The safety of drugs for the treatment of nausea and vomiting of pregnancy

Abstract

Nausea and vomiting of pregnancy (NVP) is the most common medical condition of pregnancy, affecting up to 80% of all pregnancies to some degree. In most cases it subsides by the week 16 of pregnancy, although up to 20% of women continue to have symptoms throughout pregnancy. Severe NVP (Hyperemesis gravidarum) affects < 1% of women and in some severe cases can require hospitalization and rehydration of fluids. Women suffer not only physically but also psychologically, which has been documented in a number of studies. In addition, some women have decided to terminate their pregnancy rather than tolerate severe symptoms. Even less severe cases of NVP can have significant adverse effects on the quality of a woman's life, affecting her occupational, social, domestic functioning and general well being. Therefore, it is of great importance to treat this condition effectively to improve the quality of life for these women. In this paper, the authors review different classes of antiemetics used to treat this condition and discuss that some have better safety profiles than others, but most appear to be safe to use in pregnancy. Also included is a treatment algorithm that can assist the healthcare provider in treating this condition in pregnant safely and effectively.

Association between platelet to lymphocyte ratio, plateletcrit and the presence and severity of hyperemesis gravidarum

“…The first is that they directly inhibit the action histamine at H1 receptor level. The second is that they indirectly affect the vestibular system to prevent nausea and vomiting . Although many inflammatory markers have been studied for the early diagnosis of HG, to the best of our knowledge, this study is the first to investigate the association of the PLR and PCT with the presence and severity of HG.…”

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

“…However, their use in pregnancy is marred by lack of sufficient data on effectiveness and fetal safety [34]. The only drug approved and indicated for the treatment of NVP is the delayed-release formulation of 10 mg doxylamine succinate and 10 mg pyridoxine hydrochloride (HCl), as it has been shown to be both effective and safe [35–39].…”

Management of gastrointestinal and liver diseases during pregnancy

“…It should be noted that caution is warranted when these drugs are used continuously in the third trimester of pregnancy, as neonatal withdrawal and extrapyramidal effects have been reported in newborns 19. Regarding ondansetron, studies are available on several thousand women exposed to ondansetron in pregnancy, which have largely failed to report any increased risk of birth defects 12 15 21 22…”