Review of NVP and HG and Early Pharmacotherapeutic Intervention

Division of MFM, Department of Obstetrics and Gynecology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA.
Obstetrics and Gynecology International 01/2012; 2012:252676. DOI: 10.1155/2012/252676
Source: PubMed

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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    ABSTRACT: We report a study on nausea and vomiting of pregnancy (NVP) and pregnancy-related food aversions in a small-scale society from Yasawa Island, Fiji. Because NVP has rarely been studied quantitatively in small-scale populations, we begin with a detailed description of its expression among the women of Yasawa. We found that 66% of these women experience nausea and/or vomiting in tandem with the development of aversions to certain foods. This pattern of expression is similar to what has been documented for industrialized populations, and the prevalence of 66% is close to the industrialized mean prevalence of 69%. We then use the data from the women of Yasawa to evaluate the three main hypotheses that have been put forward to explain the evolution and ecological function of NVP. We show that food aversions of pregnancy focus preferentially on food types that are more likely to carry pathogens or contain chemical toxins. Such aversions do not focus on nutrient-dense foods or on frequently encountered foods. These findings are most consistent with a hypothesis that NVP, along with pregnancy-related aversions, evolved to motivate women to avoid exposure to diseases and other toxins when they are immune-compromised by pregnancy and during a critical period of embryo development. These findings contribute to a growing body of theoretical and empirical literature that suggests that NVP symptoms represent a series of adaptations rather than pathological responses to the physiological demands of pregnancy.
    Evolution and Human Behavior 10/2014; 36(2). DOI:10.1016/j.evolhumbehav.2014.09.005 · 2.87 Impact Factor
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    ABSTRACT: Nausea and vomiting of pregnancy (NVP) affects up to 85 % of all pregnancies. Effective treatment can greatly improve a woman's quality of life, reduce the risk for maternal and fetal complications, and reduce healthcare costs. Unfortunately, many women receive either no pharmacological treatment or are recommended therapies for which fetal safety and efficacy have not been established. First-line treatment of NVP, as recommended by several leading healthcare and professional organizations, is the combination of doxylamine and pyridoxine. This combination, formulated as a 10 mg/10 mg delayed-release tablet, was approved by the US Food and Drug Administration (FDA) for the treatment of NVP in April 2013 under the brand name Diclegis(®), and has been on the Canadian market since 1979, currently under the brand name Diclectin(®). The efficacy of Diclegis(®)/Diclectin(®) has been demonstrated in several clinical trials, and, more importantly, studies on more than 200,000 women exposed to doxylamine and pyridoxine in the first trimester of pregnancy have demonstrated no increased fetal risk for congenital malformations and other adverse pregnancy outcomes. The present review aims to present the scientific evidence on the effectiveness and fetal safety of Diclegis(®)/Diclectin(®) for the treatment of NVP to justify its use as first-line treatment for NVP.
    Paediatric Drugs 02/2014; 16(3). DOI:10.1007/s40272-014-0065-5 · 1.72 Impact Factor
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    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.
    Seminars in Perinatology 09/2014; DOI:10.1053/j.semperi.2014.08.014 · 2.42 Impact Factor

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