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Piri M, Maleki A, Saed O. The effect of educational intervention on the quality of life of women suffering from pregnancy-related nausea and vomiting: a systematic review. J Matern Fetal Neonatal Med 2024; 37:2345305. [PMID: 38705838 DOI: 10.1080/14767058.2024.2345305] [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] [Received: 02/05/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE The present study aimed to determine the influence of educational interventions on improving the quality of life (QOL) of women suffering from pregnancy-related nausea and vomiting (NVP) as a systematic review. METHODS The current systematic review followed the standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist guideline. The English electronic databases were used to identify relevant studies published 2000 until 14 August 2023. The search strategies employed were based on Mesh browser keywords and free-text words. The study risk of bias was evaluated using the Cochrane Collaboration's tool for assessing the risk of bias tools and publication bias was evaluated using a funnel plot and Begg and Egger tests. The heterogeneity of the studies was evaluated using I2 and tau-squared tests. Data were analyzed using the RevMan 5 software. Results of the random-effects meta-analysis were presented using the standard mean difference, along with a 95% confidence interval (CI). RESULTS Out of the seven randomized clinical/control trial (RCT) studies with a total of 946 subjects included in the review, five studies reported a significant result, indicating that the interventions had a statistically significant effect on the QOL of women suffering NVP and in two studies did not have a significant result. A subgroup analysis was done based on the type of quality-of-life measurements. The pooled standardized mean difference (SMD) of four articles (Nausea and Vomiting Pregnancy Quality of Life, NVPQOL) with a total of 335 subjects was -2.91, and CI of -4.72 to -1.11, p value = .002, I2 = 97.2%. The pooled SMD of three articles (SF36) with a total of 611 subjects was -0.05, and CI of -0.23 to -0.12, p value = .550, I2 = 10%. CONCLUSIONS The overall results of the analysis indicated that educational intervention had a small positive impact on the QOL of women experiencing NVP. However, to draw a better conclusion, it is recommended to conduct further studies with larger sample sizes and longer follow-up periods.
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Affiliation(s)
- Mahsa Piri
- School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Azam Maleki
- Social Determinants of Health Research Center, Health and Metabolic Diseases Research Institute, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Omid Saed
- Clinical Psychology Department, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
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Nelson-Piercy C, Dean C, Shehmar M, Gadsby R, O'Hara M, Hodson K, Nana M. The Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum (Green-top Guideline No. 69). BJOG 2024; 131:e1-e30. [PMID: 38311315 DOI: 10.1111/1471-0528.17739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
An objective and validated index of nausea and vomiting such as the Pregnancy-Unique Quantification of Emesis (PUQE) and HyperEmesis Level Prediction (HELP) tools can be used to classify the severity of NVP and HG. [Grade C] Ketonuria is not an indicator of dehydration and should not be used to assess severity. [Grade A] There are safety and efficacy data for first line antiemetics such as anti (H1) histamines, phenothiazines and doxylamine/pyridoxine (Xonvea®) and they should be prescribed initially when required for NVP and HG (Appendix III). [Grade A] There is evidence that ondansetron is safe and effective. Its use as a second line antiemetic should not be discouraged if first line antiemetics are ineffective. Women can be reassured regarding a very small increase in the absolute risk of orofacial clefting with ondansetron use in the first trimester, which should be balanced with the risks of poorly managed HG. [Grade B] Metoclopramide is safe and effective and can be used alone or in combination with other antiemetics. [Grade B] Because of the risk of extrapyramidal effects metoclopramide should be used as second-line therapy. Intravenous doses should be administered by slow bolus injection over at least 3 minutes to help minimise these. [Grade C] Women should be asked about previous adverse reactions to antiemetic therapies. If adverse reactions occur, there should be prompt cessation of the medications. [GPP] Normal saline (0.9% NaCl) with additional potassium chloride in each bag, with administration guided by daily monitoring of electrolytes, is the most appropriate intravenous hydration. [Grade C] Combinations of different drugs should be used in women who do not respond to a single antiemetic. Suggested antiemetics for UK use are given in Appendix III. [GPP] Thiamine supplementation (either oral 100 mg tds or intravenous as part of vitamin B complex (Pabrinex®)) should be given to all women admitted with vomiting, or severely reduced dietary intake, especially before administration of dextrose or parenteral nutrition. [Grade D] All therapeutic measures should have been tried before considering termination of pregnancy. [Grade C].
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Rath W, Maul H, Abele H, Pauluschke J. [Hyperemesis Gravidarum - an Interprofessional and Interdisciplinary Challenge - Evidence-Based Review]. Z Geburtshilfe Neonatol 2024; 228:218-231. [PMID: 38065551 DOI: 10.1055/a-2200-9686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Hyperemesis gravidarum (HG) is a multifactorial disease characterized by severe and persisting nausea and vomiting, impairment of oral intake, weight loss of at least 5%, electrolyte abnormalities, and dehydration. The prevalence of HG ranges from 0.3 to 10% worldwide. The diagnosis is made by the patient's prehistory, clinical symptoms, physical examination, and the typical laboratory abnormalities. Therapeutic cornerstones are nutrition advice, consultation of life style, psychological/psychosocial support of the mother as well as the administration of antiemetics in a stepwise approach, depending on the severity of symptoms, and finally admission to hospital in severe cases. Treatment of patients requires close interprofessional and interdisciplinary cooperation.
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Affiliation(s)
- Werner Rath
- Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Holger Maul
- Geburtshilfe und Pränatalmedizin, Asklepios Kliniken Hamburg, Hamburg, Germany
| | - Harald Abele
- Frauenklinik, Universitätklinikum Tübingen, Tübingen, Germany
| | - Jan Pauluschke
- Frauenklinik, Universitätklinikum Tübingen, Tübingen, Germany
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Morton A, Mackle C, Pavey J. Akathisia and oculogyric crisis in hyperemesis gravidarum. Obstet Med 2024; 17:129-131. [PMID: 38784181 PMCID: PMC11110745 DOI: 10.1177/1753495x221137942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/22/2022] [Accepted: 10/23/2022] [Indexed: 05/25/2024] Open
Abstract
Hyperemesis gravidarum complicates 0.5-2% of pregnancies. HG is associated with insomnia, significantly increased risks of anxiety and depression, and may be associated with feelings of guilt, social isolation and thoughts of suicidal ideation or termination of pregnancy. Anti-emetic therapy may be complicated by akathisia and dystonic reactions, which may affect the ongoing management of nausea and vomiting. A case of akathisia and oculogyric crisis following the addition of parenteral prochlorperazine to ondansetron and metoclopramide is presented. The treatment options for extrapyramidal side effects with anti-emetics in pregnancy and for ongoing treatment of nausea and vomiting are discussed.
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Affiliation(s)
- Adam Morton
- Obstetric Medicine, Mater Health, Raymond Terrace, South Brisbane, Herston, Queensland, Australia
| | | | - Julian Pavey
- Obstetric Medicine, Mater Health, Brisbane, Australia
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Karabay G, Bayraktar B, Seyhanli Z, Sucu ST, Cakir BT, Aktemur G, Bucak M, Ozgurluk I, Iskender CT. Evaluation of controlling nutritional status (CONUT) score in the prognosis of hyperemesis gravidarum. Arch Gynecol Obstet 2024:10.1007/s00404-024-07534-x. [PMID: 38782763 DOI: 10.1007/s00404-024-07534-x] [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: 02/07/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE To investigate the predictive value of the Controlling Nutritional Status (CONUT) score on hyperemesis gravidarum (HG) severity, hospitalization, and length of stay. MATERIALS AND METHODS This retrospective cross-sectional study, conducted between December 2022 and June 2023, involved two groups. Group 1 comprised 52 pregnant women diagnosed with HG in the first trimester, receiving hospitalization and treatment. Group 2 included 105 pregnant women diagnosed with HG in the first trimester, managed and treated as outpatients. The CONUT score was calculated with the formula: Serum albumin score + total lymphocyte score + total cholesterol score. This score is calculated with a number of points between 0 and 12. The interpretation of the score involves four categories: normal (0-1), light (2-4), moderate (5-8), and severe (9-12). RESULTS The CONUT score differed significantly between the hospitalized (4, IQR: 2.25-5) and outpatient groups (2, IQR: 2-3) (p < 0.001). A CONUT score >3 was associated with the need for hospitalization, demonstrating a sensitivity of 60%, a specificity of 84% (p < 0.001). The CONUT score was the parameter with the highest odds ratio (OR) value among the parameters related to the need for hospitalization, and each unit increase in the CONUT score increased the need for hospitalization by 1.683 times [OR = 1.683 (95% CI: 1.042-2.718), p = 0.033]. A positive correlation was found between the CONUT score and the duration of hospital stay (r = 0.316, p = 0.023). CONCLUSIONS This study suggests CONUT score as a valuable tool for predicting HG severity, hospitalization need, and duration of hospital stay.
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Affiliation(s)
- Gulsan Karabay
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara Etlik City Hospital, Ankara, Turkey.
| | - Burak Bayraktar
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara Etlik City Hospital, Ankara, Turkey.
| | - Zeynep Seyhanli
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Serap Topkara Sucu
- Department of Obstetrics and Gynecology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Betul Tokgoz Cakir
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Gizem Aktemur
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Mevlut Bucak
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Izzet Ozgurluk
- Department of Obstetrics and Gynecology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Can Tekin Iskender
- Division of Perinatology, Department of Obstetrics and Gynecology, Ankara Etlik City Hospital, Ankara, Turkey
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Vinnars M, Forslund M, Claesson I, Hedman A, Peira N, Olofsson H, Wernersson E, Ulfsdottir H. Treatments for hyperemesis gravidarum: A systematic review. Acta Obstet Gynecol Scand 2024; 103:13-29. [PMID: 37891710 PMCID: PMC10755124 DOI: 10.1111/aogs.14706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 10/29/2023]
Abstract
INTRODUCTION Hyperemesis gravidarum affects 0.3%-3% of pregnant women each year and is the leading cause of hospitalization in early pregnancy. Previous systematic reviews of available treatments have found a lack of consistent evidence, and few studies of high quality. Since 2016, no systematic review has been conducted and an up-to date review is requested. In a recent James Lind Alliance collaboration, it was clear that research on effective treatments is a high priority for both patients and clinicians. MATERIAL AND METHODS Searches without time limits were performed in the AMED, CINAHL, Cochrane Library, EMBASE, Medline, PsycINFO, and Scopus databases until June 26, 2023. Studies published before October 1, 2014 were identified from the review by O'Donnell et al., 2016. Selection criteria were randomized clinical trials and non-randomized studies of interventions comparing treatment of hyperemesis gravidarum with another treatment or placebo. Outcome variables included were: degree of nausea; vomiting; inability to tolerate oral fluids or food; hospital treatment; health-related quality of life, small-for-gestational-age infant; and preterm birth. Abstracts and full texts were screened, and risk of bias of the studies was assessed independently by two authors. Synthesis without meta-analysis was performed, and certainty of evidence was assessed using the GRADE approach. PROSPERO (CRD42022303150). RESULTS Twenty treatments were included in 25 studies with low or moderate risk of bias. The certainty of evidence was very low for all treatments except for acupressure in addition to standard care, which showed a possible moderate decrease in nausea and vomiting, with low certainty of evidence. CONCLUSIONS Several scientific knowledge gaps were identified. Studies on treatments for hyperemesis gravidarum are few, and the certainty of evidence for different treatments is either low or very low. To establish more robust evidence, it is essential to use validated scoring systems, the recently established diagnostic criteria, clear descriptions and measurements of core outcomes and to perform larger studies.
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Affiliation(s)
| | - Maria Forslund
- Department of Obstetrics and GynecologyInstitute of Clinical Sciences, Sahlgrenska Akademin, University of GothenburgGothenburgSweden
| | - Ing‐Marie Claesson
- Department of Obstetrics and Gynecology, and Department of Clinical and Experimental MedicineLinköping UniversityLinköpingSweden
| | - Annicka Hedman
- Swedish Agency for Health Technology Assessment and Assessment of Social ServicesStockholmSweden
| | - Nathalie Peira
- Swedish Agency for Health Technology Assessment and Assessment of Social ServicesStockholmSweden
| | - Hanna Olofsson
- Swedish Agency for Health Technology Assessment and Assessment of Social ServicesStockholmSweden
| | - Emma Wernersson
- Swedish Agency for Health Technology Assessment and Assessment of Social ServicesStockholmSweden
| | - Hanna Ulfsdottir
- Division of Reproductive Health, Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
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Beck CT. Survivors' Experiences of Hyperemesis Gravidarum. JOURNAL OF INFUSION NURSING 2023; 46:338-346. [PMID: 37920107 DOI: 10.1097/nan.0000000000000520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Hyperemesis gravidarum can result in life-threatening physical and psychological maternal morbidity, including severe dehydration, weight loss, electrolyte imbalance, depression, and suicidal ideation. The reported prevalence of hyperemesis gravidarum ranges from 0.3% to 3.6%. The purpose of this qualitative study was to investigate what blogs can tell us about women's experiences of hyperemesis gravidarum. Thirty-three blogs written by hyperemesis gravidarum survivors posted on Hyperemesis Australia's website were analyzed using Krippendorff's qualitative content analysis method. Clustering was used and yielded 6 themes: (1) debilitating physical and mental health problems: digging deep to persevere, (2) heartbreaking choices, (3) lack of understanding and dismissed, (4) so much guilt surrounding their unborn infant, (5) it takes a village to support women with hyperemesis gravidarum, and (6) warriors and survivors: giving back. Infusion nurses are in a perfect position to provide support and compassionate care for women who are repeatedly coming to the hospital for rehydration treatment. Infusion nurses can validate women's physical and emotional struggles with hyperemesis gravidarum and help to no longer make women feel stigmatized.
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Affiliation(s)
- Cheryl Tatano Beck
- School of Nursing, University of Connecticut, 231 Glenbrook Rd, Storrs, CT
- Cheryl Tatano Beck, DNSc, CNM, FAAN, is a Distinguished Professor at the University of Connecticut School of Nursing. She also holds a joint appointment in the School of Medicine Department of Obstetrics and Gynecology. She is a fellow in the American Academy of Nursing and inducted into the Sigma Theta Tau International Nurse Researcher Hall of Fame. For over 35 years, her program of research has focused on postpartum depression and posttraumatic stress disorder due to traumatic childbirth. She developed the Postpartum Depression Screening Scale from her series of qualitative studies
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Jayawardena R, Majeed S, Sooriyaarachchi P, Abeywarne U, Ranaweera P. The effects of pyridoxine (vitamin B6) supplementation in nausea and vomiting during pregnancy: a systematic review and meta-analysis. Arch Gynecol Obstet 2023; 308:1075-1084. [PMID: 36719452 DOI: 10.1007/s00404-023-06925-w] [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] [Received: 05/26/2022] [Accepted: 01/10/2023] [Indexed: 02/01/2023]
Abstract
PURPOSE Nausea and vomiting during pregnancy (NVP) are common symptoms in pregnancy. Although no definitive treatment option for NVP, pyridoxine (Vitamin B6) supplementation has been used widely. The present study aims to systematically evaluate the current evidence regarding pyridoxine for the treatment of NVP. METHODS Data were obtained using a stepwise search process using keywords in the following online medical databases; PubMed®, Web of Science®, and Scopus® for studies published before 1st May 2021. Studies reporting intervention with pyridoxine supplementation alone and/or with other active substances were included. A meta-analysis was performed on the PUQE score and Rhode's score for nausea and vomiting. FINDINGS Initial database searching indicated 548 potentially eligible articles, of which 18 studies satisfying the inclusion criteria were selected. Eight studies showed beneficial effects with pyridoxine alone as the supplementation, while six others found that the supplementation of pyridoxine in combination with another active substance had favourable effects. Supplementation of pyridoxine alone as well as combined treatment of pyridoxine with an active ingredient as the intervention significantly improved the symptoms of nausea according to Rhode's score [0.78 [95% CI: 0.26, 1.31; p = 0.003; I2 = 57%, p = 0.10)] and PUQE score [0.75 (95% CI: 0.28, 1.22; p = 0.002; I2 = 0%, p = 0.51)], respectively. CONCLUSION Supplementation of pyridoxine alone as well as with an active ingredient demonstrated beneficial effects for women suffering from NVP.
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Affiliation(s)
- Ranil Jayawardena
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Shahana Majeed
- Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Piumika Sooriyaarachchi
- Faculty of Health, School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.
| | - Udara Abeywarne
- Medical Nutrition Unit, De Soyza Maternity Hospital for Women, Colombo, Sri Lanka
| | - Probhodana Ranaweera
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Tan PC, Ramasandran G, Sethi N, Razali N, Hamdan M, Kamarudin M. Watermelon and dietary advice compared to dietary advice alone following hospitalization for hyperemesis gravidarum: a randomized controlled trial. BMC Pregnancy Childbirth 2023; 23:450. [PMID: 37330467 DOI: 10.1186/s12884-023-05771-7] [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: 11/05/2022] [Accepted: 06/09/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Hyperemesis gravidarum (HG) affects about 2% of pregnancies and is at the severe end of the spectrum of nausea and vomiting of pregnancy. HG causes severe maternal distress and results in adverse pregnancy outcomes long after the condition may have dissipated. Although dietary advice is a common tool in management, trial evidence to base the advice on is lacking. METHODS A randomized trial was conducted in a university hospital from May 2019 to December 2020. 128 women at their discharge following hospitalization for HG were randomized: 64 to watermelon and 64 to control arm. Women were randomized to consume watermelon and to heed the advice leaflet or to heed the dietary advice leaflet alone. A personal weighing scale and a weighing protocol were provided to all participants to take home. Primary outcomes were bodyweight change at the end of week 1 and week 2 compared to hospital discharge. RESULTS Weight change (kg) at end of week 1, median[interquartile range] -0.05[-0.775 to + 0.50] vs. -0.5[-1.4 to + 0.1] P = 0.014 and to the end of week 2, + 0.25[-0.65 to + 0.975] vs. -0.5[-1.3 to + 0.2] P = 0.001 for watermelon and control arms respectively. After two weeks, HG symptoms assessed by PUQE-24 (Pregnancy-Unique Quantification of Emesis and Nausea over 24 h), appetite assessed by SNAQ (Simplified Nutritional Appetite Questionnaire), wellbeing and satisfaction with allocated intervention NRS (0-10 numerical rating scale) scores, and recommendation of allocated intervention to a friend rate were all significantly better in the watermelon arm. However, rehospitalization for HG and antiemetic usage were not significantly different. CONCLUSION Adding watermelon to the diet after hospital discharge for HG improves bodyweight, HG symptoms, appetite, wellbeing and satisfaction. TRIAL REGISTRATION This study was registered with the center's Medical Ethics Committee (on 21/05/2019; reference number 2019327-7262) and the ISRCTN on 24/05/2019 with trial identification number: ISRCTN96125404 . First participant was recruited on 31/05/ 2019.
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Affiliation(s)
- Peng Chiong Tan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Malaya, Jalan Profesor Diraja Ungku Aziz, 50603, Kuala Lumpur, Malaysia
| | - Gayaithiri Ramasandran
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Malaya, Jalan Profesor Diraja Ungku Aziz, 50603, Kuala Lumpur, Malaysia
| | - Neha Sethi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Malaya, Jalan Profesor Diraja Ungku Aziz, 50603, Kuala Lumpur, Malaysia
| | - Nuguelis Razali
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Malaya, Jalan Profesor Diraja Ungku Aziz, 50603, Kuala Lumpur, Malaysia
| | - Mukhri Hamdan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Malaya, Jalan Profesor Diraja Ungku Aziz, 50603, Kuala Lumpur, Malaysia
| | - Maherah Kamarudin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Malaya, Jalan Profesor Diraja Ungku Aziz, 50603, Kuala Lumpur, Malaysia.
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Preszler JA, McInnis KC, Baute L, Tanaka MJ. Rehabilitation of anterior knee pain in the pregnant athlete: Considerations and modifications by trimester. Phys Ther Sport 2023; 60:34-46. [PMID: 36641951 DOI: 10.1016/j.ptsp.2023.01.001] [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: 09/16/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
BACKGROUND Anterior knee pain is a common symptom many females experience during pregnancy. There are several musculoskeletal changes that occur in anatomy and physiology throughout the course of pregnancy that impact the lower extremity kinetic chain. Pregnant athletes, recreational through competitive, who attempt to maintain a high activity level through each trimester may be at increased risk for anterior knee pain due to a greater demand for lumbopelvic and hip stabilization. CLINICAL QUESTION What are the evidence-driven rehabilitation guidelines and specific modifications needed to treat anterior knee pain in the female athlete during each trimester of pregnancy? KEY RESULTS We aim to provide an overview of rehabilitation treatment guidelines for pregnant females with anterior knee pain, presenting specific physiological changes and rationale for modifications, discussed by trimester. We recommend our program be conducted under the supervision of a physical therapist working closely with the athlete's obstetrics and sports medicine team. CLINICAL APPLICATION The number of women who are active during pregnancy is increasing. We provide an overview of the guidelines and considerations for treating women with anterior knee pain during a healthy and uneventful pregnancy.
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Affiliation(s)
- Jamie A Preszler
- Department of Sports Physical Therapy, Massachusetts General Hospital, Boston, MA, USA.
| | - Kelly C McInnis
- Division of Sports Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa Baute
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Miho J Tanaka
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Moretti C, Lazzarin N, Vaquero E, Dal Lago A, Campagnolo L, Valensise H. A practical approach to the management of thyroid dysfunction during pregnancy. Gynecol Endocrinol 2022; 38:1028-1034. [PMID: 36480916 DOI: 10.1080/09513590.2022.2154337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Pregnancy has an important impact on the thyroid gland and its function. Thyroid activity changes as a consequence of the novel physiological state of pregnancy and requires a complex hormonal and metabolic adaptation, which is possible only in the presence of a perfectly functioning thyroid gland. In fact, thyroid function is crucial for the success of the implantation and the progression of pregnancy. Abnormal thyroid function is very common among childbearing age women, explaining the high incidence of thyroid diseases that occur during pregnancy. Aim of this work is to analyze the adaptive events that characterize the thyroid function during pregnancy, exploring their hormonal, metabolic and molecular mechanisms. Moreover, the interpretation of the laboratory data necessary to monitor the thyroid functioning during normal pregnancy or in the presence of thyroid abnormalities will be discussed.
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Affiliation(s)
- Costanzo Moretti
- Department of Systems' Medicine, University of Rome TorVergata, Rome, Italy
| | - Natalia Lazzarin
- Department of Obstetrics and Gynecology, Policlinico Casilino Hospital, Rome, Italy
| | - Elena Vaquero
- Department of Biomedicine and Prevention of Rome TorVergata, Rome, Italy
| | - Alessandro Dal Lago
- Department of Gender Parenting Child and Adolescent Medicine Physiopathology of Reproduction and Andrology Unit, Sandro Pertini Hospital, Rome, Italy
| | - Luisa Campagnolo
- Department of Biomedicine and Prevention, University of Rome TorVergata, Rome, Italy
| | - Herbert Valensise
- Department of Obstetrics and Gynecology, Policlinico Casilino Hospital, Rome, Italy
- Department of Surgery, University of Rome Tor Vergata, Rome, Italy
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Dean CR, Nijsten K, Spijker R, O'Hara M, Roseboom TJ, Painter RC. Systematic evidence map of evidence addressing the top 10 priority research questions for hyperemesis gravidarum. BMJ Open 2022; 12:e052687. [PMID: 36691124 PMCID: PMC9454001 DOI: 10.1136/bmjopen-2021-052687] [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] [Received: 04/22/2021] [Accepted: 06/20/2022] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Knowledge gaps regarding hyperemesis gravidarum (HG) are substantial. We aimed to systematically identify and map recent evidence addressing the top 10 priority questions for HG, as published in 2021 in a James Lind Alliance Priority Setting Partnership. DESIGN Systematic evidence map. METHODS We searched MEDLINE and EMBASE on 12 January 2021 and CINAHL on 22 February 2021 with search terms hyperemesis gravidarum, pernicious vomiting in pregnancy and their synonyms. Results were limited to 2009 onwards. Two reviewers independently screened titles and abstracts to assess whether the studies addressed a top 10 priority questions for HG. Differences were discussed until consensus was reached. Publications were allocated to one or more top 10 research questions. Study design was noted, as was patient or public involvement. Two reviewers extracted data synchronously and both cross-checked 10%. Extracted data were imported into EPPI-Reviewer software to create an evidence map. OUTCOME MEASURES The number and design of studies in the search yield, displayed per the published 10 priority questions. RESULTS Searches returned 4338 results for screening; 406 publications were included in the evidence map. 136 publications addressed multiple questions. Numerous studies address the immediate and long-term outcomes or possible markers for HG (question 8 and 9, respectively 164 and 82 studies). Very few studies seek a possible cure for HG (question 1, 8 studies), preventative treatment (question 4, 2 studies) or how to achieve nutritional requirements of pregnancy (question 10, 17 studies). Case reports/series were most numerous with 125 (30.7%) included. Few qualitative studies (9, 2.2%) were identified. 25 (6.1%) systematic reviews addressed eight questions, or aspects of them. 31 (7.6%) studies included patient involvement. CONCLUSIONS There are significant gaps and overlap in the current HG literature addressing priority questions. Researchers and funders should direct their efforts at addressing the gaps in the top 10 questions.
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Affiliation(s)
- Caitlin Rosa Dean
- Obstetrics and Gynaecology, Amsterdam UMC Location AMC, Amsterdam, Netherlands
- Pregnancy Sickness Support, 19G Normandy Way, Bodmin, UK
| | - Kelly Nijsten
- Obstetrics and Gynaecology, Amsterdam UMC Location AMC, Amsterdam, Netherlands
| | - René Spijker
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
| | | | - Tessa J Roseboom
- Obstetrics and Gynaecology, Amsterdam UMC Location AMC, Amsterdam, Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
| | - Rebecca C Painter
- Obstetrics and Gynaecology, Amsterdam UMC Location AMC, Amsterdam, Netherlands
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Mohd Nafiah NA, Chieng WK, Zainuddin AA, Chew KT, Kalok A, Abu MA, Ng BK, Mohamed Ismail NA, Nur Azurah AG. Effect of Acupressure at P6 on Nausea and Vomiting in Women with Hyperemesis Gravidarum: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10886. [PMID: 36078602 PMCID: PMC9518577 DOI: 10.3390/ijerph191710886] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
Hyperemesis gravidarum is characterized by severe nausea and vomiting. This study aims to illustrate the efficacy of acupressure at P6 in treating nausea and vomiting in hyperemesis gravidarum. This parallel randomized controlled trial was conducted from 2016-2017 in a tertiary hospital. Hospitalized women with ≤16 weeks of gestation and moderate to severe nausea and vomiting classified using a modified PUQE score were randomly assigned in a 1:1 ratio to either apply an acupressure wristband at the P6 point three times daily or to receive regular doses of intravenous antiemetics. The primary outcome was differences in modified PUQE scores among the groups. The secondary outcomes were differences in the rate of urine ketone clearance and the frequency of requiring rescue antiemetics. Ninety women were equally randomized into two groups, with no dropout. There was a statistically significant difference in the degrees of nausea and vomiting between the groups at 8, 16, and 24 hours post-admission (p8hours= 0.001, p16hours = 0.006, and p24hours = 0.001). The requirement of antiemetics and the rate of urine ketone clearance between the two groups were also statistically significant, at p = 0.001 and p = 0.02 respectively. There were no side effects in either group. The P6 acupressure was efficacious in alleviating nausea and vomiting among hyperemesis gravidarum women. The trial was retrospectively registered on ClinicalTrials.gov (NCT05175079).
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Albazee E, Almahmoud L, Al-Rshoud F, Sallam D, Albzea W, Alenezi R, Baradwan S, Abu-Zaid A. Ondansetron versus metoclopramide for managing hyperemesis gravidarum: A systematic review and meta-analysis of randomized controlled trials. Turk J Obstet Gynecol 2022; 19:162-169. [PMID: 35770443 PMCID: PMC9249360 DOI: 10.4274/tjod.galenos.2022.14367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
This investigation examined the efficacy of ondansetron (intervention) versus metoclopramide (control) in managing parturient females with hyperemesis gravidarum (HG), by pooling data from randomized controlled trials (RCTs) using a meta-analysis approach. From inception until January 2022, five information sources were screened: Cochrane Central Register of Controlled Trials, Google Scholar, Scopus, PubMed and Web of Science. Quality assessment was done through the Cochrane Risk of Bias (version 2) assessment tool. The mean difference (MD) with 95% confidence interval (CI) was used to summarize the continuous data in a fixed- or random-effects model, depending on the extent of between-study heterogeneity. Five RCTs were included, comprising a total of 695 patients (355 and 340 females were assigned to ondansetron and metoclopramide, respectively). Four RCTs had an overall “low” risk of bias, whereas one RCT had an overall “some concerns” due to lack of sufficient information about randomization. There was no significant difference between both groups regarding the pregnancy-unique quantification of emesis and nausea score [MD=0.23, 95% CI (-0.42, 0.88), p=0.49], length of hospital stay [MD=-0.17 days, 95% CI (-0.35, 0.02), p=0.08], the number of doses of drug received [MD=0.45, 95% CI (-0.08, 0.98), p=0.10], and duration of intravenous fluids [MD=-1.73 hours, 95% CI (-5.79, 2.33), p=0.40]. Among parturient females with HG, there was no substantial difference in efficacy between both agents. Nevertheless, ondansetron is favored over metoclopramide in view of its trending therapeutic efficacy and better safety profile.
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15
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Timur B, Guney G. The role of serum ADAMTS-1 levels in Hyperemesis Gravidarum. BMC Pregnancy Childbirth 2022; 22:499. [PMID: 35725415 PMCID: PMC9208199 DOI: 10.1186/s12884-022-04832-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background We aimed to investigate the levels of ADAMTS-1, which is secreted from the extracellular matrix during trophoblastic invasion in hyperemesis gravidarum (HEG). Methods In this cross-sectional study, we compared 45 HEG patients aged between 21 and 34 in terms of ADAMTS-1 levels with a control group consisting of 44 healthy pregnant women. The demographic characteristics and several laboratory parameters of the patients were recorded. Both groups were also compared in terms of ketonuria. We evaluated the correlation between ADAMTS-1 levels and ketonuria. Results The 2 groups were matched in terms of age, gestational age, gravidity, parity, and body mass index. Some inflammatory markers, such as neutrophil count, MPV, PDW, and PCT levels, were significantly higher in the HEG groups compared to the control group (all p < 0.05). However, mean MCV and serum TSH levels were statistically significantly lower in this group (both p < 0.001). ADAMTS-1 levels were 12.6 ± 1.4 ng/ml in the HEG group and 6.2 ± 1.6 ng/ml in the control group (p < 0.001). It was significantly and positively correlated with urine ketone, neutrophil count, and PDW, whereas negatively correlated with MCV and TSH value in the HEG group. ROC analysis showed that a threshold value of 11.275 ng/ml for ADAMTS-1 predicted HEG patients with a sensitivity of 60% and specificity of 95.5%. Conclusion ADAMTS-1 serum levels are increased in HEG patients, and there is a positive correlation between ADAMTS-1 levels and ketonuria.
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Affiliation(s)
- Burcu Timur
- Department of Obstetrics and Gynecology, Ordu University Training and Research Hospital, Bucak District, Nefsi Bucak Street, Ordu, 52200, Turkey.
| | - Gurhan Guney
- Department of Obstetrics and Gynecology, Balikesir University Medical Faculty, Balıkesir, Turkey
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16
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Şafak Öztürk C, Kaya Odabaş R, Sökmen Y, Taşpinar A. The Relationship between Nausea-Vomiting during Pregnancy and Attachment Styles, Marital Adjustment, and Ways of Coping. JOURNAL OF SEX & MARITAL THERAPY 2022; 49:65-76. [PMID: 35531669 DOI: 10.1080/0092623x.2022.2073302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The objective of this study is to examine the relationship between nausea and vomiting during pregnancy (NVP) and attachment styles in close relationships, marital adjustment, and ways of coping with stress. This study was performed in 2019 as an analytic case-control design. The study group consists of 60 pregnant women hospitalized with a nausea-vomiting/hyperemesis gravidarum diagnosis. The control group is composed of 64 pregnant women who applied for gynecology polyclinic for routine control. The participants were applied Pregnancy-Information Form, Experiences in Close Relationships Scale-Revised (ECR-R), Marital Adjustment Test (MAT), and Coping Styles Inventory (CSI). It was observed that the scores of the pregnant women in the study group from the helpless approach subscale of CSI were significantly higher than the control group and no significant difference was found between the two groups in terms of other scale scores. A negative correlation was found between the perceived severity of nausea and the seeking social support subscale of CSI in the study group. The study revealed findings that support the biopsychosocial approach to the etiology of NVP and showed that the women with NVP use a helpless approach in coping with stress and apply seeking social support as the severity of nausea decreases.
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Affiliation(s)
- Cennet Şafak Öztürk
- Department of Psychology, Faculty of Arts and Sciences, Aydın Adnan Menderes University, Aydın, Turkey
| | - Resmiye Kaya Odabaş
- Department of Midwifery, Faculty of Health Sciences, Kocaeli University, Kocaeli, Turkey
| | - Yasemin Sökmen
- Department of Midwifery, Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Turkey
| | - Ayten Taşpinar
- Department of Midwifery, Faculty of Health Sciences, Aydın Adnan Menderes University, Aydın, Turkey
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17
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First OK, MacGibbon KW, Cahill CM, Cooper ZD, Gelberg L, Cortessis VK, Mullin PM, Fejzo MS. Patterns of Use and Self-reported Effectiveness of Cannabis for Hyperemesis Gravidarum. Geburtshilfe Frauenheilkd 2022; 82:517-527. [PMID: 35528189 PMCID: PMC9076215 DOI: 10.1055/a-1749-5391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 01/22/2022] [Indexed: 11/01/2022] Open
Abstract
Abstract
Introduction There is limited research on effective treatment of Hyperemesis Gravidarum (HG), the most extreme version of nausea and vomiting during pregnancy (NVP). This paper
examines current patterns of use and self-reported effectiveness of cannabis/cannabis-based products (CBP) to treat HG.
Materials/Methods The study employed a 21-question survey to gather information on demographics, antiemetic prescription use, and experience with cannabis/CBPs among individuals who
experienced extreme nausea and vomiting or HG during their pregnancy. Age-adjusted unconditional logistic regression was used to compare odds of symptom relief and weight gain between
respondents who used prescription antiemetics and those who used cannabis.
Results Of the 550 survey respondents, 84% experienced weight loss during pregnancy; 96% reported using prescription antiemetics and 14% reported cannabis use for HG. Most
respondents reported using cannabis/CBPs (71%) because their prescribed antiemetics were self-reported to be ineffective. More than half of cannabis/CBP users reported using products daily
or multiple times per day (53%), primarily via smoke inhalation (59%), and mainly either delta-9-tetrahydrocannabinol (THC) only or THC dominant preparations (57%). Eighty-two percent of
cannabis/CBP users reported symptom relief, compared to 60% of prescription antiemetic users. Among patients who reported weight loss during pregnancy, 56% of cannabis users reported gaining
weight within two weeks of treatment, compared to 25% of prescription antiemetic users.
Conclusions Respondents reported using cannabis primarily because prescribed medications were self-reported to be ineffective. Although the survey approach has inherent limitations
so results should be interpreted with caution, in this sample, cannabis was self-reported to be more effective than prescription medications in alleviating HG symptoms and enabling pregnancy
weight gain. Therefore, depending on the safety profiles, randomized, double-blinded, placebo-controlled trials of cannabis compared to other antiemetics are warranted to determine whether
cannabinoids may provide an effective alternative treatment for HG.
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Affiliation(s)
- Olivia K. First
- Hyperemesis Education and Research Foundation, Clackamas, OR, USA
| | | | - Catherine M. Cahill
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Ziva D. Cooper
- UCLA Cannabis Research Initiative, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Lillian Gelberg
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | | | - Patrick M. Mullin
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Marlena S. Fejzo
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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18
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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.
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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
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19
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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.
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Affiliation(s)
| | - Yooyun Chung
- Institute of Liver Studies, King's College Hospital, London, UK
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20
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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.
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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
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21
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Liu C, Zhao G, Qiao D, Wang L, He Y, Zhao M, Fan Y, Jiang E. Emerging Progress in Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum: Challenges and Opportunities. Front Med (Lausanne) 2022; 8:809270. [PMID: 35083256 PMCID: PMC8785858 DOI: 10.3389/fmed.2021.809270] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/17/2021] [Indexed: 12/16/2022] Open
Abstract
Nausea and vomiting of pregnancy (NVP) is a common condition that affects up to 70% of pregnant women. Hyperemesis gravidarum (HG) is considered the serious form of NVP, which is reported in 0.3–10.8% of pregnant women. NVP has a relatively benign course, but HG can be linked with some poor maternal, fetal, and offspring outcomes. The exact causes of NVP and HG are unknown, but various factors have been hypothesized to be associated with pathogenesis. With the advance of precision medicine and molecular biology, some genetic factors such as growth/differentiation factor 15 (GDF15) have become therapeutic targets. In our review, we summarize the historical hypotheses of the pathogenesis of NVP and HG including hormonal factors, Helicobacter pylori, gastrointestinal dysmotility, placenta-related factors, psychosocial factors, and new factors identified by genetics. We also highlight some approaches to the management of NVP and HG, including pharmacological treatment, complementary treatment, and some supporting treatments. Looking to the future, progress in understanding NVP and HG may reduce the adverse outcomes and improve the maternal quality of life during pregnancy.
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Affiliation(s)
- Chuan Liu
- School of Medicine, Henan University, Kaifeng, China
| | - Guo Zhao
- School of Medicine, Henan University, Kaifeng, China
| | - Danni Qiao
- School of Medicine, Henan University, Kaifeng, China
| | - Lintao Wang
- Department of Neurology, The First Affiliated Hospital of Henan University, Kaifeng, China
| | - Yeling He
- School of Medicine, Henan University, Kaifeng, China
| | - Mingge Zhao
- School of Life Sciences, Henan University, Kaifeng, China
| | - Yuanyuan Fan
- School of Life Sciences, Henan University, Kaifeng, China
| | - Enshe Jiang
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, China.,Henan International Joint Laboratory for Nuclear Protein Regulation, Henan University, Kaifeng, China
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22
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Sundaram S, Giri S. Liver Diseases in the Parturient. Indian J Crit Care Med 2022; 25:S248-S254. [PMID: 35615617 PMCID: PMC9108777 DOI: 10.5005/jp-journals-10071-24027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
- Sridhar Sundaram, Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India, Phone: +91 9860096846, e-mail:
| | - Suprabhat Giri
- Department of Gastroenterology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
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23
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Hyperemesis gravidarum in the primary care setting: cross-sectional study of GPs. BJGP Open 2021; 6:BJGPO.2021.0119. [PMID: 34620600 PMCID: PMC8958745 DOI: 10.3399/bjgpo.2021.0119] [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: 07/03/2021] [Accepted: 09/02/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Hyperemesis gravidarum (HG), if untreated, can lead to malnutrition, dehydration, and Wernicke's encephalopathy. Foetal complications include low birth weight and neurodevelopmental delay. Recent evidence supports increased rates of termination of pregnancy and suicidal ideation. Drivers included difficulty in accessing medications, which thus contributed to poor perception of care. AIM To identify factors that may influence prescribers' confidence and knowledge regarding pharmacological therapy for HG. DESIGN & SETTING Cross-sectional study of qualified GPs and GP trainees in Wales. METHOD Distribution of a 22-item online survey. Statistical analysis was carried out using SPSS. RESULTS In total, 241 responses were received, with 216 included in the analysis (59% qualified GPs, 41% GP trainees). In total, 93% of responders correctly identified cyclizine as being safe in pregnancy, but no other drug recommended in the Royal College of Obstetrics and Gynaecology guidance was considered safe by more than 58%. Those reporting higher confidence levels in managing HG were more likely to correctly report guideline-recommended drugs as safe in pregnancy (P = 0.04). Additional qualifications related to obstetrics and gynaecology (O&G) and/or prior clinical experience increased confidence levels (P = 0.0001 and P = 0.0002, respectively). Only 19% of participants routinely screened for signs of mental health complications, and prior experience or education did not increase likelihood of this happening. The majority of participants (87%) would like additional education and/or access to evidence-based resources. CONCLUSION This study demonstrates a demand for improved dissemination of evidence-based education on HG to support those working in primary care. The extent to which HG is covered in pre-existing educational programmes should also be revisited.
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Jansen LAW, Koot MH, Van't Hooft J, Dean CR, Bossuyt PMM, Ganzevoort W, Gauw N, Van der Goes BY, Rodenburg J, Roseboom TJ, Painter RC, Grooten IJ. The windsor definition for hyperemesis gravidarum: A multistakeholder international consensus definition. Eur J Obstet Gynecol Reprod Biol 2021; 266:15-22. [PMID: 34555550 DOI: 10.1016/j.ejogrb.2021.09.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/30/2021] [Accepted: 09/07/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To develop an international definition for hyperemesis gravidarum to assist in clinical diagnosis and harmonize hyperemesis gravidarum definition for study populations. STUDY DESIGN A mixed-methods approach was used to identify potential hyperemesis gravidarum definition criteria (i.e. systematic review, semi-structured interviews and closed group sessions with patients and Project Steering Committee input). To reach consensus on the definition we used a web-based Delphi survey with two rounds, followed by a face-to-face consensus development meeting, held in Windsor UK, and a web-based consultation round, in which the provisional hyperemesis gravidarum definition was fed back to the stakeholders. Four stakeholder groups were identified 1) researchers; 2) women with lived experience of hyperemesis gravidarum and their families; 3) obstetric health professionals (obstetricians, gynecologists, midwives); and 4) other health professionals involved in care for women with hyperemesis gravidarum (general practitioners, dieticians, nurses). To reflect the opinions of the international community, stakeholders from countries in all global regions were invited to participate. RESULTS Twenty-one identified potential criteria entered the Delphi survey. Of the 277 stakeholders invited, 178 completed round one, and 125 (70%) also completed round two. Twenty stakeholders attended the consensus development meeting, representing all stakeholder groups. The consultation round was completed by 96 (54%) stakeholders, of which 92% agreed with the definition as presented. The consensus definition for hyperemesis gravidarum consisted of: start of symptoms in early pregnancy (before 16 weeks gestational age); nausea and vomiting, at least one of which severe; inability to eat and/or drink normally; strongly limits daily living activities. Signs of dehydration were deemed contributory for the definition for hyperemesis gravidarum. CONCLUSIONS The proposed definition for hyperemesis gravidarum will help clinical studies to achieve more uniformity, and ultimately increasing the value of evidence to inform patient care.
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Affiliation(s)
- L A W Jansen
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development, the Netherlands; Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, the Netherlands.
| | - M H Koot
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development, the Netherlands
| | - J Van't Hooft
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development, the Netherlands
| | - C R Dean
- Pregnancy Sickness Support, United Kingdom
| | - P M M Bossuyt
- Department of Epidemiology and Data Science, Amsterdam UMC, the Netherlands
| | - W Ganzevoort
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development, the Netherlands
| | - N Gauw
- Dutch Hyperemesis Gravidarum Patient Foundation (ZEHG), the Netherlands
| | - B Y Van der Goes
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands
| | - J Rodenburg
- General Practice Czaar Peter Medical Center, Amsterdam, the Netherlands
| | - T J Roseboom
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development, the Netherlands; Department of Epidemiology and Data Science, Amsterdam UMC, the Netherlands
| | - R C Painter
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development, the Netherlands
| | - I J Grooten
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development, the Netherlands
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George B, Wen X, Jaimes EA, Joy MS, Aleksunes LM. In Vitro Inhibition of Renal OCT2 and MATE1 Secretion by Antiemetic Drugs. Int J Mol Sci 2021; 22:ijms22126439. [PMID: 34208557 PMCID: PMC8234231 DOI: 10.3390/ijms22126439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 01/01/2023] Open
Abstract
The organic cation transporter 2 (OCT2) and multidrug and toxin extrusion protein 1 (MATE1) mediate the renal secretion of drugs. Recent studies suggest that ondansetron, a 5-HT3 antagonist drug used to prevent nausea and vomiting, can inhibit OCT2- and MATE1-mediated transport. The purpose of this study was to test the ability of five 5-HT3 antagonist drugs to inhibit the OCT2 and MATE1 transporters. The transport of the OCT2/MATE1 probe substrate ASP+ was assessed using two models: (1) HEK293 kidney cells overexpressing human OCT2 or MATE1, and (2) MDCK cells transfected with human OCT2 and MATE1. In HEK293 cells, the inhibition of ASP+ uptake by OCT2 listed in order of potency was palonosetron (IC50: 2.6 μM) > ondansetron > granisetron > tropisetron > dolasetron (IC50: 85.4 μM) and the inhibition of ASP+ uptake by MATE1 in order of potency was ondansetron (IC50: 0.1 μM) > palonosetron = tropisetron > granisetron > dolasetron (IC50: 27.4 μM). Ondansetron (0.5–20 μM) inhibited the basolateral-to-apical transcellular transport of ASP+ up to 64%. Higher concentrations (10 and 20 μM) of palonosetron, tropisetron, and dolasetron similarly reduced the transcellular transport of ASP+. In double-transfected OCT2-MATE1 MDCK cells, ondansetron at concentrations of 0.5 and 2.5 μM caused significant intracellular accumulation of ASP+. Taken together, these data suggest that 5-HT3 antagonist drugs may inhibit the renal secretion of cationic drugs by interfering with OCT2 and/or MATE1 function.
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Affiliation(s)
- Blessy George
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, 170 Frelinghuysen Road, Piscataway, NJ 08854, USA; (B.G.); (X.W.)
| | - Xia Wen
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, 170 Frelinghuysen Road, Piscataway, NJ 08854, USA; (B.G.); (X.W.)
| | - Edgar A. Jaimes
- Renal Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Melanie S. Joy
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO 80045, USA;
- Cancer Center, University of Colorado, Aurora, CO 80045, USA
- Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Lauren M. Aleksunes
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, 170 Frelinghuysen Road, Piscataway, NJ 08854, USA; (B.G.); (X.W.)
- Environmental and Occupational Health Sciences Institute, Piscataway, NJ 08854, USA
- Correspondence: ; Tel.: +1-848-445-5518; Fax: +1-732-445-0119
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26
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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.
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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
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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.
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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
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28
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Nurses' Clinical Work Experience during Pregnancy. Healthcare (Basel) 2020; 9:healthcare9010016. [PMID: 33374472 PMCID: PMC7823590 DOI: 10.3390/healthcare9010016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 12/28/2022] Open
Abstract
The working environment of nurses contains numerous hazards that can be particularly harmful to pregnant women. In addition, pregnancy-induced changes can themselves cause discomfort. Therefore, it is necessary to analyze pregnant nurses' experiences of clinical work. This qualitative study analyzed data collected through in-depth interviews. From January to June in 2020, 12 shift-work nurses who had experienced pregnancy within three years were interviewed. The main question was "Could you describe your clinical work experience during pregnancy?" Qualitative data from field notes and transcriptions of the interviews were analyzed using Colaizzi's method. Six categories were extracted that described the nurses' clinical work experience during pregnancy, as follows: "enduring alone," "organizational characteristics of nursing," "risky work environment," "strengths that sustain work during pregnancy," "growth as a nurse," and "methods to protect pregnant nurses." Pregnant nurses experienced various difficulties due to physical and mental changes during pregnancy, and the clinical working environment did not provide them with adequate support. The findings of this study will be helpful for developing and implementing practical maternity protection policies and work guidelines.
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29
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Guttuso T, Messing S, Tu X, Mullin P, Shepherd R, Strittmatter C, Saha S, Thornburg LL. Effect of gabapentin on hyperemesis gravidarum: a double-blind, randomized controlled trial. Am J Obstet Gynecol MFM 2020; 3:100273. [PMID: 33451591 DOI: 10.1016/j.ajogmf.2020.100273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hyperemesis gravidarum is a disabling disease of nausea, vomiting, and undernutrition in early pregnancy for which there are no effective outpatient therapies. Poor weight gain in hyperemesis gravidarum is associated with several adverse fetal outcomes including preterm delivery, low birthweight, small for gestational age, low 5-minute Apgar scores, and neurodevelopmental delay. Gabapentin is most commonly used clinically for treating neuropathic pain but also substantially reduces chemotherapy-induced and postoperative nausea and vomiting. Pregnancy registry data have shown maternal first-trimester gabapentin monotherapy to be associated with a 1.2% rate of major congenital malformations among 659 infants, which compares favorably with the 1.6% to 2.2% major congenital malformation rate in the general population. Open-label gabapentin treatment in hyperemesis gravidarum was associated with reduced nausea and vomiting and improved oral nutrition. OBJECTIVE This study aimed to determine whether gabapentin is more effective than standard-of-care therapy for treating hyperemesis gravidarum. STUDY DESIGN A double-blind, randomized, multicenter trial was conducted among patients with medically refractory hyperemesis gravidarum requiring intravenous hydration. Patients were randomized (1:1) to either oral gabapentin (1800-2400 mg/d) or an active comparator of either oral ondansetron (24-32 mg/d) or oral metoclopramide (45-60 mg/d) for 7 days. Differences in Motherisk-pregnancy-unique quantification of nausea and emesis total scores between treatment groups averaged over days 5 to 7, using intention-to-treat principle employing a linear mixed-effects model adjusted for baseline Motherisk-pregnancy-unique quantification of nausea and emesis scores, which served as the primary endpoint. Secondary outcomes included Motherisk-pregnancy-unique quantification of nausea and emesis nausea and vomit and retch subscores, oral nutrition, global satisfaction of treatment, relief, desire to continue therapy, Nausea and Vomiting of Pregnancy Quality of Life, and Hyperemesis Gravidarum Pregnancy Termination Consideration. Adjustments for multiple comparisons were made employing the false discovery rate. RESULTS A total of 31 patients with hyperemesis gravidarum were enrolled from October 2014 to May 2019. Among the 21 patients providing primary outcome data (12 assigned to gabapentin and 9 to the active comparator arm), 18 were enrolled as outpatients and all 21 were outpatients from days 5 to 7. The study groups' baseline characteristics were well matched. Gabapentin treatment provided a 52% greater reduction in days 5 to 7 baseline adjusted Motherisk-pregnancy-unique quantification of nausea and emesis total scores than treatment with active comparator (95% confidence interval, 16-88; P=.01). Most secondary outcomes also favored gabapentin over active comparator treatment including 46% and 49% decreases in baseline adjusted Motherisk-pregnancy-unique quantification of nausea and emesis nausea (95% confidence interval, 19-72; P=.005) and vomit and retch subscores (95% confidence interval, 21-77; P=.005), respectively; a 96% increase in baseline adjusted oral nutrition scores (95% confidence interval, 27-165; P=.01); and a 254% difference in global satisfaction of treatment (95% confidence interval, 48-459; P=.03). Relief (P=.06) and desire to continue therapy (P=.06) both showed trends favoring gabapentin treatment but Nausea and Vomiting of Pregnancy Quality of Life (P=.68) and Hyperemesis Gravidarum Pregnancy Termination Consideration (P=.58) did not. Adverse events were roughly equivalent between the groups. There were no serious adverse events. CONCLUSION In this small trial, gabapentin was more effective than standard-of-care therapy for reducing nausea and vomiting and increasing oral nutrition and global satisfaction in outpatients with hyperemesis gravidarum. These data build on previous findings in other patient populations supporting gabapentin as a novel antinausea and antiemetic therapy and support further research on gabapentin for this challenging complication of pregnancy.
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Affiliation(s)
- Thomas Guttuso
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY.
| | - Susan Messing
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY
| | - Xin Tu
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA
| | - Patrick Mullin
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Rachel Shepherd
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Chad Strittmatter
- Department of Obstetrics and Gynecology, Sisters of Charity Hospital, Buffalo, NY
| | - Sumona Saha
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Loralei L Thornburg
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, NY
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30
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Grammatikopoulou MG, Theodoridis X, Gkiouras K, Lampropoulou M, Petalidou A, Patelida M, Tsirou E, Papoutsakis C, Goulis DG. Methodological quality of clinical practice guidelines for nutrition and weight gain during pregnancy: a systematic review. Nutr Rev 2020; 78:546-562. [PMID: 31755916 DOI: 10.1093/nutrit/nuz065] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
CONTEXT Ensuring a healthy pregnancy and achieving optimal gestational weight gain (GWG) are important for maternal and child health. Nevertheless, the nutritional advice provided during pregnancy is often conflicting, suggesting limited adherence to clinical practice guidelines (CPGs). OBJECTIVE The aim of this review was to identify all CPGs on maternal nutrition and GWG and to critically appraise their methodological quality. DATA SOURCES The MEDLINE/PubMed, Cochrane, Guidelines International Network, and BMJ Best Practice databases, along with gray literature, were searched from inception until February 2019 for CPGs and consensus, position, and practice papers. STUDY SELECTION Clinical practice guidelines published in English and containing advice on maternal nutrition or GWG were eligible. DATA EXTRACTION Two authors independently extracted data on items pertaining to maternal nutrition or GWG, and CPGs were appraised using the AGREE II instrument. RESULTS Twenty-two CPGs were included. All scored adequately in the "scope" domain, but most were considered inadequate with regard to stakeholder involvement, rigor of development, applicability, and editorial independence. Many CPGs lacked patient or dietician involvement, and more than half did not disclose funding sources or conflicts of interest. Guidance on GWG was based mostly on Institute of Medicine thresholds, while nutrition recommendations appeared scattered and heterogeneous. CONCLUSION Despite the importance of maternal nutrition and the plethora of advising bodies publishing relevant guidance, there is room for substantial improvement in terms of development standards and content of nutritional recommendations. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42019120898.
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Affiliation(s)
- Maria G Grammatikopoulou
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, Thessaloniki, Greece.,Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Xenophon Theodoridis
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Medical School, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Konstantinos Gkiouras
- Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Medical School, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Maria Lampropoulou
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, Thessaloniki, Greece.,Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Fourth Department of Pediatrics, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Arianna Petalidou
- Medical School, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Maria Patelida
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, Thessaloniki, Greece
| | - Efrosini Tsirou
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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31
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Koren G, Cohen R. Measuring the severity of nausea and vomiting of pregnancy; a 20-year perspective on the use of the pregnancy-unique quantification of emesis (PUQE). J OBSTET GYNAECOL 2020; 41:335-339. [PMID: 32811235 DOI: 10.1080/01443615.2020.1787968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Nausea and vomiting of pregnancy (NVP) is the most common medical condition in pregnancy, affecting up to 80% of expectant women. Measuring the severity of the condition over time is important for management decisions, as well as for research into different therapeutic modalities. Twenty years ago we described and validated the Pregnancy Unique Quantification of Emesis scale (PUQE), as a clinical and research tool. PUQE has become widely used for both ends, and has been incorporated in numerous practice guidelines worldwide. In this review we describe the inception of the tool, its rational, and its wide range of use worldwide.
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Affiliation(s)
- Gideon Koren
- The Motherisk Israel Program, Shamir Medical Center, Zerifin, Israel.,Adelson Faculty of Medicine, Ariel University, Ariel, Israel
| | - Rana Cohen
- The Motherisk Israel Program, Shamir Medical Center, Zerifin, Israel
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32
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Katarey D, Westbrook RH. Pregnancy-specific liver diseases. Best Pract Res Clin Obstet Gynaecol 2020; 68:12-22. [PMID: 32381461 DOI: 10.1016/j.bpobgyn.2020.03.013] [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: 02/22/2020] [Revised: 03/21/2020] [Accepted: 03/26/2020] [Indexed: 12/17/2022]
Abstract
Liver disease presenting in pregnancy may be due to a pregnancy-specific liver disorder, due to previously unrecognised pre-existing liver disease, or de novo liver disorders coincidentally presenting in a pregnant woman. The pregnancy-specific liver diseases can span from mild disease with limited impact on maternal and foetal health to severe disorders that can result in significant morbidity and mortality for mother and foetus. Swift identification of these disorders is essential to allow timely and appropriate management via a multi-disciplinary approach. The pregnancy-specific conditions, including their presentation, investigations, and management are reviewed in this chapter in detail.
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Affiliation(s)
- Dev Katarey
- Royal Free Hospital, Pond Street, London, NW3 2QG, United Kingdom
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Ostenfeld A, Petersen TS, Futtrup TB, Andersen JT, Jensen AK, Westergaard HB, Pedersen LH, Løkkegaard ECL. Validating the effect of Ondansetron and Mirtazapine In Treating hyperemesis gravidarum (VOMIT): protocol for a randomised placebo-controlled trial. BMJ Open 2020; 10:e034712. [PMID: 32209630 PMCID: PMC7202694 DOI: 10.1136/bmjopen-2019-034712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Current pharmacological treatment options for hyperemesis gravidarum have been introduced based on scarce evidence and are often not sufficiently effective. Several case reports suggest that mirtazapine, an antidepressant, may be an effective treatment for hyperemesis gravidarum, but so far there are no controlled trials investigating the potential effect of mirtazapine on hyperemesis gravidarum. The antiemetic ondansetron is currently widely used to treat hyperemesis gravidarum despite sparse evidence of effect in pregnant women. This study aims to investigate the effect of mirtazapine on hyperemesis gravidarum while also providing data on the effect of ondansetron. METHODS AND ANALYSIS This randomised double-blind placebo-controlled multicentre trial will be conducted in eight Danish hospitals. One hundred and eighty pregnant women referred to secondary care for hyperemesis gravidarum will be randomly allocated to 14-day treatment with either mirtazapine, ondansetron or placebo. Main inclusion criterion will be Pregnancy Unique Quantification of Emesis (PUQE-24) score ≥13 or PUQE-24 score ≥7 if accompanied by weight loss >5% of pre-pregnancy weight or hospitalisation. Participants are eligible regardless of whether other antiemetics, including ondansetron, have been tried. The coprimary outcomes are effects of mirtazapine and ondansetron, respectively, on PUQE-24 score tested hierarchically on day 2 and day 14. Secondary outcomes include, but are not limited to, differences between the three groups in number of daily vomiting episodes, dropout due to treatment failure, use of rescue medication, weight change and side effects. ETHICS AND DISSEMINATION The trial has been approved by the Regional Committees on Health Research Ethics in the Capital Region of Denmark, the Danish Medicines Agency and the Danish Data Protection Agency. Results will be published in peer-reviewed journals and submitted to relevant conferences. TRIAL REGISTRATION NUMBER NCT03785691.
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Affiliation(s)
- Anne Ostenfeld
- Department of Gynecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Jon Trærup Andersen
- Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Andreas Kryger Jensen
- Department of Research, Nordsjaellands Hospital, Hillerod, Denmark
- Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Lars Henning Pedersen
- Department Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Ellen Christine Leth Løkkegaard
- Department of Gynecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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34
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Jansen LAW, Koot MH, van‘t Hooft J, Dean CR, Duffy JMN, Ganzevoort W, Gauw N, Goes BY, Rodenburg J, Roseboom TJ, Painter RC, Grooten IJ. A core outcome set for hyperemesis gravidarum research: an international consensus study. BJOG 2020; 127:983-992. [DOI: 10.1111/1471-0528.16172] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2020] [Indexed: 12/13/2022]
Affiliation(s)
- LAW Jansen
- Department of Obstetrics and Gynaecology Amsterdam UMC Academic Medical Centre Amsterdam the Netherlands
- Department of Obstetrics and Gynaecology Franciscus Gasthuis Rotterdam the Netherlands
| | - MH Koot
- Department of Obstetrics and Gynaecology Amsterdam UMC Academic Medical Centre Amsterdam the Netherlands
| | - J van‘t Hooft
- Department of Obstetrics and Gynaecology Amsterdam UMC Academic Medical Centre Amsterdam the Netherlands
| | - CR Dean
- Pregnancy Sickness Support Bodmin UK
| | - JMN Duffy
- Institute for Women’s Health University College London London UK
| | - W Ganzevoort
- Department of Obstetrics and Gynaecology Amsterdam UMC Academic Medical Centre Amsterdam the Netherlands
| | - N Gauw
- Dutch Hyperemesis Gravidarum Patient Foundation (ZEHG) Dussen the Netherlands
| | - BY Goes
- Department of Obstetrics and Gynaecology Leiden University Medical Centre Leiden the Netherlands
| | - J Rodenburg
- General practice Czaar Peter Medical Centre Amsterdam the Netherlands
| | - TJ Roseboom
- Department of Obstetrics and Gynaecology Amsterdam UMC Academic Medical Centre Amsterdam the Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics Amsterdam UMC Academic Medical Centre Amsterdam the Netherlands
| | - RC Painter
- Department of Obstetrics and Gynaecology Amsterdam UMC Academic Medical Centre Amsterdam the Netherlands
| | - IJ Grooten
- Department of Obstetrics and Gynaecology Amsterdam UMC Academic Medical Centre Amsterdam the Netherlands
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van Casteren DS, van den Brink AM, Terwindt GM. Migraine and other headache disorders in pregnancy. HANDBOOK OF CLINICAL NEUROLOGY 2020; 172:187-199. [PMID: 32768088 DOI: 10.1016/b978-0-444-64240-0.00011-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Migraine prevalence is three times higher in women than in men during fertile years, which is mainly due to sex hormone differences. The majority of women suffering from migraine without aura report improvement of their migraine attacks during pregnancy. Migraine attacks with aura can also improve during pregnancy, but more often remain the same or worsen. Anovulation caused by lactation is generally associated with a decrease in migraine attacks in breastfeeding women. This chapter describes the current knowledge on acute and prophylactic treatment options of migraine and other primary headache disorders during pregnancy and lactation. Further, clinical profiles of secondary headaches during pregnancy and the postpartum period are summarized.
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Affiliation(s)
- Daphne S van Casteren
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands; Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
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Abstract
Nausea and vomiting of pregnancy (NVP) is a common condition that affects as many as 70% of pregnant women. Although no consensus definition is available for hyperemesis gravidarum (HG), it is typically viewed as the severe form of NVP and has been reported to occur in 0.3-10.8% of pregnant women. HG can be associated with poor maternal, fetal and child outcomes. The majority of women with NVP can be managed with dietary and lifestyle changes, but more than one-third of patients experience clinically relevant symptoms that may require fluid and vitamin supplementation and/or antiemetic therapy such as, for example, combined doxylamine/pyridoxine, which is not teratogenic and may be effective in treating NVP. Ondansetron is commonly used to treat HG, but studies are urgently needed to determine whether it is safer and more effective than using first-line antiemetics. Thiamine (vitamin B1) should be introduced following protocols to prevent refeeding syndrome and Wernicke encephalopathy. Recent advances in the genetic study of NVP and HG suggest a placental component to the aetiology by implicating common variants in genes encoding placental proteins (namely GDF15 and IGFBP7) and hormone receptors (namely GFRAL and PGR). New studies on aetiology, diagnosis, management and treatment are under way. In the next decade, progress in these areas may improve maternal quality of life and limit the adverse outcomes associated with HG.
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Baig AM, Katyara P, Rajabali MN, Khaleeq A, Nazim F, Lalani S. Neuroleptic Drug Targets a Brain-Eating Amoeba: Effects of Promethazine on Neurotropic Acanthamoeba castellanii. ACS Chem Neurosci 2019; 10:2868-2876. [PMID: 30977998 DOI: 10.1021/acschemneuro.9b00100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Acanthamoeba spp. has recently been reported to express diverse group of ion channels and receptors that are expressed by human cells which bind drugs that are used in noninfectious diseases. Bioinformatics computational tools, growth assays, and 3D structural modeling have enabled the discovery of primitive muscarinic receptors, voltage-gated calcium channels, and ion transport pumps such as Na-K ATPase in this protist pathogen. The significance of the reported receptors and ion channels in the biology of Acanthamoeba is yet to be determined. We selected promethazine, which is a known antagonist of proteins like dopaminergic, histaminergic, muscarinic receptors, and calmodulin, to determine its effects on the growth and proliferation of trophozoites and cysts of Acanthamoeba spp. In order to elucidate the receptors involved in the effects produced by promethazine, we also performed individual experiments on Acanthamoeba trophozoites and cysts in the presence of the agonist of the above-mentioned receptors. Our results show that promethazine in the range of 60-100 μg/mL proved to be amoebicidal for Acanthamoeba trophozoites and at slightly higher doses ranging around 125-250 μg/mL also showed partial cysticidal effects. We also show the evidence of homology between the human targets of promethazine and similar targets in Acanthamoeba by the use of bioinformatic computational tools and 3D modeling. Promethazine and its structural analogs, because of being FDA-approved, have a wider margin of safety that can be tested as potential anti- Acanthamoeba agents in diseases like keratitis and encephalitis caused by this protist pathogen.
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Affiliation(s)
- Abdul Mannan Baig
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Preet Katyara
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Mehdia Nadeem Rajabali
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Areeba Khaleeq
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Fizza Nazim
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Salima Lalani
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
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Abstract
Early in pregnancy women frequently experience nausea, vomiting, and vaginal bleeding. Nausea and vomiting can be mild, managed by dietary modifications and medications, or severe, requiring intravenous fluids and medications. Care should be used when selecting medications for nausea to avoid additional side effects or potential harm to the developing fetus. When evaluating vaginal bleeding in early pregnancy, ectopic pregnancy must be ruled out. If an intrauterine pregnancy is seen, threatened miscarriage should be considered and the patient appropriately counseled. If neither intrauterine pregnancy nor ectopic pregnancy can be established, a management algorithm for pregnancy of unknown location is presented.
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Affiliation(s)
- Elizabeth Pontius
- Department of Emergency Medicine, Georgetown University School of Medicine, MedStar Georgetown University Hospital, MedStar Washington Hospital Center, 110 Irving Street, Northwest, NA 1177, Washington, DC 20010, USA
| | - Julie T Vieth
- Department of Emergency Medicine, Canton-Potsdam Hospital, 50 Leroy Street, Potsdam, NY 13676, USA.
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van Limburg Stirum EV, van Pampus MG, Jansen JM, Janszen EW. Abdominal pain and vomiting during pregnancy due to cholesterolosis. BMJ Case Rep 2019; 12:12/3/e227826. [PMID: 30898960 DOI: 10.1136/bcr-2018-227826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a 22-year-old pregnant woman at 15 weeks of gestation, with abdominal pain and vomiting. We demonstrate that diagnosis and treatment of vomiting and abdominal pain in pregnancy can be difficult. Therefore, involvement of other medical specialists is important when common treatments fail. Cholesterolosis can cause symptoms similar to those caused by cholelithiasis. Controversial to gallstones, identification of cholesterolosis by ultrasound is hard. Cholecystectomy is the only effective treatment option for cholesterolosis and can be performed safely during pregnancy. Cholecystectomy in pregnancy should be considered if, despite atypical symptoms, gallbladder disease is suspected and other diagnoses are ruled out. This may reduce recurrent symptoms, hospital admissions, exposure to harmful drugs and obstetric complications.
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Affiliation(s)
| | - Maria G van Pampus
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, The Netherlands
| | - Jeroen M Jansen
- Department of Gastro-enterology, OLVG, Amsterdam, The Netherlands
| | - Erica Wm Janszen
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, The Netherlands
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Havnen GC, Truong MBT, Do MLH, Heitmann K, Holst L, Nordeng H. Women's perspectives on the management and consequences of hyperemesis gravidarum - a descriptive interview study. Scand J Prim Health Care 2019; 37:30-40. [PMID: 30822254 PMCID: PMC6454401 DOI: 10.1080/02813432.2019.1569424] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Hyperemesis gravidarum (HG) affects 0.3-3% of pregnant women and is a leading cause of hospitalization in early pregnancy. The aim of the study was to investigate women's treatment and management of HG, as well as the consequences of HG on women's daily life. DESIGN AND SETTING A cross-sectional study based on a structured telephone interview and an online questionnaire. Participants were recruited by social media and by the Norwegian patient's organization for HG. SUBJECTS Norwegian women that experienced HG. MAIN OUTCOME MEASURE Women's perspectives on management and consequences of HG. RESULTS The study included 107 women. Maternal morbidity was profound; about 3/4 of participants were hospitalized due to HG, and the majority showed clinical signs of dehydration (79%), ketonuria (75%), and >5% weight loss (84%). Antiemetics were used by >90% and frequently prescribed "as needed". Metoclopramide (71%) and meclozine (51%) were most commonly used. Participants described HG as having severe psychosocial consequences and profound impact on daily activities. Almost two out of five reported thoughts of elective abortion, and 8 women had at least one elective pregnancy termination due to HG. Overall, 20 women (19%) changed GPs due to dissatisfaction with HG management. CONCLUSION Despite the high psychosocial burden and major impact on daily activities, many women with HG reported a lack of support from healthcare professionals and suboptimal management. Greater awareness and knowledge among healthcare professionals is needed to improve care for women with HG. Key Points There is a paucity of studies on management and the consequences of HG on women's daily lives and psychosocial burden. We found that: • Many women described HG as one of their worst life experiences with profound morbidity. • Many women reported suboptimal management of HG and lack of support from healthcare professionals. • Greater understanding of patient perspectives among healthcare professionals is important to improve care and management for HG patients.
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Affiliation(s)
- Gro C. Havnen
- Regional Medicines Information and Pharmacovigilance Centre (RELIS), Oslo University Hospital, Oslo, Norway;
- CONTACT Gro C. Havnen Regional Medicines Information and Pharmacovigilance Centre (RELIS), Oslo University Hospital HF Rikshopitalet, Pb 4950 Nydalen, 0424Oslo, Norway
| | - Maria Bich-Thuy Truong
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway;
| | - Mai-Linh H. Do
- Regional Medicines Information and Pharmacovigilance Centre (RELIS), Oslo University Hospital, Oslo, Norway;
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway;
| | - Kristine Heitmann
- Regional Medicines Information and Pharmacovigilance Centre (RELIS), Haukeland University Hospital, Bergen, Norway;
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;
| | - Lone Holst
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway;
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
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Bovbjerg ML. Current Resources for Evidence-Based Practice, March 2019. J Obstet Gynecol Neonatal Nurs 2019; 48:230-248. [PMID: 30735623 DOI: 10.1016/j.jogn.2019.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A review of new resources to support the provision of evidence-based care for women and infants.
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Nausea and vomiting of pregnancy and resource implications: the NVP Impact Study. Br J Gen Pract 2018; 69:e217-e223. [PMID: 30559108 PMCID: PMC6400600 DOI: 10.3399/bjgp18x700745] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/13/2018] [Indexed: 11/30/2022] Open
Abstract
Background Nausea and vomiting of pregnancy (NVP) is the most prevalent medical condition associated with pregnancy. The Royal College of Obstetricians and Gynaecologists published its first guidelines for management of NVP in 2016, although many current treatments are off label, with only one recently licensed treatment for NVP in the UK. Aim To identify the current practices for NVP management across the patient pathway, and estimate the economic burden to NHS services. Design and setting This was an observational, retrospective research study conducted in the Newcastle Gateshead Clinical Commissioning Group (CCG) health economy area in England. Method Data were collected from GP practices, local hospital datasets, ambulance services (April 2013–March 2016), and the Hospital Episode Statistics dataset (2006–2016). Results Eight GP practices participated in the study. In all, 15.2% of the total pregnant population presented with NVP. Treatment varied significantly between GP practices, and 33.6% of women re-presented to their GP. There was an annual increase in women admitted to hospital for NVP symptoms, with increasing length of stay per admission. Almost half (44.6%) of the calls to 999/111 from women experiencing NVP symptoms resulted in an ambulance dispatch. The annual cost of NVP to this health economy was estimated to be £199 804, which crudely extrapolates to £25 758 731 at UK level. Due to underestimations of costs, the impact to the UK NHS could be up to £62 373 961. Conclusion There is considerable variation in current management practices for NVP outside of recently published guidelines, and this may result in substantial resource use and avoidable financial impact to the NHS.
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Sridharan K, Sivaramakrishnan G. Interventions for treating hyperemesis gravidarum: a network meta-analysis of randomized clinical trials. J Matern Fetal Neonatal Med 2018; 33:1405-1411. [PMID: 30173590 DOI: 10.1080/14767058.2018.1519540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: Several interventions were explored in clinical trials for treating hyperemesis gravidarum (HG). The present study is a network meta-analysis of such interventions.Methods: Electronic databases were searched for appropriate randomized clinical trials comparing interventions for treatment of patients with HG. Control of HG symptoms was the primary outcome and emetic episodes, hospital stay, nausea scores, patients requiring rescue antiemetics, hospital readmission, adverse events, and adverse pregnancy outcomes were the secondary outcome measures. Random-effects model was used and odds ratio (OR) [95% confidence interval (CI)] was the effect estimate for categorical outcomes and weighted mean difference (WMD) [95% confidence interval] for numerical outcomes.Results: Twenty studies were included in the systematic review and 18 in the meta-analysis. Acupuncture (OR: 18.9; 95% CI: 2.1, 168), acupressure (OR: 26.7; 95% CI: 2.5, 283.1) and methylprednisolone (OR: 6.7; 95% CI: 1.1, 38.8) were associated with better control of HG symptoms than standard of care. Acupressure decreases the requirement of rescue antiemetics (OR: 0.06; 95% CI: 0.01, 0.44); ondansetron with reduced hospital stay (WMD: -0.2; 95% CI: -0.31, -0.01) and diazepam with reduced risk of hospital admission (OR: 0.11; 95% CI: 0.01, 0.95). The quality of evidence is very low.Conclusion: Acupuncture, acupressure, and methylprednisolone were observed with better therapeutic benefits than other interventions for treating HG. However, the pooled estimates may change with the advent of results from future head-to-head clinical trials.
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Affiliation(s)
- Kannan Sridharan
- Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Gowri Sivaramakrishnan
- School of Oral Health, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
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