September 23, 2015
Recent Guidelines Offer New Options for “Morning
Washington, D.C.—So-called “morning sickness” often is undertreated in pregnant women, even though it can affect the health of the mother and fetus as well as lowering quality of life and adding to medical costs.
That’s according to a new practice bulletin published recently in the journal Obstetrics & Gynecology, which also points out that some mothers-to-be are hesitant to seek treatment because of concerns about the safety of medications.
In updating 2004 guidelines, the American College of Obstetricians & Gynecologists now recommends the combination of doxylamine and vitamin B6, which was taken off the market in 1983, saying that it has been proven safe and effective. In fact, ACOG says the combination should be considered first-line pharmacotherapy.
In 2013, the FDA approved Diclegis (doxylamine succinate and pyridoxine hydrochloride) for women who have not adequately responded to conservative management of nausea and vomiting during pregnancy, such as dietary and lifestyle modifications.
As for ondansetron, marketed as Zofran, the review includes a list of medications that should be avoided when taking the drug. The review notes that, while some studies have shown an increased risk for birth defects with early ondansetron use, other studies have not. It concludes that the absolute risk to any fetus is low, but, as with all medications, suggests the risks and benefits should be weighed in each case.
The practice bulletin points out that about 50% of pregnant women experience nausea and vomiting, 25% have nausea only, and 25% are unaffected. Recurrence with subsequent pregnancies ranges from 15.2% to 81%, the authors report.
The guideline urges that nausea and vomiting be treated early in pregnancy, before the condition progresses, to help control symptoms and prevent more serious complications, including hospitalization.
The document also cautions that, since “morning sickness” symptoms almost always present before 9 weeks of gestation, nausea or vomiting that begin after 9 weeks should be evaluated for other causes.
In other advice, guideline authors endorse taking prenatal vitamins for 3 months before conception, suggesting that could reduce the incidence and severity of nausea and vomiting in pregnancy.
Only limited evidence was found for using ginger to relieve nausea, although authors said it could be considered a nonpharmacologic option.
Limited evidence also was available for treatment of severe nausea and vomiting of pregnancy, or hyperemesis gravidarum, with methylprednisolone; although it could be effective in refractory cases, the risk profile of methylprednisolone suggests it should be used as a last resort, according to guideline authors.
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