Contemporary approaches to hyperemesis during pregnancy

Department of Obstetrics and Gynecology, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia.
Current opinion in obstetrics & gynecology (Impact Factor: 2.07). 02/2011; 23(2):87-93. DOI: 10.1097/GCO.0b013e328342d208
Source: PubMed


Nausea and vomiting of pregnancy (NVP) affects 90% of pregnant women and its impact is often underappreciated. Hyperemesis gravidarum, the most severe end of the spectrum, affects 0.5-2% of pregnancies. The pathogenesis of this condition remains obscure and its management has largely been empirical. This review aims to provide an update on advances in pregnancy hyperemesis focusing on papers published within the past 2 years.
The cause of hyperemesis is continuing to be elaborated. Recent data attest to the effectiveness of the oral doxylamine-pyridoxine in NVP. Follow-up data of children exposed in early pregnancy to doxylamine-pyridoxine for NVP are reassuring. Evidence is increasing for ginger as an effective herbal remedy for NVP. Metoclopramide is effective in NVP and hyperemesis gravidarum, with a good balance of efficacy and tolerability. A recent large-scale study on first trimester exposure to metoclopramide is reassuring of its safety. Evidence is emerging for the treatment of acid reflux to ameliorate NVP. The role of corticosteroids for hyperemesis gravidarum remains controversial. Transpyloric feeding may be warranted for persistent weight loss, despite optimal antiemetic therapy.
Women with significant NVP should be identified so that they can be safely and effectively treated.

1 Follower
19 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: To compare the effects of promethazine with those of metoclopramide for hyperemesis gravidarum. Women at their first hospitalization for hyperemesis gravidarum were approached when intravenous antiemetic therapy was needed. They were randomly assigned to receive 25 mg promethazine or 10 mg metoclopramide every 8 hours for 24 hours in a double-blind study. Primary outcomes were vomiting episodes by diary and well-being visual numerical rating scale score (10-point scale) in the 24-hour main study period. Participants also filled out an adverse-effects questionnaire at 24 hours and a nausea visual numerical rating scale score at recruitment and at 8, 16, and 24 hours. A total of 73 and 76 women, randomized to metoclopramide and promethazine, respectively, were analyzed. Median vomiting episodes were one (range 0-26) compared with two (range 0-26) (P=.81), and well-being visual numerical rating scale scores were 8 (range 1-10) compared with 7 (range 2-10) (P=.24) for metoclopramide and promethazine, respectively. Repeat-measures analysis of variance of the nausea visual numerical rating scale scores showed no significant difference between study drugs (F score=0.842, P=.47). Reported drowsiness (58.6% compared with 83.6%, P=.001, number needed to treat to benefit [NNTb] 5), dizziness (34.3% compared with 71.2%, P<.001, NNTb 3), dystonia (5.7% compared with 19.2%, P=.02, NNTb 8), and therapy curtailment owing to adverse events (0 of 73 [0%] compared with 7 of 76 [9.2%], P=.014) were encountered less frequently with metoclopramide. Promethazine and metoclopramide have similar therapeutic effects in patients who are hospitalized for hyperemesis gravidarum. The adverse effects profile was better with metoclopramide.
    No preview · Article · May 2010 · Obstetrics and Gynecology
  • [Show abstract] [Hide abstract]
    ABSTRACT: This is a descriptive retrospective case series of 14 pregnant women treated with ondansetron for hyperemesis gravidarum (HG) at CHU Sainte-Justine, from January 2002 to October 2011. Two of the patients received ondansetron during two separate pregnancies. Both pregnancies were analyzed separately for the purposes of this study. Another woman had twins who were included in the analysis. Therefore, the outcomes of 16 pregnancies and 17 newborns are presented. The patients were on average 28.1 ± 4.6 years old and were admitted to the hospital 5.0 ± 4.0 times. All patients who received ondansetron had previously been treated using the standard HG protocol to which they had not optimally responded. Ondansetron was initiated on average at 11.8 ± 4.8 weeks' gestation. In seven cases, administration was carried out during organogenesis. We observed 16 live births, including a set of twins, and one minor birth defect (isolated atrial and ventricular septal defects) reported after a second trimester exposure. Mean gestational age at birth was 36.9 ± 3.4 weeks and mean birth weight was 2.85±0.86 kg. We also noted six other pregnancy or neonatal outcomes (intrauterine growth retardation [IUGR] for each twin and a in a single pregnancy, a transient tachypnea, a mild hydrocele, and an extrarenal pelvis). Furthermore, we noted two premature births, one at 24 weeks of gestation and her infant died in the first weeks of life due to complications of prematurity and a second birth at 36 2/7 weeks of gestation. Teratogenicity associated with the use of ondansetron has so far not been shown in humans. This case series adds information on ondansetron use during pregnancy. However, until we have more published data, ondansetron should be used as a second-line agent for the management of HG.
    No preview · Article · Jan 2012 · The Canadian journal of clinical pharmacology = Journal canadien de pharmacologie clinique
  • [Show abstract] [Hide abstract]
    ABSTRACT: Ginger is a common traditional remedy taken by numerous women experiencing nausea and vomiting in pregnancy (NVP). There is considerable evidence to support its effectiveness as an anti-emetic, but also increasing concern over its safety. Ginger is a powerful herbal medicine which acts pharmacologically and thus has specific indications, contraindications, precautions and side-effects, the most notable of which is an anticoagulant action. Midwives and other professionals advising women in early pregnancy about strategies for coping with NVP should be aware of the risks and benefits of ginger in order to provide comprehensive and safe information to expectant mothers. This paper reviews some of the contemporary research evidence which demonstrates that ginger is not a universally appropriate or safe choice for women with NVP and offers a checklist for professionals advising expectant mothers.
    No preview · Article · Feb 2012 · Complementary therapies in clinical practice
Show more