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Tinti S, Praticò F, Bonaldo V, Rovetto MY, Barattini DF, Casolati E, Piccolo E, Piazza R, Liberati M, Locci M, Cetin I. Prevalence and burden of nausea and vomiting in pregnant women: Interim analysis of the PURITY survey. Eur J Obstet Gynecol Reprod Biol 2023; 290:135-142. [PMID: 37793320 DOI: 10.1016/j.ejogrb.2023.09.016] [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: 05/17/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES Nausea and vomiting in pregnancy is a common and invalidating condition in early pregnancy. However, no data are available on its prevalence in Italy. This survey aims to evaluate the prevalence and impact of nausea and vomiting during pregnancy on the quality of life of Italian women. STUDY DESIGN The survey was performed in three Italian public University Hospitals in two distinct periods: a first interview took place between the 18th and 22nd week of pregnancy, using the Questionnaire for Pregnancy Period (14 questions regarding demographic data and 30 questions about nausea and vomiting in pregnancy, including Pregnancy-Unique Quantification of Emesis questionnaire), and a follow-up interview, by telephone call, took place immediately after giving birth and in any case within 14 days of delivery, using the Questionnaire for Post-Pregnancy (9 questions). Included women were Caucasian, in physiological pregnancy and between the 18th and 22nd week (time of morphological ultrasound), able to communicate adequately with the interviewer, understand the questionnaires and able to provide valid informed consent. Twin pregnancies and women who recurred to medically assisted procreation were excluded. This is an interim report on data collected from 232 of the planned 600 women. RESULTS Mean age of the recruited subjects was 32.6 ± 4.6 years, with approximately 60% primiparous. The prevalence of nausea and vomiting in pregnancy in the sample examined was 65.5% overall (152 out of 232 subjects). Of these 152 women, 63 (41.4%) experienced only nausea, 6 (3.9%) only vomiting, and 83 (54.6%) reported both. Symptoms were reported to begin at 7.2 ± 2.7 weeks, lasted 10.2 ± 5.6 weeks, and persisted at the time of the interview in 32.2% of cases. Overall, over 50% of the women interviewed experienced a negative impact of nausea and vomiting in pregnancy on social relationships and work activity. CONCLUSIONS A high prevalence of nausea and vomiting in pregnancy, 65.5% overall, was found in this interim analysis. These symptoms appeared capable of negatively influencing women quality of life. Screening procedures should be offered during pregnancy and measures that address nausea and vomiting in pregnancy impact warranted.
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Affiliation(s)
- Serena Tinti
- Department of Woman, Mother and Neonate, Vittore Buzzi Children's Hospital, University of Milan, Italy
| | - Francesca Praticò
- Department of Woman, Mother and Neonate, Vittore Buzzi Children's Hospital, University of Milan, Italy
| | - Veronica Bonaldo
- Department of Woman, Mother and Neonate, Vittore Buzzi Children's Hospital, University of Milan, Italy
| | - Marika Ylenia Rovetto
- Department of Neuroscience and Reproductive and Dentistry Sciences, University of Naple Federico II, Italy
| | | | - Elena Casolati
- Private Practice of Obstetrics and Gynecology, Milan, Italy
| | - Elena Piccolo
- Italfarmaco SpA, Medical Affairs Department, Milan, Italy
| | - Roberto Piazza
- Italfarmaco SpA, Medical Affairs Department, Milan, Italy
| | - Marco Liberati
- Obstetrics-Gynecology Clinic, SS. Annunziata Hospital, University of Chieti, G. D'Annunzio, Chieti, Italy
| | - Mariavittoria Locci
- Department of Neuroscience and Reproductive and Dentistry Sciences, University of Naple Federico II, Italy
| | - Irene Cetin
- Department of Woman, Mother and Neonate, Vittore Buzzi Children's Hospital, University of Milan, Italy.
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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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Atiba FA, Popoola OA, Odukogbe AA, Ihunwo AO. Prevalence and consumption pattern of kolanut among pregnant women in Ibadan metropolis. Sci Rep 2023; 13:14422. [PMID: 37660226 PMCID: PMC10475128 DOI: 10.1038/s41598-023-41754-6] [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: 05/26/2022] [Accepted: 08/31/2023] [Indexed: 09/04/2023] Open
Abstract
Kolanut contains caffeine and it is widely consumed in various social contexts in Nigeria and other Sub-Saharan African countries. While some studies have suggested that kolanut is consumed by pregnant women, there is a dearth of information on the prevalence, consumption pattern and reasons for kolanut consumption among this group. This study investigated kolanut use among pregnant women in Ibadan, Oyo State, Nigeria. A cross-sectional study involving 478 consenting pregnant women in all trimesters of pregnancy was conducted. Semi-structured questionnaires were used to collect data. Associations between kolanut use and respondent characteristics were investigated using the chi-square test and logistic regression analysis. The mean age of the women was 28.7 ± 6.3 years. One hundred and sixty-two (33.9%) of women reported kolanut use during pregnancy, 140 (29.3%) in the current pregnancy. Fifty-five (39.3%) pregnant women reported frequent use and 46 (32.9%) used it in high quantities. Significant associations were found between current kolanut use and Hausa respondents (p = 0.014), educational level; secondary (p = 0.032), tertiary (p = 0.006), TBA (p = 0.005). The majority (93.7%) used kolanut to prevent spitting, nausea, and vomiting. This study showed that kolanut use is quite common among pregnant women and frequently used in large quantities.
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Affiliation(s)
- F A Atiba
- Department of Anatomy, College of Medicine, University of Ibadan, Ibadan, Nigeria.
- School of Anatomical Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - O A Popoola
- Departrment of Community Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - A A Odukogbe
- Department of Obstetrics and Gynecology College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - A O Ihunwo
- School of Anatomical Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Ngo E, Truong MBT, Nordeng H. Impact of a primary care pharmacist consultations on pregnant women's medication use: the SafeStart intervention study linked to a national prescription database. Int J Clin Pharm 2023:10.1007/s11096-023-01577-x. [PMID: 37156960 PMCID: PMC10366231 DOI: 10.1007/s11096-023-01577-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: 11/07/2022] [Accepted: 03/14/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Prior studies show that pharmacist consultations are highly appreciated by pregnant women and feasible in community pharmacies. However, it is unknown whether such counseling has an impact on medication use during pregnancy. AIM This study aimed to assess whether a pharmacist consultation in early pregnancy was associated with pregnant women's medication use, with a focus on antiemetic medications. METHOD The SafeStart study recruited Norwegian pregnant women in the first trimester between February 2018 and February 2019. Women in the intervention group received a pharmacist consultation in a community pharmacy or by phone. A follow-up questionnaire was completed 13 weeks after enrollment. Data from the SafeStart study were linked to the Norwegian Prescription Database. Logistic regression was used to assess the association between the pharmacist intervention and medication use in the second trimester. RESULTS The study included 103 women in the intervention group and 126 in the control group. Overall prescription fills in the first and second trimesters were 55% and 45% (intervention group) and 49% and 52% (control group), respectively. In total, 16-20% of women in the first trimester and 21-27% of women in the second trimester had a prescription for antiemetics. The pharmacist intervention was not associated with women's medication use in the second trimester. CONCLUSION This study did not detect an impact of a pharmacist consultation on pregnant women's use of medications. In the future, pharmacist consultations should focus on other outcome factors, such as risk perception, knowledge level, and the use of other health care services. Trial registration The SafeStart study is registered with ClinicalTrials.gov (identifier: NCT04182750, registration date: December 2, 2019).
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Affiliation(s)
- Elin Ngo
- PharmacoEpidemiology and Drug Safety, Department of Pharmacy, University of Oslo, Blindern, Postbox 1068, 0316, Oslo, Norway.
| | - Maria Bich-Thuy Truong
- PharmacoEpidemiology and Drug Safety, Department of Pharmacy, University of Oslo, Blindern, Postbox 1068, 0316, Oslo, Norway
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety, Department of Pharmacy, University of Oslo, Blindern, Postbox 1068, 0316, Oslo, Norway
- Department of Child Health and Development, National Institute of Public Health, Oslo, Norway
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Liu Y, Li Z, Li N, An H, Zhang L, Liu X, Ye R. Effects of passive smoking on severe nausea and vomiting of pregnancy among urban Chinese nonsmoking women. Heliyon 2023; 9:e15294. [PMID: 37077685 PMCID: PMC10106501 DOI: 10.1016/j.heliyon.2023.e15294] [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: 12/08/2021] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/21/2023] Open
Abstract
Background Nausea and vomiting of pregnancy (NVP) is one of the most common pregnancy-associated symptoms, but little is known about the effects of passive smoking on this symptom. Passive smoking among women is widespread and severe in China due to the high proportion of men who smoke actively. The aim of this study is to examine the association between maternal passive smoking and severe NVP in early pregnancy among nonsmoking women in urban China. Methods We collected information on passive smoking status and severe NVP in early pregnancy based on an ongoing prospective cohort study conducted from October 2017 to May 2019 in Beijing, China. We used multivariable logistic model to calculate adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) after controlling for confounding factors. Results Among 3064 participants who were involved in the final analysis, 7.4% (n = 227) were passive smokers and 9.8% (n = 299) reported severe NVP. After adjusting for potential confounders, passive smoking conferred an increased risk of NVP (adjusted OR = 1.62, 95% CI: 1.08, 2.43). The frequency of exposure to second-hand smoke showed a positive relationship with the risk of severe NVP, and significant subgroup differences were also observed in stratified analyses by parity and education level. Conclusions Our results suggested that maternal exposure to second-hand smoke remained to be a major public health problem in urban China, and that passive smoking during the first trimester may increase the risk of severe NVP among nonsmoking pregnant women. Measures should be taken to reduce the impact of second-hand smoke exposure on pregnant women.
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Affiliation(s)
- Yingying Liu
- National Center for Pediatric Cancer Surveillance, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
- Institute of Reproductive and Child Health, Chinese National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, China
| | - Zhiwen Li
- Institute of Reproductive and Child Health, Chinese National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, China
- Corresponding author. 38 Xueyuan Rd, Haidian District, Beijing 100191, China.
| | - Nan Li
- Institute of Reproductive and Child Health, Chinese National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, China
- Corresponding author. 38 Xueyuan Rd, Haidian District, Beijing 100191, China.
| | - Hang An
- Institute of Reproductive and Child Health, Chinese National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, China
| | - Le Zhang
- Institute of Reproductive and Child Health, Chinese National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, China
| | - Xiaohong Liu
- Department of Obstetrics and Gynecology, Haidian Maternal and Child Health Hospital, Beijing, China
| | - Rongwei Ye
- Institute of Reproductive and Child Health, Chinese National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, China
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Tombari RJ, Mundy PC, Morales KM, Dunlap LE, Olson DE, Lein PJ. Developmental Neurotoxicity Screen of Psychedelics and Other Drugs of Abuse in Larval Zebrafish ( Danio rerio). ACS Chem Neurosci 2023; 14:875-884. [PMID: 36753397 PMCID: PMC9983010 DOI: 10.1021/acschemneuro.2c00642] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
In recent years, psychedelics have garnered significant interest as therapeutic agents for treating diverse neuropsychiatric disorders. However, the potential for these compounds to produce developmental neurotoxicity has not been rigorously assessed, and much of the available safety data is based on epidemiological studies with limited experimental testing in laboratory animal models. Moreover, the experimental safety data available thus far have focused on adult organisms, and the few studies conducted using developing organisms have tested a limited number of compounds, precluding direct comparisons between various chemical scaffolds. In the present study, 13 psychoactive compounds of different chemical or pharmacological classes were screened in a larval zebrafish model for teratological and behavioral abnormalities following acute and chronic developmental exposures. We found that the psychedelic tryptamines and ketamine were less neurotoxic to larval zebrafish than LSD and psychostimulants. Our work, which leverages the advantage of using zebrafish for higher throughput toxicity screening, provides a robust reference database for comparing the neurotoxicity profiles of novel psychedelics currently under development for therapeutic applications.
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Affiliation(s)
- Robert J Tombari
- Department of Chemistry, University of California, Davis, Davis, California 95616, United States
| | - Paige C Mundy
- Department of Molecular Biosciences, University of California, Davis, Davis, California 95616, United States
| | - Kelly M Morales
- Department of Molecular Biosciences, University of California, Davis, Davis, California 95616, United States
| | - Lee E Dunlap
- Department of Chemistry, University of California, Davis, Davis, California 95616, United States
| | - David E Olson
- Department of Chemistry, University of California, Davis, Davis, California 95616, United States.,Department of Biochemistry & Molecular Medicine, School of Medicine, University of California, Davis, Sacramento, California 95817, United States.,Center for Neuroscience, University of California, Davis, Davis, California 95618, United States.,Institute for Psychedelics and Neurotherapeutics, University of California, Davis, Davis, California 95616, United States
| | - Pamela J Lein
- Department of Molecular Biosciences, University of California, Davis, Davis, California 95616, United States.,Center for Neuroscience, University of California, Davis, Davis, California 95618, United States
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Fisher A, Paterson JM, Winquist B, Wu F, Reynier P, Suissa S, Dahl M, Ma Z, Lu X, Zhang J, Raymond CB, Filion KB, Platt RW, Moriello C, Dormuth CR. Patterns of antiemetic medication use during pregnancy: A multi-country retrospective cohort study. PLoS One 2022; 17:e0277623. [PMID: 36454900 PMCID: PMC9714905 DOI: 10.1371/journal.pone.0277623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/31/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To compare patterns in use of different antiemetics during pregnancy in Canada, the United Kingdom, and the United States, between 2002 and 2014. METHODS We constructed population-based cohorts of pregnant women using administrative healthcare data from five Canadian provinces (Alberta, British Columbia, Manitoba, Ontario, and Saskatchewan), the Clinical Practice Research Datalink from the United Kingdom, and the IBM MarketScan Research Databases from the United States. We included pregnancies ending in live births, stillbirth, spontaneous abortion, or induced abortion. We determined maternal use of antiemetics from pharmacy claims in Canada and the United States and from prescriptions in the United Kingdom. RESULTS The most common outcome of 3 848 734 included pregnancies (started 2002-2014) was live birth (66.7% of all pregnancies) followed by spontaneous abortion (20.2%). Use of antiemetics during pregnancy increased over time in all three countries. Canada had the highest prevalence of use of prescription antiemetics during pregnancy (17.7% of pregnancies overall, 13.2% of pregnancies in 2002, and 18.9% in 2014), followed by the United States (14.0% overall, 8.9% in 2007, and 18.1% in 2014), and the United Kingdom (5.0% overall, 4.2% in 2002, and 6.5% in 2014). Besides use of antiemetic drugs being considerably lower in the United Kingdom, the increase in its use over time was more modest. The most commonly used antiemetic was combination doxylamine/pyridoxine in Canada (95.2% of pregnancies treated with antiemetics), ondansetron in the United States (72.2%), and prochlorperazine in the United Kingdom (63.5%). CONCLUSIONS In this large cohort study, we observed an overall increase in antiemetic use during pregnancy, and patterns of use varied across jurisdictions. Continued monitoring of antiemetic use and further research are warranted to better understand the reasons for differences in use of these medications and to assess their benefit-risk profile in this population.
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Affiliation(s)
- Anat Fisher
- Faculty of Medicine, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada,* E-mail:
| | - J. Michael Paterson
- ICES, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Brandace Winquist
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada,Saskatchewan Health Quality Council, Saskatoon, Saskatchewan, Canada
| | | | - Pauline Reynier
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Quebec, Canada
| | - Samy Suissa
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada
| | - Matthew Dahl
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Zhihai Ma
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Xinya Lu
- Saskatchewan Health Quality Council, Saskatoon, Saskatchewan, Canada
| | - Jianguo Zhang
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Colette B. Raymond
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kristian B. Filion
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Quebec, Canada,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada,Department of Medicine, McGill University, Montréal, Quebec, Canada
| | - Robert W. Platt
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Quebec, Canada,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada,Department of Pediatrics, McGill University, Montréal, Quebec, Canada
| | - Carolina Moriello
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Quebec, Canada
| | - Colin R. Dormuth
- Faculty of Medicine, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
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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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Fiurašková K, Havlíček J, Roberts SC. Dietary and psychosocial correlates of nausea and vomiting in pregnancy. Food Qual Prefer 2021. [DOI: 10.1016/j.foodqual.2021.104266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Hyperemesis gravidarum (HG) is a condition at the extreme end of the pregnancy sickness spectrum, estimated to affect 1-2 % of pregnant women. This narrative review provides an overview of the current literature concerning the nutritional implications and management of HG. HG can persist throughout pregnancy, causing malnutrition, dehydration, electrolyte imbalance and unintended weight loss, requiring hospital admission in most cases. In addition to its negative effect on maternal, physical and psychological wellbeing, HG can negatively impact fetal growth and may have adverse consequences on the health of the offspring. HG care and research have been hampered in the past due to stigma, inconsistent diagnostic criteria, mismanagement and lack of investment. Little is known about the nutritional intake of women with HG and whether poor intake at critical stages of pregnancy is associated with perinatal outcomes. Effective treatment requires a combination of medical interventions, lifestyle changes, dietary changes, supportive care and patient education. There is, however, limited evidence-based research on the effectiveness of dietary approaches. Enteral tube feeding and parenteral nutrition are generally reserved for the most intractable cases, where other treatment modalities have failed. Wernicke encephalopathy is a rare but very serious and avoidable consequence of unmanaged HG. A recent priority-setting exercise involving patients, clinicians and researchers highlighted the importance of nutrition research to all. Future research should focus on these priorities to better understand the nutritional implications of HG. Ultimately improved recognition and management of malnutrition in HG is required to prevent complications and optimise nutritional care.
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The Contribution of Registered Dietitians in the Management of Hyperemesis Gravidarum in the United Kingdom. Nutrients 2021; 13:nu13061964. [PMID: 34201043 PMCID: PMC8226879 DOI: 10.3390/nu13061964] [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: 05/17/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 02/07/2023] Open
Abstract
Hyperemesis Gravidarum (HG) is a condition at the extreme end of the pregnancy sickness spectrum, which can cause poor oral intake, malnutrition, dehydration and weight loss. The aim of this study is to explore the role of Registered Dietitians (RD) in the management of HG in the United Kingdom (UK). A survey was designed and distributed electronically to members of the British Dietetic Association. There were 45 respondents, 76% (n = 34) worked in secondary care hospitals, 11% (n = 5) were in maternal health specialist roles. The most commonly used referral criteria was the Malnutrition Universal Screening Tool (40%, n = 18), followed by second admission (36%, n = 16). However 36% (n = 16) reported no specific referral criteria. About 87% (n = 37) of respondents did not have specific clinical guidelines to follow. Oral nutrition supplements were used by 73% (n = 33) either ‘sometimes’ or ‘most of the time’. Enteral and parenteral nutrition were less commonly used. There was an inconsistent use of referral criteria to dietetic services and a lack of specific clinical guidelines and patient resources. Further training for all clinicians and earlier recognition of malnutrition, alongside investment in the role of dietitians were recommended to improve the nutritional care of those with HG.
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Elmas B, Vatansever M, Civan Kahve A, Salman Özgü B, Asut G, Çakmak IB, Bestel A, Erkaya S. Evaluation of psychological resilience and anxiety levels of patients with hyperemesis gravidarum diagnosis and comparison with healthy pregnant women. Turk J Obstet Gynecol 2021; 18:115-123. [PMID: 34083634 PMCID: PMC8191320 DOI: 10.4274/tjod.galenos.2021.05994] [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] [Indexed: 12/01/2022] Open
Abstract
Objective: To compare the psychological resilience and anxiety levels of patients diagnosed with hyperemesis gravidarum (HG) and healthy pregnant women. Materials and Methods: A sociodemographic data form and the Resilience scale for Adults (RSA) and the State-Trait Anxiety Inventory (STAI) were administered. The sociodemographic data form was completed by the physician, and the RSA and STAI were completed by the participant. The sample of the study consisted of 60 pregnant women with HG and hospitalized and 97 healthy voluntary pregnant women with similar characteristics to the research group without any pregnancy complications. Data were evaluated using descriptive statistical analyses, the independent samples t-test, the Mann-Whitney U test and Pearson’s correlation analysis. Results: The age range was 18-42 years for HG group and 20-43 years for control group. The average age of the HG group was 28.17±5.96 years and that of the control group was 29.45±5.83 years. There was no statistically significant difference between the groups in terms of pregnancy week. Regarding the prevalence of state and trait anxiety between the groups, it was found that 66.7% of the HG group had a high level of trait anxiety and 51.7% had a high level of state anxiety. It was found that 61.9% of the control group had a high level of trait anxiety and 38.1% had a high level of state anxiety. There was no difference between the healthy pregnant group and the HG group in terms of anxiety (p=0.125). It was found that there was a significant difference between the groups in terms of only sub-dimensions of RSA, which were perception of self (U=2385.00, p=0.044) and perception of future (U=2350.50, p=0.030). The perception of self and perception of future scores of the healthy control group were higher. Conclusion: There was no difference between the healthy pregnant group and the HG group in terms of anxiety. It was observed that the HG group had a lower perception of self and future. Apart from the usual increase in anxiety levels during pregnancy, HG accompanied by stubborn nausea and vomiting does not create an extra psychological burden, either as a cause or a result.
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Affiliation(s)
- Burak Elmas
- Private Olbamed Hospital, Clinic of Obstetrics and Gynecology, Mersin, Turkey
| | - Merve Vatansever
- Ankara University Institute of Forensic Sciences, Departmant of Forensic Psychology, Ankara, Turkey
| | - Aybeniz Civan Kahve
- Ministry of Health Ankara City Hospital, Clinic of Psychiatry, Ankara, Turkey
| | - Burçin Salman Özgü
- Ministry of Health Ankara City Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Gonca Asut
- Tekirdağ State Hospital, Clinic of Psychiatry, Tekirdağ, Turkey
| | - Işık Batuhan Çakmak
- Ministry of Health Ankara City Hospital, Clinic of Psychiatry, Ankara, Turkey
| | - Ayşegül Bestel
- University of Health Sciences Turkey, Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Salim Erkaya
- University of Health Sciences Turkey, Ankara Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
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13
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Abstract
Akupressur ist eine nicht pharmakologische Technik, die das Potenzial hat, verschiedene Krankheiten zu lindern. Diese Kurzübersicht beschäftigt sich mit Fakten wissenschaftlicher Akupressurstudien und fasst einige wichtige Aspekte zusammen. Wissenschaftliche Artikel aus den Datenbanken PubMed, Google Scholar und CNKI dienten als Forschungsdokumente. Darüber hinaus umfasste die Forschung zur Akupressur im Vergleich zu pharmakologischen Interventionen bei mentalen Erkrankungen eigenes Material, das bereits in wissenschaftlichen Artikeln veröffentlicht wurde. Insgesamt wurden 9 gelistete Publikationen identifiziert, von denen 8 als relevant angesehen wurden. Der Autor überprüfte den Inhalt auf Wertigkeit und diskutiert in diesem Artikel die Einschränkungen der nicht pharmakologischen Behandlungsmethode kritisch. Die verfügbaren Beweise, dass Akupressur als zusätzliche nicht pharmakologische Methode zur Intervention bei mentalen Erkrankungen eingesetzt werden kann, sind spärlich. Es konnte keine evidenzbasierte Qualitätsstudie identifiziert werden, in der Akupressur mit pharmakologischen Behandlungen bei mentalen Erkrankungen direkt verglichen wird. Obwohl bei der Bewertung der alten traditionellen Akupressurmethode erhebliche Fortschritte erzielt wurden, werden in den kommenden Jahren weitere Forschungsarbeiten wie beispielsweise gut konzipierte randomisierte kontrollierte Studien erforderlich sein.
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Affiliation(s)
- Gerhard Litscher
- Leiter der Forschungseinheit für Biomedizinische Technik in Anästhesie und Intensivmedizin, der Forschungseinheit für Komplementäre und Integrative Lasermedizin, Chairman des TCM Forschungszentrums Graz, Medizinische Universität Graz, Auenbruggerplatz 39, EG19, 8036 Graz, Österreich
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14
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Sun J, Liu J, Zhang J, Xia H. Meclizine-loaded nanostructured lipid carriers to manage nausea and vomiting: Oral bioavailability improvement. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Saadatnia S, Tiznobaik A, Saber A. The effects of psychological counseling and acupressure based on couple therapy procedure for alleviation of vomiting and nausea in pregnant women in Iran country. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2021; 19:423-427. [PMID: 33962493 DOI: 10.1515/jcim-2020-0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/17/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Nausea and vomiting have psychological negative effects on some pregnant women during gestation. Different strategies have been used for the treatment of nausea and vomiting during pregnancy, such as acupressure and psychological interventions. This study was conducted to evaluate the effects of psychological counseling and acupressure based on couple therapy procedures on vomiting and nausea in pregnant women in Iran. METHODS Two hundred and eight women were divided into four groups (n=52): 1) they did not any intervention (control group), 2) they received the psychological intervention, 3) they received acupressure intervention, and 4) they received a combination of psychological + acupressure interventions. To investigate the effects of interventions on nausea and vomiting, the Rhodes index of nausea, vomiting and retching were used. The counseling period has lasted for 4 weeks. The pressure intervention on the site was conducted in clockwise form for 1 min and anticlockwise form for another 1 min. RESULTS Groups did not have a significant difference for abortion and income (p>0.05). The effects of counseling, and acupressure interventions on severity and period of vomiting and nausea were not significant (p>0.05), but the intervention based on counseling and acupressure decreased severity of vomiting and nausea (p<0.05). CONCLUSIONS The intervention based on counseling and acupressure could not reduce nausea and vomiting during the gestation, but the intervention based on a combination of both decreased nausea and vomiting. It can be suggested to apply an intervention based on a combination of counseling and acupressure in short-time period for decreasing nausea and vomiting in women during pregnancy.
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Affiliation(s)
- Sahar Saadatnia
- Faculty of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Azita Tiznobaik
- Department of Midwifery, Maternity and Child Care Research Center, Faculty of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amir Saber
- Department of Nutritional Sciences, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Truong MBT, Ngo E, Ariansen H, Tsuyuki RT, Nordeng H. The effect of a pharmacist consultation on pregnant women's quality of life with a special focus on nausea and vomiting: an intervention study. BMC Pregnancy Childbirth 2020; 20:766. [PMID: 33298010 PMCID: PMC7727235 DOI: 10.1186/s12884-020-03472-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 12/02/2020] [Indexed: 11/16/2022] Open
Abstract
Background Maternal wellbeing and quality of life (QOL) are increasingly being recognized as important for healthy pregnancies. The aim of this study was to investigate the impact of a pharmacist consultation on pregnant women’s QOL focusing on nausea and vomiting in pregnancy (NVP), and patient satisfaction. Methods For this intervention study in 14 community pharmacies, women in early pregnancy were recruited and assigned to a pharmacist consultation (intervention) or standard care (control). The consultation aimed to address each woman’s concerns regarding medications and pregnancy-related ailments. Data were collected through online questionnaires at baseline (Q1) and during the second trimester (Q2). The intervention group completed an additional satisfaction questionnaire after the consultation was completed. The primary outcome was the impact of the intervention on the Quality of Life Scale (QOLS) scores between the first and second trimesters. The impact of the intervention was assessed by linear regression, and secondary analyses were performed to assess effect modification by NVP. Results Of the 340 women enrolled in the study, we analyzed data for 245. Half (170/340) of the original participants were allocated to the intervention group, of whom 131 received the pharmacist consultation. Most women (75%, 78/96) reported that the consultation was useful to a large/very large extent. The consultation had no overall impact on QOLS scores between the first and the second trimesters compared with standard care (adjusted β: 0.7, 95% CI: -2.1, 3.4). The impact of the intervention on QOLS was greater amongst women with moderate/severe NVP (adjusted β: 3.6, 95% CI: -0.6, 7.7) compared to those with no/mild NVP (adjusted β: -1.4, 95% CI: -5.1, 2.2) (interaction term study group*NVP severity, p = 0.048). Conclusions The pregnant women highly appreciated the pharmacist consultation, but the intervention did not affect their QOL scores compared with standard care. Future studies should further explore the effect of a pharmacist consultation specifically for NVP and on other outcomes such as use of health care services and medication use in pregnancy. Trial registration Retrospectively registered in ClinicalTrials.gov (identifier: NCT04182750, registration date: December 2, 2019). Supplementary Information The online version contains supplementary material available at 10.1186/s12884-020-03472-z.
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Affiliation(s)
- Maria Bich-Thuy Truong
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway.
| | - Elin Ngo
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway
| | | | - Ross T Tsuyuki
- Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - 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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17
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Contestabile R, di Salvo ML, Bunik V, Tramonti A, Vernì F. The multifaceted role of vitamin B 6 in cancer: Drosophila as a model system to investigate DNA damage. Open Biol 2020; 10:200034. [PMID: 32208818 PMCID: PMC7125957 DOI: 10.1098/rsob.200034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A perturbed uptake of micronutrients, such as minerals and vitamins, impacts on different human diseases, including cancer and neurological disorders. Several data converge towards a crucial role played by many micronutrients in genome integrity maintenance and in the establishment of a correct DNA methylation pattern. Failure in the proper accomplishment of these processes accelerates senescence and increases the risk of developing cancer, by promoting the formation of chromosome aberrations and deregulating the expression of oncogenes. Here, the main recent evidence regarding the impact of some B vitamins on DNA damage and cancer is summarized, providing an integrated and updated analysis, mainly centred on vitamin B6. In many cases, it is difficult to finely predict the optimal vitamin rate that is able to protect against DNA damage, as this can be influenced by a given individual's genotype. For this purpose, a precious resort is represented by model organisms which allow limitations imposed by more complex systems to be overcome. In this review, we show that Drosophila can be a useful model to deeply understand mechanisms underlying the relationship between vitamin B6 and genome integrity.
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Affiliation(s)
- Roberto Contestabile
- Istituto Pasteur Italia-Fondazione Cenci Bolognetti and Dipartimento di Scienze Biochimiche 'A. Rossi Fanelli', Sapienza Università di Roma, P.le A. Moro, 5, 00185, Roma, Italy
| | - Martino Luigi di Salvo
- Istituto Pasteur Italia-Fondazione Cenci Bolognetti and Dipartimento di Scienze Biochimiche 'A. Rossi Fanelli', Sapienza Università di Roma, P.le A. Moro, 5, 00185, Roma, Italy
| | - Victoria Bunik
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow 119991, Russia.,Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, Moscow 119991, Russia.,Sechenov Medical University, Sechenov University, 119048 Moscow, Russia
| | - Angela Tramonti
- Istituto Pasteur Italia-Fondazione Cenci Bolognetti and Dipartimento di Scienze Biochimiche 'A. Rossi Fanelli', Sapienza Università di Roma, P.le A. Moro, 5, 00185, Roma, Italy.,Istituto di Biologia e Patologia Molecolari, Consiglio Nazionale delle Ricerche, Pl.e A. Moro, 5, 00185 Roma, Italy
| | - Fiammetta Vernì
- Dipartimento di Biologia e Biotecnologie 'Charles Darwin', Sapienza Università di Roma, Pl.e A. Moro, 5, 00185 Roma, Italy
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18
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Bérard A, Sheehy O, Gorgui J, Zhao JP, Soares de Moura C, Bernatsky S. New evidence for concern over the risk of birth defects from medications for nausea and vomitting of pregnancy. J Clin Epidemiol 2019; 116:39-48. [PMID: 31352006 DOI: 10.1016/j.jclinepi.2019.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 06/11/2019] [Accepted: 07/20/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of the study was to quantify the risk of major congenital malformations (MCM) associated with first-trimester exposure to antiemetics. STUDY DESIGN AND SETTING Using the Quebec Pregnancy Cohort (1998-2015), first-trimester doxylamine-pyridoxine, metoclopramide, and ondansetron exposures were assessed for their association with MCM. Generalized estimating equations were used to estimate odds ratios (OR), adjusting for potential confounders (aOR). RESULTS Within 17 years of follow-up, the prevalence of antiemetic use during pregnancy increased by 76%. Within our cohort, 45,623 pregnancies were exposed to doxylamine-pyridoxine, 958 to metoclopramide, and 31 to ondansetron. Doxylamine-pyridoxine and metoclopramide use were associated with an increased risk of overall MCM (aOR 1.07, 95% confidence interval [CI]: 1.03-1.11; 3,945 exposed cases) and (aOR 1.27, 95% CI: 1.03-1.57; 105 exposed cases), respectively. Doxylamine-pyridoxine exposure was associated with increased risks of spina bifida (aOR 1.87, 95% CI: 1.11-3.14; 23 exposed cases), nervous system (aOR 1.25, 95% CI: 1.06-1.47; 225 exposed cases), and musculoskeletal system defects (aOR 1.08, 95% CI: 1.02-1.14; 1,735 exposed cases). Metoclopramide exposure was associated with an increased risk of genital organ defects (aOR 2.26, 95% CI: 1.14-4.48; 10 exposed cases). No statistically significant association was found between ondansetron exposure and the risk of overall MCM. CONCLUSION First-trimester doxylamine-pyridoxine and metoclopramide exposure was associated with a significantly increased risk of overall and specific MCM.
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Affiliation(s)
- Anick Bérard
- Research Center, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, Montréal, Québec H3T 1C5, Canada; Faculty of Pharmacy, University of Montreal, Pavillon Jean-Coutu, 2940, chemin de Polytechnique, Montréal, Québec H3T 1J4, Canada.
| | - Odile Sheehy
- Research Center, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, Montréal, Québec H3T 1C5, Canada
| | - Jessica Gorgui
- Research Center, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, Montréal, Québec H3T 1C5, Canada; Faculty of Pharmacy, University of Montreal, Pavillon Jean-Coutu, 2940, chemin de Polytechnique, Montréal, Québec H3T 1J4, Canada
| | - Jin-Ping Zhao
- Research Center, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, Montréal, Québec H3T 1C5, Canada
| | - Cristiano Soares de Moura
- Faculty of Medicine, Department of Clinical Epidemiology, McGill University, Purvis Hall 1020 Pine Ave. West, Montréal, Québec H3A 1A2, Canada
| | - Sasha Bernatsky
- Faculty of Medicine, Department of Clinical Epidemiology, McGill University, Purvis Hall 1020 Pine Ave. West, Montréal, Québec H3A 1A2, Canada
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19
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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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20
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Combining and Using the Utrecht Method and the Analytic Hierarchy Process to Facilitate Professional and Ethical Deliberation and Decision Making in Complementary and Alternative Medicine: A Case Study among a Panel of Stakeholders. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:2315938. [PMID: 30671126 PMCID: PMC6323446 DOI: 10.1155/2018/2315938] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/14/2018] [Accepted: 11/19/2018] [Indexed: 11/17/2022]
Abstract
Background In daily practice, healthcare practitioners face many challenges in ethical and professional decision making. Currently, little is known on the ethical and professional deliberations and weighing benefits against risks in daily complementary and alternative medicine (CAM) practice. The aim of this study was to combine the Utrecht method and the Analytic Hierarchy Process (AHP) in deliberations, weighing benefits against risks of using ginger for a pregnant woman suffering nausea and vomiting of pregnancy (NVP) along with other comorbidities. Methods A hypothetical case was constructed using the twelve tips for constructing dilemma case-based assessment. Three CAM practitioners, two physicians, three pharmacists, and two patients were recruited, and the Utrecht and the AHP methods were combined and used to deliberate and weigh benefits against risks of using ginger for the presented case. Results Responses from the ten panelists were obtained. Priority ratings showed significantly higher scores (p-value < 0.001) for alleviating symptoms of NVP (30.7% ± 16.6%) compared to other potential benefits. Increasing the risk of bleeding was given significantly higher (p-value < 0.0001) weight scores (24.7% ± 13.5%) than other potential side effects. Potential risk of spontaneous abortion and risk of impairment of fetal development were given higher (p-value < 0.001) weight scores than risk of fetal hypoglycemia. When benefits were compared against side effects and risks to the fetus and pregnancy, potential benefits were given higher (p-value < 0.001) weight scores (72.3% ± 5.2%). Conclusions Considering the anticipated benefits and risks, a shared decision was made to use ginger in the case presented. The woman should also be informed of the potential side effects and risks of using ginger. The use of this combined method might promote openness and transparency in making shared decisions for healthcare providers and patients.
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21
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Zambelli-Weiner A, Via C, Yuen M, Weiner DJ, Kirby RS. First trimester ondansetron exposure and risk of structural birth defects. Reprod Toxicol 2018; 83:14-20. [PMID: 30385129 DOI: 10.1016/j.reprotox.2018.10.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 08/13/2018] [Accepted: 10/26/2018] [Indexed: 11/30/2022]
Abstract
This study investigates risk of specific structural birth defects associated with ondansetron exposure during the first trimester in a large US commercially-insured population. Medical claims data were obtained from Truven Health Analytics for 864,083 mother-infant pairs from 2000 to 2014. Logistic regression was used to measure the association between first trimester exposure to ondansetron and risk of cardiac defects, orofacial clefts and other specific structural defects in offspring. First trimester exposure to ondansetron was associated with increased risk of cardiac (OR: 1.52 95% CI: 1.35-1.70) and orofacial cleft defects (OR: 1.32 95% CI: 0.76-2.28) in offspring compared to women with no antiemetic exposure during pregnancy. This analysis addresses limitations of prior studies including limited power, exposure misclassification, and generalizability to the US population. In a large, US population we found a statistically significant association between early pregnancy ondansetron exposure and specific structural birth defects in offspring.
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Affiliation(s)
- April Zambelli-Weiner
- TTi Health Research & Economics, 1231 Tech Ct, Suite 201, Westminster, MD 21157, USA.
| | - Christina Via
- TTi Health Research & Economics, 1231 Tech Ct, Suite 201, Westminster, MD 21157, USA
| | - Matt Yuen
- TTi Health Research & Economics, 1231 Tech Ct, Suite 201, Westminster, MD 21157, USA
| | - Daniel J Weiner
- TTi Health Research & Economics, 1231 Tech Ct, Suite 201, Westminster, MD 21157, USA
| | - Russell S Kirby
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B Downs Blvd, Tampa, FL 33612, USA
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22
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Design, in vitro/in vivo evaluation of meclizine HCl-loaded floating microspheres targeting pregnancy-related nausea and vomiting. J Drug Deliv Sci Technol 2018. [DOI: 10.1016/j.jddst.2018.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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23
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Soo JY, Wiese MD, Berry MJ, McMillen IC, Morrison JL. Intrauterine growth restriction may reduce hepatic drug metabolism in the early neonatal period. Pharmacol Res 2018; 134:68-78. [PMID: 29890254 DOI: 10.1016/j.phrs.2018.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/23/2018] [Accepted: 06/04/2018] [Indexed: 11/26/2022]
Abstract
The effects of intrauterine growth restriction (IUGR) extend well into postnatal life. IUGR is associated with an increased risk of adverse health outcomes, which often leads to greater medication usage. Many medications require hepatic metabolism for activation or clearance, but hepatic function may be altered in IUGR fetuses. Using a sheep model of IUGR, we determined the impact of IUGR on hepatic drug metabolism and drug transporter expression, both important mediators of fetal drug exposure, in late gestation and in neonatal life. In the late gestation fetus, IUGR decreased the gene expression of uptake drug transporter OATPC and increased P-glycoprotein protein expression in the liver, but there was no change in the activity of the drug metabolising enzymes CYP3A4 or CYP2D6. In contrast, at 3 weeks of age, CYP3A4 activity was reduced in the livers of lambs born with low birth weight (LBW), indicating that LBW results in changes to drug metabolising capacity in neonatal life. Together, these results suggest that IUGR may reduce hepatic drug metabolism in fetal and neonatal life through different mechanisms.
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Affiliation(s)
- Jia Yin Soo
- Early Origins of Adult Health Research Group, Adelaide, SA, 5001, Australia; School of Pharmacy & Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA, 5001, Australia
| | - Michael D Wiese
- School of Pharmacy & Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA, 5001, Australia
| | - Mary J Berry
- Centre for Translational Physiology, Wellington, New Zealand; Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | | | - Janna L Morrison
- Early Origins of Adult Health Research Group, Adelaide, SA, 5001, Australia; School of Pharmacy & Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA, 5001, Australia.
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Zhang Y, Li Z, Zhang L, Liu J, Jin L, Ren A. Association between severe nausea and vomiting in early pregnancy and the risk of neural tube defects in Northern China. Birth Defects Res 2017; 110:406-412. [DOI: 10.1002/bdr2.1169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/10/2017] [Accepted: 10/28/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Yali Zhang
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health; National Health and Family Planning Commission of the People's Republic of China, Peking University; Beijing 100191 People's Republic of China
- Department of Epidemiology and Biostatistics; School of Public Health, Peking University; Beijing 100191 People's Republic of China
| | - Zhiwen Li
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health; National Health and Family Planning Commission of the People's Republic of China, Peking University; Beijing 100191 People's Republic of China
- Department of Epidemiology and Biostatistics; School of Public Health, Peking University; Beijing 100191 People's Republic of China
| | - Le Zhang
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health; National Health and Family Planning Commission of the People's Republic of China, Peking University; Beijing 100191 People's Republic of China
- Department of Epidemiology and Biostatistics; School of Public Health, Peking University; Beijing 100191 People's Republic of China
| | - Jufen Liu
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health; National Health and Family Planning Commission of the People's Republic of China, Peking University; Beijing 100191 People's Republic of China
- Department of Epidemiology and Biostatistics; School of Public Health, Peking University; Beijing 100191 People's Republic of China
| | - Lei Jin
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health; National Health and Family Planning Commission of the People's Republic of China, Peking University; Beijing 100191 People's Republic of China
- Department of Epidemiology and Biostatistics; School of Public Health, Peking University; Beijing 100191 People's Republic of China
| | - Aiguo Ren
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health; National Health and Family Planning Commission of the People's Republic of China, Peking University; Beijing 100191 People's Republic of China
- Department of Epidemiology and Biostatistics; School of Public Health, Peking University; Beijing 100191 People's Republic of China
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25
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Abstract
OBJECTIVE To examine the risk of birth defects in children born to women who used ondansetron early in pregnancy for nausea and vomiting of pregnancy or hyperemesis gravidarum. DATA SOURCES PubMed, EMBASE, Cochrane, Scopus, Web of Science, Journals@Ovid Fulltext, ClinicalTrials.gov, and Google Scholar databases. METHODS OF STUDY SELECTION Studies were included for review if they were written in English, included a comparison population of patients not exposed to ondansetron, and reported human data, original research, exposure to ondansetron during the first trimester, and structural birth defects as an outcome. TABULATION, INTEGRATION, AND RESULTS A total of 423 records were identified. After accounting for duplicate records and including only relevant articles, a total of eight records met criteria for review. Data from the various studies were conflicting: whereas the three largest studies showed no increased risk of birth defects as a whole (36 malformations, 1,233 exposed compared with 141 malformations and 4,932 unexposed; 58/1,248 exposed compared with 31,357/895,770 unexposed; and 38/1,349 exposed compared with 43,620/1,500,085 unexposed; with odds ratios [ORs] of 1.12 (95% confidence interval [CI] 0.69-1.82), 1.3 [95% CI 1.0-1.7], and 0.95 [95% CI 0.72-1.26], respectively), two of these studies demonstrated a slightly increased risk of cardiac defects specifically (OR 2.0 [95% CI 1.3-3.1] and 1.62 [95% CI 1.04-2.14]), a finding that was not replicated in other studies. The most consistent association (if any) appears to be a small increase in the incidence of cardiac abnormalities, the bulk of which are septal defects. CONCLUSION The overall risk of birth defects associated with ondansetron exposure appears to be low. There may be a small increase in the incidence of cardiac abnormalities in ondansetron-exposed neonates. Therefore, ondansetron use for nausea and vomiting of pregnancy should be reserved for those women whose symptoms have not been adequately controlled by other methods.
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Shawahna R, Taha A. Which potential harms and benefits of using ginger in the management of nausea and vomiting of pregnancy should be addressed? a consensual study among pregnant women and gynecologists. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:204. [PMID: 28390419 PMCID: PMC5385053 DOI: 10.1186/s12906-017-1717-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/01/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Nausea and vomiting of pregnancy (NVP) affect approximately 80-90% of the pregnant women. Ginger (Zingiber officinale Roscoe) is the most widely used herbal therapy in the management of NVP. Like conventional therapies, herbal therapies have potential harms and benefits that patients need to be informed about in order to develop their therapy preferences. The aim of this study was to achieve consensus among women who suffered NVP and physicians often consulted by pregnant women on a core list of potential harms and benefits of using ginger to manage NVP to be addressed during clinical consultations. METHODS In this study, the Delphi technique was used to achieve consensus on a core list of important harms and benefits of using ginger in the management of NVP to be addressed during the clinical consultation. A Delphi process was followed in two panels in parallel sessions. One panel was composed of 50 gynecologists and other physicians who are often consulted by pregnant women suffering NVP and the other panel was composed of 50 women who suffered NVP. RESULTS Consensus was achieved on 21 (75%) of the 28 potential harms presented to the panelists. Panelists agreed that potential harms of the anticoagulant effects of ginger, risk with other co-morbidities, and risk of potential allergic reactions are important to address during the clinical consultation. Of the 14 potential benefits presented to the panelists in both panels, consensus was achieved on 13 (92.9%). Partial consensus on 7 potential harms and 1 potential benefit was achieved in both panels. CONCLUSIONS Addressing important potential harms and benefits of using ginger for the management of NVP during the clinical consultations is important in promoting congruence and reducing patient dissatisfaction in clinical practice. Consensus was achieved on a core list of important harms and benefits of using ginger for the management of NVP to be addressed during the clinical consultations by a panel of women and a panel of physicians. Further studies are still needed to investigate what is being addressed during clinical consultations.
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Affiliation(s)
- Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, New Campus, Building: 19, Office: 1340, P.O. Box 7, Nablus, Palestine
- An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine
| | - Assim Taha
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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Crozier SR, Inskip HM, Godfrey KM, Cooper C, Robinson SM. Nausea and vomiting in early pregnancy: Effects on food intake and diet quality. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 27896913 PMCID: PMC5400073 DOI: 10.1111/mcn.12389] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 09/07/2016] [Accepted: 09/12/2016] [Indexed: 11/30/2022]
Abstract
Experiences of nausea and/or vomiting in pregnancy (NVP) vary greatly, but the paucity of studies with pre-pregnancy dietary data mean that little is known about the effects of NVP on diet. Using an administered food frequency questionnaire, diet was assessed before pregnancy and at 11 and 34 weeks' gestation in 2270 participants in a UK birth cohort study (Southampton Women's Survey). Experience of NVP in early pregnancy was graded as none, mild, moderate, or severe. Participants reported their level of food consumption as more, the same, or less than before pregnancy. "Prudent" diet scores (derived using principal component analysis) were used to describe participants' diet quality before, in early and late pregnancy. In early pregnancy, 89% of women were nauseous, although most commonly, the NVP experienced was mild (48%) or moderate (30%); 11% had severe NVP. A total of 39% of women reported an increase in their level of food intake in early pregnancy; 34% reported a reduction. Increasing severity of nausea was associated with changes in intake of a range of foods, most notably reduced consumption of vegetables, tea/coffee, rice/pasta, breakfast cereals, beans/pulses and citrus fruits/fruit juices and increased consumption of white bread, and soft drinks. Increasing severity of nausea was also associated with decreasing prudent diet score from before to early pregnancy, such that women with severe nausea had prudent diet scores 0.29 SDs lower than those with no nausea (P < 0.001). However, this was transient as NVP was not related to change in diet quality from before to late pregnancy.
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Affiliation(s)
- Sarah R Crozier
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Hazel M Inskip
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Sian M Robinson
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
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- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
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Yilmaz E, Yilmaz Z, Cakmak B, Karsli MF, Gultekin IB, Guneri Dogan N, Kara OF, Kucukozkan T. Nausea and Vomiting in Early Pregnancy of Adolescents: Relationship with Depressive Symptoms. J Pediatr Adolesc Gynecol 2016; 29:65-8. [PMID: 26143555 DOI: 10.1016/j.jpag.2015.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 06/16/2015] [Accepted: 06/22/2015] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To determine the relationship between severity of nausea and vomiting during pregnancy (NVP) and depressive symptoms in pregnant adolescents. DESIGN Prospective cross-sectional study. SETTING A maternity research hospital outpatient clinic, Ankara, Turkey. PARTICIPANTS A total of 200 pregnant adolescents. INTERVENTIONS AND MAIN OUTCOME MEASURES Demographic features and obstetric histories of the participants were assessed. The Rhodes test was performed to determine nausea and vomiting severity in a face-to-face interview, and the self-reported Edinburgh Postnatal Depression Scale was administered with supervision. RESULTS The Rhodes test results showed that 52/200 patients (26%) were classified with none, 83/200 patients (41.5%) with mild, 48/200 patients (24.0%) with moderate, and 17/200 patients (8.5%) with severe symptoms. The mean depression score in the severe vomiting group was significantly higher than that in the no NVP and mild NVP groups (P = .028 and .041, respectively). No differences were found between the other groups. CONCLUSION Severe nausea and vomiting was associated with greater depressive symptom severity in pregnant adolescents.
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Affiliation(s)
- Elif Yilmaz
- Dr Sami Ulus Women's and Children's Health Teaching and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Zehra Yilmaz
- Dr Sami Ulus Women's and Children's Health Teaching and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Bulent Cakmak
- Dr Sami Ulus Women's and Children's Health Teaching and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Mehmet Fatih Karsli
- Dr Sami Ulus Women's and Children's Health Teaching and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Ismail Burak Gultekin
- Dr Sami Ulus Women's and Children's Health Teaching and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Nihan Guneri Dogan
- Dr Sami Ulus Women's and Children's Health Teaching and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Osman Fadil Kara
- Dr Sami Ulus Women's and Children's Health Teaching and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Tuncay Kucukozkan
- Dr Sami Ulus Women's and Children's Health Teaching and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
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Arslan M, Ozdemir L. Oral intake of ginger for chemotherapy-induced nausea and vomiting among women with breast cancer. Clin J Oncol Nurs 2015; 19:E92-7. [PMID: 26414587 DOI: 10.1188/15.cjon.e92-e97] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chemotherapy-induced nausea and vomiting (CINV) is among the most common and distressing symptoms experienced by patients receiving cancer treatment. Nurses play a substantial role in the prevention and management of CINV. Ginger (Zingiber officinale Roscoe) is often advocated as beneficial for nausea and vomiting. Whether the herb is truly efficacious for this condition is, however, still a matter of debate. OBJECTIVES This experimental randomized, controlled trial was done to assess the effect of ginger on chemotherapy-related nausea and vomiting. METHODS All patients in the study (N = 60) received standard antiemetic drugs. The patients in the study group (n = 30) also received oral ginger for the first three days of the chemotherapy cycle. No intervention was performed in the control group (n = 30) except for the routine antiemetic treatment. Nausea severity and the number of vomiting and retching episodes were measured four times each day for the first five days of the chemotherapy cycle in the patient diary. Nausea severity was evaluated using a numeric scale ranging from 0 (no nausea) to 10 (very severe nausea). FINDINGS The researchers analyzed the five-day mean score of nausea severity and the number of vomiting and retching episodes. Based on this comparison, nausea severity and the number of vomiting episodes were significantly lower in the intervention group than in the control group (p > 0.05). However, the change in the number of retching episodes between the intervention and control groups was not statistically significant (p > 0.05).
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Smith JA, Julius JM, Gaikwad A, Berens PD, Alcorn J, Moise KJ, Refuerzo JS. Evaluating the potential effect on fetal tissue after exposure to granisetron during pregnancy. Reprod Toxicol 2015; 53:92-8. [DOI: 10.1016/j.reprotox.2015.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 02/19/2015] [Accepted: 02/27/2015] [Indexed: 11/15/2022]
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Pope E, Maltepe C, Koren G. Comparing pyridoxine and doxylamine succinate-pyridoxine HCl for nausea and vomiting of pregnancy: A matched, controlled cohort study. J Clin Pharmacol 2015; 55:809-14. [DOI: 10.1002/jcph.480] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/08/2015] [Accepted: 02/04/2015] [Indexed: 01/28/2023]
Affiliation(s)
- Eliza Pope
- Motherisk Program; Division of Clinical Pharmacology/Toxicology; The Hospital for Sick Children; Toronto Ontario Canada
- Faculty of Health Sciences; McMaster University; Hamilton Ontario Canada
| | - Caroline Maltepe
- Motherisk Program; Division of Clinical Pharmacology/Toxicology; The Hospital for Sick Children; Toronto Ontario Canada
| | - Gideon Koren
- Motherisk Program; Division of Clinical Pharmacology/Toxicology; The Hospital for Sick Children; Toronto Ontario Canada
- University of Toronto; Toronto Ontario Canada
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Ondansetron compared with doxylamine and pyridoxine for treatment of nausea in pregnancy: a randomized controlled trial. Obstet Gynecol 2015; 124:735-742. [PMID: 25198265 DOI: 10.1097/aog.0000000000000479] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate whether ondansetron or the combination of doxylamine and pyridoxine was superior for the treatment of nausea and vomiting of pregnancy. METHODS This was a double-blind, randomized, controlled trial in which women with nausea and vomiting of pregnancy were assigned to 4 mg of ondansetron plus a placebo tablet or 25 mg pyridoxine plus 12.5 mg of doxylamine for 5 days. The primary outcome was an improvement in nausea as reported on a 100-mm visual analog scale (VAS). Secondary outcomes were a reduction in vomiting on the VAS and the proportion of patients reporting sedation or constipation while using either study regimen. RESULTS Thirty-six women (18 in each group) were randomized to either ondansetron or pyridoxine and doxylamine, of whom 13 (72%) and 17 (94%) completed follow-up, respectively. There were no differences among the groups with regard to demographic characteristics or baseline nausea. Patients randomized to ondansetron were more likely to have an improvement in their baseline nausea as compared with those using pyridoxine and doxylamine over the course of 5 days of treatment (median VAS score decreased 51 mm [interquartile range 37-64] compared with 20 mm [8-51]; P=.019). Furthermore, women using ondansetron reported less vomiting (median VAS decreased 41 [interquartile range 17-57] compared with 17 [-4 to 38]; P=.049). There was no significant difference between the groups regarding sedation or constipation. CONCLUSION Our investigation showed ondansetron to be superior to the combination of pyridoxine and doxylamine in the treatment of nausea and emesis in pregnancy. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT01668069. LEVEL OF EVIDENCE : I.
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Clark SM, Dutta E, Hankins GDV. The outpatient management and special considerations of nausea and vomiting in pregnancy. Semin Perinatol 2014; 38:496-502. [PMID: 25267280 DOI: 10.1053/j.semperi.2014.08.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
With 50-90% of pregnant women experiencing nausea and vomiting of pregnancy (NVP), the burden of illness can become quite significant if symptoms are under-treated and/or under-diagnosed, thus allowing for progression of the disease. The majority of these women will necessitate at least one visit with a provider to specifically address NVP, and up to 10% or greater will require pharmacotherapy after failure of conservative measures to adequately control symptoms. As a result, initiation of prompt and effective treatment in the outpatient setting is ideal. Once NVP is diagnosed and treatment is started, it is crucial to track symptoms in order to assess for a decrease in or resolution of symptoms as well as an escalation in symptoms requiring additional therapy. Of note, co-existing gastroesophageal reflux disease (GERD), Helicobacter pylori infection, and psychosocial factors may have a negative impact on the management of NVP. Ultimately, every woman has her own perception of disease severity and desire for treatment. It is critical that both the provider and patient be proactive in the diagnosis and management of NVP.
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Affiliation(s)
- Shannon M Clark
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555.
| | - Eryn Dutta
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555; US Navy Medicine Professional Development Center, Bethesda, MD
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Julius JM, Tindall A, Moise KJ, Refuerzo JS, Berens PD, Smith JA. Evaluation of the maternal-fetal transfer of granisetron in an ex vivo placenta perfusion model. Reprod Toxicol 2014; 49:43-7. [PMID: 25019977 DOI: 10.1016/j.reprotox.2014.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 06/09/2014] [Accepted: 06/12/2014] [Indexed: 11/26/2022]
Abstract
The objective of this study was to estimate maternal-fetal transplacental passage of granisetron in an ex vivo placental perfusion model. Term human placentas (N=8) were collected immediately after delivery. A single cotyledon from each placenta was perfused granisetron concentration to mimic systemic maternal peak plasma concentrations following either IV (50ng/mL) or transdermal administration (5ng/mL). To assess drug transfer and accumulation, samples were collected from maternal and fetal compartments. In the 50ng/mL open model, the mean transport fraction was 0.21±0.08 with clearance index of 0.53±0.66. Fetal peak concentrations achieved was 5.6±6.6ng/mL with mean accumulation of 5.35±6.4ng/mL. No drug was detected in the fetal compartment with the 5ng/mL models. Transplacental passage of granisetron was inconsistent at the 50ng/mL concentration that achieved with IV dosing. However, there consistently was no detectable passage in all the placentas evaluated of the granisetron at 5ng/mL concentration that would be achieved after transdermal patch administration.
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Affiliation(s)
- Justin M Julius
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Andrew Tindall
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kenneth J Moise
- Department of Gynecology, Obstetrics & Reproductive Sciences, The University of Texas Health Sciences Center at Houston Medical School, Houston, TX, United States
| | - Jerrie S Refuerzo
- Department of Gynecology, Obstetrics & Reproductive Sciences, The University of Texas Health Sciences Center at Houston Medical School, Houston, TX, United States
| | - Pamela D Berens
- Department of Gynecology, Obstetrics & Reproductive Sciences, The University of Texas Health Sciences Center at Houston Medical School, Houston, TX, United States
| | - Judith A Smith
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; Department of Gynecology, Obstetrics & Reproductive Sciences, The University of Texas Health Sciences Center at Houston Medical School, Houston, TX, United States.
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Saberi F, Sadat Z, Abedzadeh-Kalahroudi M, Taebi M. Effect of ginger on relieving nausea and vomiting in pregnancy: a randomized, placebo-controlled trial. Nurs Midwifery Stud 2014; 3:e11841. [PMID: 25414888 PMCID: PMC4228518 DOI: 10.17795/nmsjournal11841] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 08/20/2013] [Accepted: 11/27/2013] [Indexed: 11/25/2022] Open
Abstract
Background: Nausea and vomiting are common and unpleasant complications in pregnancy. Although many alternative therapists support the use of ginger for nausea and vomiting of pregnancy, there is currently insufficient clinical evidence to support its use in this condition Objectives: The present study was performed to assess the effectiveness of ginger in the treatment of nausea and vomiting in pregnancy. Patients and Methods: This seven-day clinical trial was performed on 120 eligible pregnant women with symptoms of mild to moderate nausea and vomiting before 16 weeks gestation. They were divided into; ginger, placebo and control groups, by block randomization. Women were asked to record their nausea and vomiting for three days, and then participants received either ginger capsules, or a placebo for four days. No intervention was done with the control group. Data measure was self-recorded symptoms according to the Rhodes Index. Data were analyzed by ANOVA, ANCOVA, Kruskal-Wallis, Chi-square, and Fisher’s exact test, for the quantitative and qualitative variables. Results: There were no statistical differences in the baseline demographics between the three groups apart from age of marriage and wanted or unwanted pregnancy. An ANCOVA test (covariance test) showed significant differences in mean scores after the intervention in the three groups (P < 0.001). Conclusions: Ginger was effective for the relief of mild to moderate nausea and vomiting in pregnant women at less than 16 weeks gestation.
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Affiliation(s)
- Farzaneh Saberi
- Department of Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Zohreh Sadat
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | | | - Mahboobeh Taebi
- Department of Midwifery, Isfahan University of Medical Sciences, Isfahan, IR Iran
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Viljoen E, Visser J, Koen N, Musekiwa A. A systematic review and meta-analysis of the effect and safety of ginger in the treatment of pregnancy-associated nausea and vomiting. Nutr J 2014; 13:20. [PMID: 24642205 PMCID: PMC3995184 DOI: 10.1186/1475-2891-13-20] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 03/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Nausea and vomiting during pregnancy (NVP) occur commonly. Possible harmful side-effects of conventional medicine to the fetus create the need for alternative options to relieve NVP. This systematic review (SR) investigated current evidence regarding orally administered ginger for the treatment of NVP. The primary objective was to assess the effectiveness of ginger in treating NVP. The secondary objective was to assess the safety of ginger during pregnancy. METHODS A comprehensive electronic bibliographic database search was carried out. Randomized controlled trials (RCTs) of the efficacy of orally administered ginger, as treatment for NVP in pregnant women at any stage of pregnancy, published in English, were included. Two researchers independently extracted data and assessed trial quality. RevMan5 software (Cochrane Collaboration) was used for data analysis. p < 0.05 was considered statistically significant. RESULTS Twelve RCTs involving 1278 pregnant women were included. Ginger significantly improved the symptoms of nausea when compared to placebo (MD 1.20, 95% CI 0.56-1.84, p = 0.0002, I² = 0%). Ginger did not significantly reduce the number of vomiting episodes during NVP, when compared to placebo, although there was a trend towards improvement (MD 0.72, 95% CI -0.03-1.46, p = 0.06, I² = 71%). Subgroup analyses seemed to favor the lower daily dosage of <1500 mg ginger for nausea relief. Ginger did not pose a significant risk for spontaneous abortion compared to placebo (RR 3.14, 95% CI 0.65-15.11, p = 0.15; I² = 0%), or to vitamin B₆ (RR 0.49, 95% CI 0.17-1.42, p = 0.19, I² = 40%). Similarly, ginger did not pose a significant risk for the side-effects of heartburn or drowsiness. CONCLUSIONS This review suggests potential benefits of ginger in reducing nausea symptoms in pregnancy (bearing in mind the limited number of studies, variable outcome reporting and low quality of evidence). Ginger did not significantly affect vomiting episodes, nor pose a risk for side-effects or adverse events during pregnancy. Based on evidence from this SR, ginger could be considered a harmless and possibly effective alternative option for women suffering from NVP. International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42011001237.
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Affiliation(s)
- Estelle Viljoen
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
- Current affiliation: Discipline of Human Nutrition and Dietetics, School of Health Care Sciences, University of Limpopo, MEDUNSA Campus, Garankuwa, South Africa
| | - Janicke Visser
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Nelene Koen
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Alfred Musekiwa
- Centre for Evidence Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Saberi F, Sadat Z, Abedzadeh-Kalahroudi M, Taebi M. Acupressure and ginger to relieve nausea and vomiting in pregnancy: a randomized study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:854-61. [PMID: 24616799 PMCID: PMC3929824 DOI: 10.5812/ircmj.12984] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 07/21/2013] [Accepted: 08/10/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nausea and vomiting of pregnancy (NVP) is the most common medical condition of pregnancy, affecting up to 85% of expecting mothers. NVP can have serious adverse effects on the quality of a woman's life, social, and domestic functioning, and her general well-being. Therefore, it is very important to treat this condition. OBJECTIVES The effectiveness of ginger and acupressure in the treatment of NVP was compared in the present study. PATIENTS AND METHODS 159 eligible pregnant women with symptoms of mild to moderate nausea and/or vomiting before 16 weeks gestational age participated in a 7-day clinical trial. They were divided randomly into three groups: the acupressure, ginger, and control. Participants did not receive any intervention for three days and interventions were performed for the women in acupressure and ginger groups for four days. No intervention was performed for the control group. Data was collected by self-recorded symptoms according to the Rhodes index. Data was analyzed by ANOVA, Kruskal-Wallis, Chi-square, and Fisher exact tests for quantitative and qualitative variables. RESULTS There were no statistical differences in the baseline demographics between the three groups. ANOVA test showed that there were significantly differences in mean difference Rhodes index scores (vomiting, nausea, retching and total score) in the three groups (P < 0.001). CONCLUSIONS Ginger is more effective than acupressure to relieve mild to moderate nausea and vomiting in symptomatic pregnant women in less than 16 weeks of gestational age.
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Affiliation(s)
- Farzaneh Saberi
- Department of Midwifery, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Zohreh Sadat
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | | | - Mahboobeh Taebi
- Department of Midwifery, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, IR Iran
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Chortatos A, Haugen M, Iversen PO, Vikanes Å, Magnus P, Veierød MB. Nausea and vomiting in pregnancy: associations with maternal gestational diet and lifestyle factors in the Norwegian Mother and Child Cohort Study. BJOG 2013; 120:1642-53. [PMID: 23962347 DOI: 10.1111/1471-0528.12406] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2013] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate primarily the dietary intake, as well as demographics and selected lifestyle factors, of women experiencing nausea and vomiting in pregnancy, nausea only, or women who are symptom free. DESIGN Prospective cohort study. SETTING The Norwegian Mother and Child Cohort Study, a population-based pregnancy cohort. SAMPLE Analyses were based on 51 675 Norwegian pregnancies. METHODS Dietary intake was assessed by a self-reported food frequency questionnaire answered in the first trimester of pregnancy, as were data regarding nausea and vomiting. Chi-squared tests, one-way analysis of variance, and multiple linear regression were used. MAIN OUTCOME MEASURES Nausea and vomiting in pregnancy (NVP), gestational weight gain (GWG), and dietary intake. RESULTS We found that 17 070 (33%) women experienced NVP, 20 371 (39%) experienced only nausea, and 14 234 (28%) were symptom free. Women with NVP were younger and heavier at pregnancy onset, with the lowest GWG and highest energy intake during pregnancy, primarily from carbohydrates and added sugars, compared with the other groups (P < 0.001). In multiple linear regression analysis of GWG and group adjusted for body mass index (BMI), gestational length, smoking during pregnancy, and energy intake, a significant interaction was found between BMI and group (P < 0.001). A significant effect of group (P < 0.001) was found in all BMI strata, except among underweight women (P = 0.65). CONCLUSIONS Our study suggests that women with NVP are characterised by high intakes of carbohydrates and added sugar, primarily from sugar-containing soft drinks. Whether higher intakes of carbohydrates are a response aimed to alleviate symptoms, or are actually provoking the condition, is not known.
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Affiliation(s)
- A Chortatos
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Blindern, Oslo, Norway; Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Blindern, Oslo, Norway
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Preemptive treatment of nausea and vomiting of pregnancy: results of a randomized controlled trial. Obstet Gynecol Int 2013; 2013:809787. [PMID: 23476657 PMCID: PMC3588181 DOI: 10.1155/2013/809787] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 12/20/2012] [Accepted: 12/21/2012] [Indexed: 12/22/2022] Open
Abstract
Objectives. To determine whether the initiation of treatment (preemptive treatment) before the symptoms of nausea and vomiting of pregnancy (NVP) versus when the symptoms begin can improve the outcome in patients at a high risk for recurrence of severe NVP. Study Design. Prospective, randomized controlled trial. Results. Preemptive therapy conferred a significant reduction in HG as compared to the previous pregnancy (P = 0.047). In the preemptive arm, there were 2.5-fold fewer cases of moderate-severe cases of NVP than those in the control group (15.4% versus 39.13%) in the first 3 weeks of NVP (P = 0.05). In the preemptive group, significantly more women had their NVP resolved before giving birth (78.2% versus 50%) (P < 0.002). Conclusions. Preemptive treatment with antiemetics is superior to the treatment that starts only when the symptoms have already occurred in decreasing the risk of severe forms of NVP.
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Michieli M, Peccatori FA, Lleshi A, Del Pup L, Valente D, Rupolo M, Tirelli U, Berretta M. Antiblastic treatment of haematological malignancies during pregnancy: a crucial decision. Int J Immunopathol Pharmacol 2013; 25:21S-32S. [PMID: 23092517 DOI: 10.1177/03946320120250s202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Antiblastic treatment of hematological malignancies during pregnancy poses a number of issues related to the curability of the maternal disease, the need of a prompt treatment and the potential toxicity of chemotherapy for the fetus. Here we report the results of a systematic literature search about the management of the most frequent hematological malignancies that may occur during pregnancy, focusing on specific issues related to gestational age at diagnosis, fetal toxicity and efficacy on the maternal side. The standard approach in non-pregnant women is illustrated as reference.
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Affiliation(s)
- M Michieli
- Department of Medical Oncology, National Cancer Institute, Aviano (PN), Italy.
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Spiegel DR, Webb K. A case of treatment refractory hyperemesis gravidarum in a patient with comorbid anxiety, treated successfully with adjunctive gabapentin: a review and the potential role of neurogastroentereology in understanding its pathogenesis and treatment. INNOVATIONS IN CLINICAL NEUROSCIENCE 2012; 9:31-38. [PMID: 23346516 PMCID: PMC3552461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Hyperemesis gravidarum occurs in 0.3 to 10 percent of pregnant women, with a 0.8 percent hospital admission rate. While older theories supported the psychosocial model as a cause for hyperemesis gravidarum, more recent studies have shown significant data to support a biological etiology. Hyperemesis gravidarum has serious complications including include increased risk for miscarriage, low birth weight infants, dehydration, Wernicke's encephalopathy, secondary depression, and negative attitudes toward a consecutive pregnancy. Because of these life-threatening complications and complexity of the disease, it is important to treat both somatic and psychosocial causes of hyperemesis gravidarum to provide the best care for the patient. This paper presents a case of a woman with anxiety symptoms who was experiencing severe nausea and vomiting since Week 2 of pregnancy, with minimal reduction of these symptoms on standard medications utilized in hyperemesis gravidarum. The patient had marked reduction of nausea and vomiting with adjunctive gabapentin. After a brief review of relevant neurogastroenterology, we discuss a possible mechanism for the added gabapentin.
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Affiliation(s)
- David R Spiegel
- Drs. Spiegel and Webb are from Eastern Virginia Medical School, Department of Psychiatry and Behavioral Sciences in Norfolk, Virginia
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45
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Review of NVP and HG and Early Pharmacotherapeutic Intervention. Obstet Gynecol Int 2011; 2012:252676. [PMID: 22190950 PMCID: PMC3236407 DOI: 10.1155/2012/252676] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 10/15/2011] [Accepted: 10/15/2011] [Indexed: 12/03/2022] Open
Abstract
NVP occurs in 50–90% of pregnancies, making it a common medical condition in pregnancy. Women present differently with any combination of signs and symptoms. It is appropriate to take the pregnancy-related versus nonpregnancy-related approach when determining the cause of nausea and vomiting but other causes should be considered. The most common etiologies for NVP include the hormonal changes associated with pregnancy, the physiologic changes in the gastrointestinal tract, and a genetic predisposition. Up to 10% of women will require pharmacotherapy to treat the symptoms of NVP despite conservative measures. ACOG currently recommends that a combination of oral pyridoxine hydrochloride and doxylamine succinate be used as first-line treatment for NVP if pyridoxine monotherapy does not relieve symptoms. A review of NVP and early pharmacotherapeutic management is presented due to the fact that NVP is largely undertreated, and investigations into the safe and effective pharmacotherapies available to treat NVP are lacking.
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Anderka M, Mitchell AA, Louik C, Werler MM, Hernández-Diaz S, Rasmussen SA. Medications used to treat nausea and vomiting of pregnancy and the risk of selected birth defects. ACTA ACUST UNITED AC 2011; 94:22-30. [PMID: 22102545 DOI: 10.1002/bdra.22865] [Citation(s) in RCA: 134] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 08/27/2011] [Accepted: 08/30/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND Nausea and vomiting of pregnancy (NVP) occurs in up to 80% of pregnant women, but its association with birth outcomes is not clear. Several medications are used for the treatment of NVP; however, data are limited on their possible associations with birth defects. METHODS Using data from the National Birth Defects Prevention Study (NBDPS)-a multi-site, population-based, case-control study-we examined whether NVP or its treatment was associated with the most common noncardiac defects in the NBDPS (nonsyndromic cleft lip with or without cleft palate [CL/P], cleft palate alone [CP], neural tube defects, and hypospadias) compared with randomly selected nonmalformed live births. RESULTS Among the 4524 cases and 5859 controls included in this study, 67.1% reported first-trimester NVP, and 15.4% of them reported using at least one agent for NVP. Nausea and vomiting of pregnancy was not associated with CP or neural tube defects, but modest risk reductions were observed for CL/P (adjusted odds ratio [aOR] = 0.87; 95% confidence interval [CI], 0.77-0.98) and hypospadias (aOR = 0.84; 95% CI, 0.72-0.98). Regarding treatments for NVP in the first trimester, the following adjusted associations were observed with an increased risk: proton pump inhibitors and hypospadias (aOR = 4.36; 95% CI, 1.21-15.81), steroids and hypospadias (aOR = 2.87; 95% CI, 1.03-7.97), and ondansetron and CP (aOR = 2.37; 95% CI, 1.18-4.76), whereas antacids were associated with a reduced risk for CL/P (aOR = 0.58; 95% CI, 0.38-0.89). CONCLUSIONS NVP was not observed to be associated with an increased risk of birth defects; however, possible risks related to three treatments (i.e., proton pump inhibitors, steroids and ondansetron), which could be chance findings, warrant further investigation.
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Affiliation(s)
- Marlene Anderka
- Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston, Massachusetts 02108, USA.
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Koren G, Maltepe C, Gow R. Therapeutic choices for nausea and vomiting of pregnancy: a critical review of a systematic review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2011; 33:733-735. [PMID: 21749751 DOI: 10.1016/s1701-2163(16)34960-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
With 80% of pregnant women suffering from some degree of "morning sickness," or nausea and vomiting of pregnancy (NVP), symptom management is a major challenge. A recent Cochrane systematic review of randomized controlled trials concluded that, to date, there is no strong evidence of effectiveness for practically any therapeutic agent used for management of NVP. Because of fears of teratogenicity and litigation, RCTs are rarely conducted in pregnancy. In the absence of the best possible evidence from RCTs, well planned and executed prospective observational studies should be used as the best available evidence to guide clinical practice.
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Affiliation(s)
- Gideon Koren
- Motherisk Program, Hospital for Sick Children, Toronto ON
| | | | - Rachel Gow
- Motherisk Program, Hospital for Sick Children, Toronto ON
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