Interventions for nausea and vomiting in early pregnancy

School of Nursing, Dublin City University, Collins Avenue, Dublin, Ireland, 9.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 03/2014; 3(3):CD007575. DOI: 10.1002/14651858.CD007575.pub3
Source: PubMed


Nausea, retching or dry heaving, and vomiting in early pregnancy are very common and can be very distressing for women. Many treatments are available to women with "morning sickness", including drugs and complementary and alternative therapies. This review aimed to examine if these treatments have been found to be effective and safe because of the concern that taking medications may adversely affect the development of the fetus. This review found a lack of high-quality evidence to back up any advice on which interventions to use. We examined 27 randomised controlled trials which included 4041 women in early pregnancy. These studies examined the effectiveness of many treatments including acupressure to the acupuncture point on the wrist (P6), acustimulation, acupuncture, ginger, vitamin B6 and several conventional drugs that are used to reduce nausea or vomiting. Some studies showed a benefit in improving nausea and vomiting symptoms for women, but generally effects were inconsistent and limited. Studies were carried out in a way that meant they were at high risk of bias, and therefore, it was difficult to draw firm conclusions. Most studies had different ways of measuring the symptoms of nausea and vomiting and therefore, we could not look at these findings together. Few studies reported maternal and fetal adverse outcomes and there was very little information on the effectiveness of treatments for improving women's quality of life.

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Available from: David M Haas, Oct 09, 2014
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    • "Nausea and vomiting of pregnancy (NVP) is a common condition affecting 70–85% of pregnancies [1]. Hyperemesis gravidarum (HG) is a severe form of NVP most commonly defined as persistent vomiting not related to other causes, ketonuria, and weight loss greater than 5% of prepregnancy weight [2]. "
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    ABSTRACT: A 21-year-old primigravida had a pregnancy complicated by hyperemesis gravidarum (HG) beginning at 7-week gestation. Despite medical therapy, she lost 18% of her prepregnancy weight. Early ultrasound at 14 weeks demonstrated a flattened facial profile with nasal hypoplasia (Binder phenotype) consistent with vitamin K deficiency from HG. She had a percutaneous endoscopic gastrojejunostomy tube placed for enteral feeding at 15-week gestation. At repeated anatomy ultrasound at 21-week gestation, delivery, and postnatal pediatric genetics exam, nasal hypoplasia was consistent with vitamin K deficiency embryopathy from HG. Nausea and vomiting of pregnancy is a common condition. HG, the most severe form, has many maternal and fetal effects. Evaluation of vitamin K status could potentially prevent this rare and disfiguring embryopathy.
    09/2015; 2015(4):324173. DOI:10.1155/2015/324173
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    • "In general, there has been a lack of high-quality evidence to support the effectiveness of any specific intervention in NVP,21 but available data support the efficacy of doxylamine and pyridoxine as an antiemetic for mild-to-moderate NVP (Table 1). A randomized controlled trial of the effectiveness of the delayed-release combination of doxylamine succinate 10 mg and pyridoxine hydrochloride 10 mg (Diclectin) for NVP was crucial for its reintroduction by the FDA into practice in the US. "
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    ABSTRACT: Nausea and vomiting in pregnancy (NVP) is common and often undertreated, in part due to fears of adverse effects of medications on the fetus during early pregnancy. In April 2013, the US Food and Drug Administration (FDA) approved doxylamine succinate 10 mg and pyridoxine hydrochloride (a vitamin B6 analog) 10 mg as a delayed-release combination pill called Diclegis for the treatment of NVP. Diclegis is currently the only medication that is FDA-approved for the indication of NVP. This review addresses the historical context, safety, efficacy, pharmacology, and practical role of doxylamine and pyridoxine for the management of NVP. The reintroduction of this doxylamine-pyridoxine combination pill into the American market fills a therapeutic gap in the management of NVP left by the removal of the same active drugs marketed over 30 years ago in the form of Bendectin. The substantial amount of safety data accumulated over the years makes it one of the few drugs that qualify for FDA Pregnancy Category A status. In the hierarchical approach to pharmacological treatment of NVP, the combination of doxylamine and pyridoxine should thus be first-tier.
    International Journal of Women's Health 04/2014; 6(1):401-409. DOI:10.2147/IJWH.S46653
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    • "Literature indicate that the exact cause and treatment of NVP is still unclear [2,6,17,34-37]. Mothers and health practitioners often investigate alternative options to alleviate symptoms of NVP, due to the possible harmful side effects that conventional medicine may pose to the unborn fetus. In this regard, ginger is considered by many as a possible non-pharmacological treatment option for NVP. "
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    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. 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. 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. 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.
    Nutrition Journal 03/2014; 13(1):20. DOI:10.1186/1475-2891-13-20 · 2.60 Impact Factor
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