; Université de Paris, Laboratoire de Psychologie du développement et de l'Éducation de l'Enfant, CNRS, Paris, France
| | - F Chrétien
- Institut Pasteur, Experimental Neuropathology Unit, Paris, France; GHU PARIS Psychiatrie & Neurosciences, site Sainte-Anne, Service de Neuropathologie, Paris, France
| | - R Gaillard
- GHU PARIS Psychiatrie & Neurosciences, site Sainte-Anne, Service Hospitalo-Universitaire, Pôle Hospitalo-Universitaire Paris 15, Paris, France; Université de Paris, Paris, France; Institut Pasteur, Experimental Neuropathology Unit, Paris, France
| |
Collapse
|
92
|
Plaze M, Attali D, Petit AC, Blatzer M, Simon-Loriere E, Vinckier F, Cachia A, Chrétien F, Gaillard R. [Repurposing of chlorpromazine in COVID-19 treatment: the reCoVery study]. L'ENCEPHALE 2020; 46:S35-S39. [PMID: 32387014 PMCID: PMC7188634 DOI: 10.1016/j.encep.2020.04.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/27/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The ongoing COVID-19 pandemic comprises a total of more than 2,350,000 cases and 160,000 deaths. The interest in anti-coronavirus drug development has been limited so far and effective methods to prevent or treat coronavirus infections in humans are still lacking. Urgent action is needed to fight this fatal coronavirus infection by reducing the number of infected people along with the infection contagiousness and severity. Since the beginning of the COVID-19 outbreak several weeks ago, we observe in GHU PARIS Psychiatrie & Neurosciences (Sainte-Anne hospital, Paris, France) a lower prevalence of symptomatic and severe forms of COVID-19 infections in psychiatric patients (∼4%) compared to health care professionals (∼14%). Similar observations have been noted in other psychiatric units in France and abroad. Our hypothesis is that psychiatric patients could be protected from severe forms of COVID-19 by their psychotropic treatments. Chlorpromazine (CPZ) is a phenothiazine derivative widely used in clinical routine in the treatment of acute and chronic psychoses. This first antipsychotic medication has been discovered in 1952 by Jean Delay and Pierre Deniker at Sainte-Anne hospital. In addition, to its antipsychotic effects, several in vitro studies have also demonstrated a CPZ antiviral activity via the inhibition of clathrin-mediated endocytosis. Recently, independent studies revealed that CPZ is an anti-MERS-CoV and an anti-SARS-CoV-1 drug. In comparison to other antiviral drugs, the main advantages of CPZ lie in its biodistribution: (i) preclinical and clinical studies have reported a high CPZ concentration in the lungs (20-200 times higher than in plasma), which is critical because of the respiratory tropism of SARS-CoV-2; (ii) CPZ is highly concentrated in saliva (30-100 times higher than in plasma) and could therefore reduce the contagiousness of COVID-19; (iii) CPZ can cross the blood-brain barrier and could therefore prevent the neurological forms of COVID-19. METHODS Our hypothesis is that CPZ could decrease the unfavorable evolution of COVID-19 infection in oxygen-requiring patients without the need for intensive care, but also reduce the contagiousness of SARS-CoV-2. At this end, we designed a pilot, phase III, multicenter, single blind, randomized controlled clinical trial. Efficacy of CPZ will be assessed according to clinical, biological and radiological criteria. The main objective is to demonstrate a shorter time to response (TTR) to treatment in the CPZ+standard-of-care (CPZ+SOC) group, compared to the SOC group. Response to treatment is defined by a reduction of at least one level of severity on the WHO-Ordinal Scale for Clinical Improvement (WHO-OSCI). The secondary objectives are to demonstrate in the CPZ+SOC group, compared to the SOC group: (A) superior clinical improvement; (B) a greater decrease in the biological markers of viral attack by SARS-CoV-2 (PCR, viral load); (C) a greater decrease in inflammatory markers (e.g. CRP and lymphopenia); (D) a greater decrease in parenchymal involvement (chest CT) on the seventh day post-randomization; (E) to define the optimal dosage of CPZ and its tolerance; (F) to evaluate the biological parameters of response to treatment, in particular the involvement of inflammatory cytokines. Patient recruitment along with the main and secondary objectives are in line with WHO 2020 COVID-19 guidelines. CONCLUSION This repositioning of CPZ as an anti-SARS-CoV-2 drug offers an alternative and rapid strategy to alleviate the virus propagation and the infection severity and lethality. This CPZ repositioning strategy also avoids numerous developmental and experimental steps and can save precious time to rapidly establish an anti-COVID-19 therapy with well-known, limited and easy to manage side effects. Indeed, CPZ is an FDA-approved drug with an excellent tolerance profile, prescribed for around 70 years in psychiatry but also in clinical routine in nausea and vomiting of pregnancy, in advanced cancer and also to treat headaches in various neurological conditions. The broad spectrum of CPZ treatment - including antipsychotic, anxiolytic, antiemetic, antiviral, immunomodulatory effects along with inhibition of clathrin-mediated endocytosis and modulation of blood-brain barrier - is in line with the historical French commercial name for CPZ, i.e. LARGACTIL, chosen as a reference to its "LARGe ACTion" properties. The discovery of those CPZ properties, as for many other molecules in psychiatry, is both the result of serendipity and careful clinical observations. Using this approach, the field of mental illness could provide innovative therapeutic approaches to fight SARS-CoV-2.
Collapse
Affiliation(s)
- M Plaze
- GHU Paris psychiatrie et neurosciences, site Sainte-Anne, service hospitalo-universitaire, pôle hospitalo-universitaire Paris 15, Paris, France; Université de Paris, Paris, France.
| | - D Attali
- GHU Paris psychiatrie et neurosciences, site Sainte-Anne, service hospitalo-universitaire, pôle hospitalo-universitaire Paris 15, Paris, France; Université de Paris, Paris, France; Physics for medicine Paris, Inserm, ESPCI Paris, CNRS, PSL Research university, université Paris Diderot, Sorbonne Paris Cite, Paris, France
| | - A-C Petit
- GHU Paris psychiatrie et neurosciences, site Sainte-Anne, service hospitalo-universitaire, pôle hospitalo-universitaire Paris 15, Paris, France; Institut Pasteur, experimental neuropathology unit, Paris, France
| | - M Blatzer
- Institut Pasteur, experimental neuropathology unit, Paris, France
| | - E Simon-Loriere
- Institut Pasteur, G5 evolutionary genomics of RNA viruses, Paris, France
| | - F Vinckier
- GHU Paris psychiatrie et neurosciences, site Sainte-Anne, service hospitalo-universitaire, pôle hospitalo-universitaire Paris 15, Paris, France; Université de Paris, Paris, France
| | - A Cachia
- Université de Paris, Institut de Psychiatrie et Neurosciences de Paris, INSERM, Paris, France; Université de Paris, Laboratoire de Psychologie du développement et de l'Éducation de l'Enfant, CNRS, Paris, France
| | - F Chrétien
- Institut Pasteur, experimental neuropathology unit, Paris, France; GHU PARIS Psychiatrie et Neurosciences, site Sainte-Anne, service de Neuropathologie, Paris, France
| | - R Gaillard
- GHU Paris psychiatrie et neurosciences, site Sainte-Anne, service hospitalo-universitaire, pôle hospitalo-universitaire Paris 15, Paris, France; Université de Paris, Paris, France; Institut Pasteur, experimental neuropathology unit, Paris, France
| |
Collapse
|
93
|
Hanson L, VandeVusse L, Garnier-Villarreal M, McCarthy D, Jerofke-Owen T, Malloy E, Paquette H. Validity and Reliability of the Antepartum Gastrointestinal Symptom Assessment Instrument. J Obstet Gynecol Neonatal Nurs 2020; 49:305-314. [PMID: 32272088 DOI: 10.1016/j.jogn.2020.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the psychometric properties of the nine-item Antepartum Gastrointestinal Symptom Assessment (AP-GI-SA) instrument. DESIGN Single-group prospective design. SETTING Urban prenatal clinic serving a diverse population. PARTICIPANTS Convenience sample of 45 pregnant women. METHODS Participants completed the AP-GI-SA before a scheduled prenatal care appointment. We used Bayesian structural equation modeling to evaluate the construct validity of the scale and assessed known-groups validity. We assessed reliability through maximal reliability coefficient estimate and measured internal consistency with Cronbach's alpha coefficient. RESULTS Participants completed the instrument in 2 minutes or less. Construct validity was supported by confirmatory factor analysis (posterior predictive p value = 0.49, gamma-hat = 0.970, and root mean square error of approximation = 0.065), which indicated that the single-factor model is a plausible data-generative model for GI symptoms. The maximal reliability coefficient of 0.75 and Cronbach's alpha coefficient of 0.67 supported reliability. Average AP-GI-SA scores were the highest for women in the third trimester. Of all nine GI symptoms, heartburn in the third trimester received the highest score. CONCLUSION Our findings provide preliminary support for the validity and reliability of the AP-GI-SA. The instrument may be used as a measure in intervention studies where GI symptoms of pregnancy are an outcome. The AP-GI-SA could also be useful in clinical settings to quickly evaluate GI symptoms.
Collapse
|
94
|
The Management of Nausea and Vomiting of Pregnancy: Synthesis of National Guidelines. Obstet Gynecol Surv 2020; 74:161-169. [PMID: 31634919 DOI: 10.1097/ogx.0000000000000654] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Nausea and vomiting of pregnancy (NVP) affects a high proportion of the pregnant population. Objective The aim of this study was to compare and synthesize recommendations from national guidelines regarding the management of NVP. Evidence Acquisition A descriptive review of 3 recently published national guidelines on NVP was conducted: Royal College of Obstetricians and Gynaecologists on "The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum," American College of Obstetricians and Gynecologists on "Nausea and Vomiting of Pregnancy," and Society of Obstetricians and Gynaecologists of Canada on "The Management of Nausea and Vomiting of Pregnancy." These guidelines were summarized and compared in terms of the recommended management of pregnant women. The quality of evidence was also reviewed based on the method of reporting. Results Several differences were identified on the different guidelines regarding the management of NVP. Frequent small meals and avoidance of iron supplements are recommended for prevention. The consumption of ginger, acustimulations, antihistamines, phenothiazines, dopamine, and serotonin 5-hydroxytryptamine type 3 receptor antagonists is routinely recommended for use in the community as treatment. Conclusions Evidence-based medicine may lead to the adoption of an international guideline for the management of NVP, which may lead to a more effective management of that entity.
Collapse
|
95
|
Second-Trimester Fetal Loss in a Patient With Hyperemesis Gravidarum Complicated by Refeeding Syndrome. Obstet Gynecol 2020; 133:1167-1170. [PMID: 31135730 DOI: 10.1097/aog.0000000000003276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Refeeding syndrome is a rare constellation of electrolyte abnormalities after reintroduction of glucose during an adaptive state of starvation and malnutrition, resulting in fluid shifts, end-organ damage, and, potentially, death. We present a case of fetal death in a patient with hyperemesis gravidarum complicated by refeeding syndrome. CASE A 32-year-old obese, multigravid patient was admitted at 16 weeks of gestation with hyperemesis gravidarum and laboratory abnormalities concerning for refeeding syndrome after consuming a sugar-rich beverage. She was admitted to the hospital for electrolyte and fluid repletion; however, on hospital day 2, fetal death was diagnosed. CONCLUSION Refeeding syndrome is a potentially fatal complication of hyperemesis gravidarum. Caution should be taken when reintroducing glucose during prolonged states of malnutrition to prevent the development of refeeding syndrome.
Collapse
|
96
|
Buckingham L, Janssen M, Ray EM, Tucker K, Davidson BA, Arenth J, Lefkowits C, Jones JA, Gehrig P, Jones CA. Top Ten Tips Palliative Care Clinicians Should Know About Caring for Serious Illness in Pregnancy. J Palliat Med 2020; 23:712-718. [PMID: 31928374 DOI: 10.1089/jpm.2019.0651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Palliative care (PC) teams are increasingly being called upon to provide care earlier and more remote from end of life. Because much of the field has grown out of hospice and geriatric care, most teams have little to no experience caring for pregnant women or their fetuses when serious or life-threatening illness strikes. This article, written by a team of oncologists (gynecologic, medical, and radiation) and PC providers, seeks to demystify the care of seriously ill pregnant women and their fetuses by exploring the diagnostic, treatment, prognostication, symptom management, and communication needs of these patients. Truly comprehensive PC extends throughout the life span, from conception to death, regardless of age. Accordingly, increased knowledge of the unique needs of these vulnerable groups will enhance our ability to provide care across this continuum.
Collapse
Affiliation(s)
- Lindsey Buckingham
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Matthew Janssen
- Division of Maternal Fetal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emily M Ray
- Division of Hematology and Oncology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Katherine Tucker
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brittany A Davidson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Joshua Arenth
- Divisions of Pediatric Critical Care and Pediatric Palliative Care, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Carolyn Lefkowits
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Division of Palliative Care, Department of Internal Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Joshua A Jones
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paola Gehrig
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christopher A Jones
- Department of Medicine and the Palliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
97
|
Ali A, Beckett K, Flink C. Emergent MRI for acute abdominal pain in pregnancy-review of common pathology and imaging appearance. Emerg Radiol 2020; 27:205-214. [PMID: 31902010 DOI: 10.1007/s10140-019-01747-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/20/2019] [Indexed: 12/23/2022]
Abstract
Acute abdominal pain in pregnancy remains a clinically challenging presentation, often requiring imaging. The threat of morbidity and mortality to both mother and fetus necessitates quick and accurate imaging diagnosis, often via ultrasound. However, many of the common causes of acute abdominal pain are not readily diagnosed with sonography, and magnetic resonance imaging (MRI) is increasingly favored in this setting. The purpose of this review is to familiarize the reader with common pathologies which may be encountered in pregnant females presenting with acute abdominal pain requiring emergent MRI.
Collapse
Affiliation(s)
- Arafat Ali
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH, 45267, USA.
| | - Katrina Beckett
- Department of Radiology, University of California Los Angeles Medical Center, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
| | - Carl Flink
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH, 45267, USA
| |
Collapse
|
98
|
Shapira M, Avrahami I, Mazaki-Tovi S, Shai D, Zemet R, Barzilay E. The safety of early pregnancy exposure to granisetron. Eur J Obstet Gynecol Reprod Biol 2019; 245:35-38. [PMID: 31841778 DOI: 10.1016/j.ejogrb.2019.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Current 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. DESIGN Medical 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. RESULTS 100 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. CONCLUSION Granisetron 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.
Collapse
Affiliation(s)
- Moran Shapira
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Israel.
| | - Inbal Avrahami
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Israel
| | - Shali Mazaki-Tovi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Israel
| | - Daniel Shai
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Israel
| | - Roni Zemet
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Israel
| | - Eran Barzilay
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Israel; Department of Obstetrics and Gynecology, Assuta Ashdod University Hospital, Ashdod, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
99
|
The Hepatobiliary System: An Overview of Normal Function and Diagnostic Testing in Pregnancy. Clin Obstet Gynecol 2019; 63:122-133. [PMID: 31770121 DOI: 10.1097/grf.0000000000000504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Pregnancy is associated with physiological adaptions that affect every organ system. Changes in liver function in pregnancy have important effects on nutrient metabolism, protein synthesis, and the biotransformation of substances in preparation for excretion. A clear understanding of the anatomic and functional changes of the hepatobiliary system is necessary for the diagnosis and evaluation of disease, as well as understanding how these changes predispose women to pregnancy-specific hepatic conditions. In this review, the effect of gestational changes in hepatobiliary function on laboratory tests and the role of diagnostic imaging of the liver and gallbladder in pregnancy will be discussed.
Collapse
|
100
|
Abstract
The proportion of women entering medicine and surgery is increasing steadily. As more women surgeons have children during residency and practice, it is essential that we adopt a team approach to the pregnant surgeon, as a pregnancy undoubtedly impacts the team and not just the individual. Coauthored by a practicing surgeon mother of 2 (J. D.) and a postgraduate year 8 colorectal surgery fellow mother of 2 who is currently pregnant (C. H.), we aim to review the data while providing some practical advice for pregnant surgeons and those considering pregnancy, as well as their valued colleagues, mentors, and administrators. Physical challenges are discussed by trimester, as are the risks facing the pregnant surgeon, the logistics of transitioning in and out of maternity leave, and postpartum considerations.
Collapse
Affiliation(s)
- Cristina R. Harnsberger
- Division of Colon and Rectal Surgery, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts
| | - Jennifer S. Davids
- Division of Colon and Rectal Surgery, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts
| |
Collapse
|