Antiemetic use among pregnant women in the United States: the escalating use of ondansetron

Taylor, Lisa; Bird, Steven T.; Şahin, Leyla; Tassinari, Melissa S.; Greene, Patty; Reichman, Marsha E.; Andrade, Susan E.; Haffenreffer, Katherine; Toh, Sengwee

doi:10.1002/pds.4185

Cited by 51 publications

(58 citation statements)

References 15 publications

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“…While mouse studies cannot be directly translated to humans, the results of altered 5-HT3A receptor signaling that we describe suggest more thorough investigation focused on the outcomes of pharmacological intervention at this receptor during gestation is warranted. Ondansetron, a potent 5-HT3A receptor antagonist, is commonly prescribed to pregnant women to treat severe nausea (Mcparlin et al, 2016 ; Taylor et al, 2017 ). Additionally, the selective serotonin reuptake inhibitor (SSRI) fluoxetine, which is also prescribed frequently to pregnant women for the treatment of depression, has been shown by other groups to interact with 5-HT3A (Eisensamer et al, 2003 ; Smit-Rigter et al, 2012 ).…”

Section: Discussionmentioning

confidence: 99%

Serotonin Receptor 5-HT3A Affects Development of Bladder Innervation and Urinary Bladder Function

et al. 2017

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The autonomic and sensory nervous systems are required for proper function of all visceral organs, including the lower urinary tract (LUT). Despite the wide prevalence of bladder dysfunction, effective treatment options remain limited. Pelvic innervation regenerative strategies are promising, but surprisingly little is known about the molecular factors driving the development of bladder innervation. Given prior evidence that serotonin receptor 5-HT3A is expressed early in LUT development and is an important mediator of adult bladder function, we sought to determine if 5-HT3A is required for the development of autonomic innervation of the bladder. We found that 5-HT3A is expressed early in fetal mouse pelvic ganglia and is maintained through adulthood. Htr3a knockout male mice, but not females, exhibit increased urinary voiding frequency compared to wild type littermates. Analysis of LUT function via anesthetized cystometry revealed decreased voiding efficiency in male Htr3a mutants. Htr3a−/− mutant animals exhibit a transient disturbance of autonomic neuronal subtype markers (tyrosine hydroxylase and choline acetyl transferase) within the fetal pelvic ganglia, although the imbalance of neuronal subtype markers assayed is no longer apparent in adulthood. Loss of 5-HT3A activity results in a higher density of autonomic and sensory neuronal fibers supplying bladder smooth muscle in both fetal and adult mice. Collectively, our findings highlight 5-HT3A as a critical component in the autonomic control of micturition and identify a novel role for this serotonin receptor in peripheral nervous system development.

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Section: Discussionmentioning

confidence: 99%

Serotonin Receptor 5-HT3A Affects Development of Bladder Innervation and Urinary Bladder Function

et al. 2017

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“… 35 However, an increasing body of evidence suggests that these drugs can be used safely in the perioperative setting also in CS patients: a marked increase in ondansetron use, prescribed to nearly one-quarter of insured pregnant women in 2014, occurring in conjunction with decreased use of promethazine and metoclopramide has been reported. 37 Albeit, based on limited human pregnancy data, ondansetron has not been associated with a significantly increased risk of birth defects or other adverse pregnancy outcomes. 38 …”

Section: Discussion: Current Guidelines and Literaturementioning

confidence: 99%

Preventing nausea and vomiting in women undergoing regional anesthesia for cesarean section: challenges and solutions

Jelting

Klein

Harlander

et al. 2017

LRA

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BackgroundIntraoperative nausea and vomiting (IONV) or postoperative nausea and vomiting (PONV) affecting women undergoing regional anesthesia for cesarean section is an important clinical problem since these techniques are used widely. There are burdens of literature about IONV/PONV and several in parturient and cesarean. However, it needs more attention. The underlying mechanisms of IONV and PONV in the obstetrical setting mainly include hypotension due to sympathicolysis during neuraxial anesthesia, bradycardia owing to an increased vagal tone, the visceral stimulation via the surgical procedure and intravenously administered opioids.MethodsGiven the high and even increasing rate of cesarean sections and the sparse information on the etiology, incidence and severity of nausea and vomiting and the impact of prophylactic measures on the incidence of PONV/IONV, this article aims to review the available information and provide pragmatic suggestions on how to prevent nausea and vomiting in this patient cohort. Current literature and guidelines were identified by electronic database searching (MEDLINE via PubMed and Cochrane database of systematic reviews) up to present, searching through reference lists of included literature and personal contact with experts.Discussion and conclusionTaking into account the current guidelines and literature as well as everyday clinical experience, the first step for decreasing the incidence of IONV and PONV is a comprehensive management of circulatory parameters. This management includes liberal perioperative fluid administration and the application of vasopressors as the circumstances require. By using low-dose local anesthetics, an additional application of intrathecal or spinal opioids or hyperbaric solutions for a sufficient controllability of neuraxial distribution, maternal hypotension might be reduced. Performing a combined spinal–epidural anesthesia or epidural anesthesia may be considered as an alternative to spinal anesthesia. Antiemetic drugs may be administered restrainedly due to off-label use in pregnant women for IONV or PONV prophylaxis and may be reserved for treatment.

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“…In the fetus/newborn, the metabolic pathways are subject to developmental changes, and thus, enzyme activity levels are in flux. A number of medications reportedly used during and after pregnancy are known to be impacted by PGx variants, including medications for nausea,56 prevention of preterm labor,57 opiate maintenance such as methadone,39 and pain 58–60. Predictive models of transfer into human milk thus far have not accounted for maternal PGx variants 28,61,62.…”

Section: Prenatal and Newborn Periodmentioning

confidence: 99%

<p>Pharmacogenomic Testing In Pediatrics: Navigating The Ethical, Social, And Legal Challenges</p>

Haga

2019

PGPM

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For the past several years, the implementation of pharmacogenetic (PGx) testing has become widespread in several centers and clinical practice settings. PGx testing may be ordered at the point-of-care when treatment is needed or in advance of treatment for future use. The potential benefits of PGx testing are not limited to adult patients, as children are increasingly using medications more often and at earlier ages. This review provides some background on the use of PGx testing in children as well as mothers (prenatally and post-natally) and discusses the challenges, benefits, and the ethical, legal, and social implications of providing PGx testing to children.

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Antiemetic use among pregnant women in the United States: the escalating use of ondansetron

Cited by 51 publications

References 15 publications

Serotonin Receptor 5-HT3A Affects Development of Bladder Innervation and Urinary Bladder Function

Serotonin Receptor 5-HT3A Affects Development of Bladder Innervation and Urinary Bladder Function

Preventing nausea and vomiting in women undergoing regional anesthesia for cesarean section: challenges and solutions

<p>Pharmacogenomic Testing In Pediatrics: Navigating The Ethical, Social, And Legal Challenges</p>

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