Article

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

ABSTRACT

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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    • "Approximately 0.8–2 % of all pregnancies are complicated by HG[2]. Currently, there are no treatments with proven efficacy available according to the latest Cochrane review on interventions for nausea and vomiting in early pregnancy[1]. Hospitalisation can be required for intravenous treatment of dehydration and electrolyte imbalance. Currently, women who suffer from HG do not receive any particular nutritional attention, although enteral tube feeding is sometimes used as a treatment of last resort[2,13]. "
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    ABSTRACT: Background Hyperemesis gravidarum (HG), or intractable vomiting during pregnancy, is the single most frequent cause of hospital admission in early pregnancy. HG has a major impact on maternal quality of life and has repeatedly been associated with poor pregnancy outcome such as low birth weight. Currently, women with HG are admitted to hospital for intravenous fluid replacement, without receiving specific nutritional attention. Nasogastric tube feeding is sometimes used as last resort treatment. At present no randomised trials on dietary or rehydration interventions have been performed. Small observational studies indicate that enteral tube feeding may have the ability to effectively treat dehydration and malnutrition and alleviate nausea and vomiting symptoms. We aim to evaluate the effectiveness of early enteral tube feeding in addition to standard care on nausea and vomiting symptoms and pregnancy outcomes in HG patients. Methods/Design The MOTHER trial is a multicentre open label randomised controlled trial (www. studies-obsgyn. nl/ mother). Women ≥ 18 years hospitalised for HG between 5 + 0 and 19 + 6 weeks gestation are eligible for participation. After informed consent participants are randomly allocated to standard care with intravenous rehydration or early enteral tube feeding in addition to standard care. All women keep a weekly diary to record symptoms and dietary intake until 20 weeks gestation. The primary outcome will be neonatal birth weight. Secondary outcomes will be the 24-h Pregnancy Unique Quantification of Emesis and nausea score (PUQE-24), maternal weight gain, dietary intake, duration of hospital stay, number of readmissions, quality of life and side-effects. Also gestational age at birth, placental weight, umbilical cord plasma lipid concentration and neonatal morbidity will be evaluated. Analysis will be according to the intention to treat principle. Discussion With this trial we aim to clarify whether early enteral tube feeding is more effective in treating HG than intravenous rehydration alone and improves pregnancy outcome. Trial registration Trial registration number: NTR4197. Date of registration: October 2nd 2013.
    Full-text · Article · Dec 2016 · BMC Pregnancy and Childbirth
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    • "Currently, medical approaches are usually used to alleviate or eliminate NVP. However, sufficient evidence indicating that medical approaches are effective is not currently available [7] [8]. "
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    ABSTRACT: Objectives: The aim of this study was to assess the effects of follow-up counselling on the duration and severity of nausea and vomiting in pregnant women. Study design: This study is quasi-experimental and included 62 pregnant women with nausea and vomiting. The group that received counselling was considered to be the experimental group, and the group that received a standard outpatient clinic service was the control group. Data were collected with a demographic data form, that is, the Nausea and Vomiting in Pregnancy Instrument and Pregnancy Unique Quantification of Emesis and Nausea. Significance tests of the differences between two mean values, the Mann-Whitney U test and survival analyses were used to test the hypotheses. Results: In pregnant women with mild or moderate nausea and vomiting, nausea and vomiting terminated in a significantly shorter time in the experimental group than in the control group (p <. 0.001), but this difference was not significant for pregnant women with severe nausea and vomiting (p > 0.05). In addition, the number of weekly telephone follow-ups in the experimental group was significantly smaller (p <. 0.001). Conclusion: Counselling effectively reduced the duration and severity of mild or moderate nausea and vomiting during pregnancy. However, it did not affect the duration of severe nausea and vomiting during pregnancy.
    Full-text · Article · Nov 2015
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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.
    Full-text · Article · Sep 2015
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