SURVIVING MORNING SICKNESS SUCCESSFULLY: FROM PATIENT’S PERCEPTION TO RATIONAL MANAGEMENT
Main Article Content
Keywords
Pregnancy, nausea and vomiting, hyperemesis gravidarum, pharmacological and non - pharmacological management
Abstract
Nausea and vomiting of pregnancy (NVP) affects up to 85% of pregnant women, with varying degrees of severity. The most severe form of NVP, known as hyperemesis gravidarum (HG), affects up to 2% of pregnancies. Women who have suffered with severe NVP/HG in a previous pregnancy have a 75 -85% recurrence rate. Both patients and physicians often fear the use of pharmacological therapies during pregnancy due to the concerns of potential risks to the fetus. The symptoms and impact of NVP and HG can vary greatly among women, therefore treatment must be tailored to the individual. Updated Motherisk guidelines are presented.
References
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6. Koren G, Maltepe C. Pre-emptive therapy for severe nausea and vomiting of pregnancy and hyperemesis gravidarum. J Obste t Gynaecol 2004;24(5):530- 533.
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9. Piwko C, Ungar WJ, Einarson TR, et al. The weekly cost of nausea and vomiting of pregnancy for women calling the Toronto Motherisk Program. Curr Med Res Opin 2007;23(4):833- 840.
10. Piwko C, Koren G, Babashov V, et al. Economic burden of nausea and vomiting of pregnancy in the USA. J Popul Ther Clin Pharmacol 2013 [cited 2014 Oct 15];20(2):e149- 160. Available from: http ://www.jptcp.com/jptcp_1308_e149_e160_p iwko -pdf -r194583
11. Fejzo MS, Poursharif B, Korst LM, et al. Symptoms and pregnancy outcomes associated with extreme weight loss among women with hyperemesis gravidarum. J Women's Health (Larchmt) 2009;18(12):1981- 1987.
12. Veenendaal MV, van Abeelen AF, Painter RC, et al. Consequences of hyperemesis gravidarum for offspring: a systematic review and meta-analysis. BJOG 2011;118(11):1302- 1313.
13. Baggley A, Navioz Y, Maltepe C, et al. Determinants of women's decision making on whether to treat nausea and vomiting of pregnancy pharmacologically. J Midwifery Women's Health 2004;49(4):350- 354.
14. Niemeijer MN, Grooten IJ, Vos N, et al. Diagnostic markers for hyperemesis gravidarum: a systematic review and meta-analysis. Am J Obstet Gyn ecol 2014;211(2):150.e1- 15. doi: 10.1016/j.ajog.2014.02.012. Epub 2014 Feb 13.
15. Verberg MF, Gillott DJ, Al -Fardan N, et al. Hyperemesis gravidarum, a literature review. Hum Reprod Update. 2005;11(5):527– 539.
16. Goodwin TM. Hyperemesis gravidarum. Obstet Gyneco l Clin N Am 2008;35:401- 417.
17. Einarson A, Maltepe C, Boskovic R, at al. Treatment of nausea and vomiting in pregnancy. An updated algorithm. Can Fam Physician 2007[cited 2014 Jul 26];53(12):2109- 2111. Available from: http://www.cfp.ca/content/53/12/2109.full.pdf+html
18. Koren G, Maltepe C. How to survive morning sickness successfully. Toronto (ON): Motherisk; 2013 [cited 2014 Jul 27]. Available from: www.motherisk.org/documents/BSRC_morning _sickness_EN.pdf
19. Maltepe C, Koren G. Preemptive treatment of nausea and vomiting of pregnancy: results of a randomized controlled trial. Obstet Gynecol Int 2013 [cited 2014 Jul 27] ;2013:809787. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC 3588181
20. Gill SK, Maltepe C, Koren G. The effect of heartburn and acid reflux on the severity of nausea and vomiting of pregnancy. Can J Gastroenterol 2009 [cited 2012 Jul 26];23(4):270- 272. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC 2711677
21. Gill SK, Maltepe C, Mastali K, et al. The effect of acid-reducing pharmacotherapy on the severity of nausea and vomiting of pregnancy. Obstet Gynecol Int 2009 [cited 2014 Jul 26];2009:585269. Available from: http://www.ncbi.nlm.ni h.gov/pmc/articles/PMC 2778456
22. Law R, Maltepe C, Bozzo P, et al. Treatment of heartburn and acid reflux associated with nausea and vomiting during pregnancy. Can Fam Physician 2010 [cited 2014 Jul 26];56(2):143- 144. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC 2821234/pdf/0560143.pdf
23. Gill SK, Maltepe C, Koren G. The effectiveness of discontinuing iron-containing prenatal multivitamins on reducing the severity of nausea and vomiting of pregnancy. J Obstet Gynaecol 2009;29(1):13- 16.
24. Product monograph. Diclectin. Blainville (QC): Duchesnay Inc.; 2014 Jul 2 [cited 2014 Oct 13] . Available from: http://webprod5.hc - sc.gc.ca/dpd -bdpp/item -iteme.do?pm - mp=00025684
25. Atanackovic G, Navioz Y, Moretti ME, et al. The safety of higher than standard dose of doxylamine -pyridoxine (Diclec tin) for nausea and vomiting of pregnancy. J Clin Pharmacol 2001;41(8):842- 845.
26. Nulman I, Rovet J, Barrera M, et al. Long- term neurodevelopment of children exposed to maternal nausea and vomiting of pregnancy and diclectin. J Pediatr 2009;155(1):45 -50.
27. Ko ren G, Clark S, Hankins GD, et al. Effectiveness of delayed -release doxylamine and pyridoxine for nausea and vomiting of pregnancy: a randomized placebo controlled trial. Am J Obstet Gynecol 2010;203(6):571.e1- 7. doi: 10.1016/j.ajog.2010.07.030. Epub 2010 Sep 16.
28. Seto A, Einarson T, Koren G. Pregnancy outcome following first trimester exposure to antihistamines: meta -analysis. Am J Perinatol 1997;14(3):119- 124.
29. Gill SK, Einarson A. The safety of drugs for the treatment of nausea and vomiting of pregnancy. Expert Opin Drug Saf 2007;6(6):685- 694.
30. Matok I, Gorodischer R, Koren G, et al. The safety of metoclopramide use in the first trimester of pregnancy. N Engl J Med 2009 [cited 2014 Jul 26];360(24):2528- 2535. Available from: http://www.nejm.org/doi/pdf/10.1056/NEJMoa0 807154
31. Pasternak B, Svanström H, Mølgaard -Nielsen D, et al. Metoclopramide in pregnancy and risk of major congenital malformations and fetal death. JAMA 2013 [cited 2014 Jul 26];310(15):1601- 1611. Available from: http://jama.jamanetwork.com/article.aspx?doi=1 0.1001/jama.2013.278343
32. Anderka M, Mitchell MM, Louik C, et al. Medications used to treat nausea and vomiting of pregnancy and the risk of selected birth defects. Birth Defects Res A Clin Mol Teratol 2012 [cited 2014 Jul 26];94(1):22-30. Available from: http://www.ncbi.nlm.nih. gov/pmc/articles/PMC 3299087
33. Pasternak B, Svanström H, Hviid A. Ondansetron in pregnancy and risk of adverse fetal outcomes. NEJM 2013 [cited 2014 Jul 26];368(9):814- 823. Available from: htt p://www.nejm.org/doi/pdf/10.1056/NEJMoa1 211035
34. Andersen JT, Espen J -S, Andersen N, et al. Ondansetron use in early pregnancy and the risk of congenital malformations - A register based nationwide cohort study. Abstracts of the 29th International Conferenc e on Pharmacoepidemiology & Therapeutic Risk Management; 2013 Aug 25– 28, 2013; Montréal, Canada. Malden (MA): John Wiley & Sons, Inc., c2013, 541 p. (Pharmacoepidemiology and Drug Safety V ol 22). http://www.motherisk.org/documents/studies/On dansetron -Use -In-Early -Pregnancy.pdf
35. FDA Drug Safety Communication: Abnormal heart rhythms may be associated with use of Zofran (ondansetron) [Internet]. Silver Spring (MD ): U.S. Food and Drug Administration; 2011 Sep 15 [cited 2014 Jul 26]. Available from: http://www.fda.gov/drugs/drugsafety/ucm27191 3.htm
36. Koren G. Scary science: ondansetron safety in pregnancy -two opposing results from the same Danish registry. Ther Drug Monit 2014 Jan 9 ; [Epub ahead of print; cited 2014 Oct 13]. Available from: http:// www.helpher.org/blog/wp -nt content/uploads/2014/01/2014 -Koren - Ondansetron- Safety -TDM.pdf 37. Park -Wyllie L, Mazzotta P, Pastuszak A, et al. Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta -analysis of epidemiological st udies. Teratology 2000;62(6):385- 392.
38. Carmichael SL, Shaw GM, Ma C, et al. Maternal corticosteroid use and orofacial clefts. Am J Obstet Gynecol 2007;197(6):585.e1- 7.
39. Gur C, Diav -Citrin O, Shechtman S, et al. Pregnancy outcome after first trimester exposur e to corticosteroids: a prospective controlled study. Reprod Toxicol 2004;18:93- 101.
40. Bottomley C, Bourne T. Management strategies for hyperemesis. Best Pract Res Clin Obstet Gynaecol 2009;23(4):549- 564.
41. Mattiuzzi GN, Cortes JE, Blamble DA, et al. Daily pal onosetron is superior to ondansetron in the prevention of delayed chemotherapy -induced nausea and vomiting in patients with acutemyelogenous leukemia. Cancer 2010;15;116(24):5659- 5666.
42. Gil A, Nachum Z, Tal D, et al. A comparison of cinnarizine and transde rmal scopolamine for the prevention of seasickness in naval crew: a double -blind, randomized, crossover study. Clin Neuropharmacol 2012;35(1):37- 39.
43. Hejaz, RA, McCallum RW. Review article: cyclic vomiting syndrome in adults - rediscovering and redefining an old entity. Aliment Pharmacol Ther 2011;34(3):263- 273.
2. Arsenault MY, Lane CA, MacKinnon CJ, et al. The management of nausea and vomiting of pregnancy. J Obstet Gynaecol Canada 2002; 24(10):817- 833.
3. Klebanoff MA, Koslowe PA, Kaslow R, et al. Epidemiology of vomiting in early pregnancy. Obstet Gynecol 1985;66:612- 616.
4. Clark SM, Constantine MM, Hankins GD. Review of NVP and HG and early pharmacotherapeutic intervention. Obstet Gynecol Int. 2012 [cited 2014 Jul 20];2012:252676. doi: 10.1155/2012/252676. Available from: http://dx.doi.org/10.1155/2012/25267 6
5. Ebrahimi N, Maltepe C, Einarson A. Optimal management of nausea and vomiting of pregnancy. Int J Women's Health 2010: 2(1):241- 248.
6. Koren G, Maltepe C. Pre-emptive therapy for severe nausea and vomiting of pregnancy and hyperemesis gravidarum. J Obste t Gynaecol 2004;24(5):530- 533.
7. Koren G, Maltepe C, Phelan ST, Editors. Nausea and Vomiting of Pregnancy. APGO Continuing Educational Series on Women’s Health Education [Internet]. Crofton (MD): Association of Professors of Gynecology and Obstetrics; c2014 [cited 2014 Jul 20]. Available from: https://www.apgo.org/education/women/nausea - and -vomiting -of-pregnancy.html
8. O’Brien B, Naber S. Nausea and vomiting during pregnancy: effects on the quality of women’s lives. Birth 1992;19:138- 143.
9. Piwko C, Ungar WJ, Einarson TR, et al. The weekly cost of nausea and vomiting of pregnancy for women calling the Toronto Motherisk Program. Curr Med Res Opin 2007;23(4):833- 840.
10. Piwko C, Koren G, Babashov V, et al. Economic burden of nausea and vomiting of pregnancy in the USA. J Popul Ther Clin Pharmacol 2013 [cited 2014 Oct 15];20(2):e149- 160. Available from: http ://www.jptcp.com/jptcp_1308_e149_e160_p iwko -pdf -r194583
11. Fejzo MS, Poursharif B, Korst LM, et al. Symptoms and pregnancy outcomes associated with extreme weight loss among women with hyperemesis gravidarum. J Women's Health (Larchmt) 2009;18(12):1981- 1987.
12. Veenendaal MV, van Abeelen AF, Painter RC, et al. Consequences of hyperemesis gravidarum for offspring: a systematic review and meta-analysis. BJOG 2011;118(11):1302- 1313.
13. Baggley A, Navioz Y, Maltepe C, et al. Determinants of women's decision making on whether to treat nausea and vomiting of pregnancy pharmacologically. J Midwifery Women's Health 2004;49(4):350- 354.
14. Niemeijer MN, Grooten IJ, Vos N, et al. Diagnostic markers for hyperemesis gravidarum: a systematic review and meta-analysis. Am J Obstet Gyn ecol 2014;211(2):150.e1- 15. doi: 10.1016/j.ajog.2014.02.012. Epub 2014 Feb 13.
15. Verberg MF, Gillott DJ, Al -Fardan N, et al. Hyperemesis gravidarum, a literature review. Hum Reprod Update. 2005;11(5):527– 539.
16. Goodwin TM. Hyperemesis gravidarum. Obstet Gyneco l Clin N Am 2008;35:401- 417.
17. Einarson A, Maltepe C, Boskovic R, at al. Treatment of nausea and vomiting in pregnancy. An updated algorithm. Can Fam Physician 2007[cited 2014 Jul 26];53(12):2109- 2111. Available from: http://www.cfp.ca/content/53/12/2109.full.pdf+html
18. Koren G, Maltepe C. How to survive morning sickness successfully. Toronto (ON): Motherisk; 2013 [cited 2014 Jul 27]. Available from: www.motherisk.org/documents/BSRC_morning _sickness_EN.pdf
19. Maltepe C, Koren G. Preemptive treatment of nausea and vomiting of pregnancy: results of a randomized controlled trial. Obstet Gynecol Int 2013 [cited 2014 Jul 27] ;2013:809787. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC 3588181
20. Gill SK, Maltepe C, Koren G. The effect of heartburn and acid reflux on the severity of nausea and vomiting of pregnancy. Can J Gastroenterol 2009 [cited 2012 Jul 26];23(4):270- 272. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC 2711677
21. Gill SK, Maltepe C, Mastali K, et al. The effect of acid-reducing pharmacotherapy on the severity of nausea and vomiting of pregnancy. Obstet Gynecol Int 2009 [cited 2014 Jul 26];2009:585269. Available from: http://www.ncbi.nlm.ni h.gov/pmc/articles/PMC 2778456
22. Law R, Maltepe C, Bozzo P, et al. Treatment of heartburn and acid reflux associated with nausea and vomiting during pregnancy. Can Fam Physician 2010 [cited 2014 Jul 26];56(2):143- 144. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC 2821234/pdf/0560143.pdf
23. Gill SK, Maltepe C, Koren G. The effectiveness of discontinuing iron-containing prenatal multivitamins on reducing the severity of nausea and vomiting of pregnancy. J Obstet Gynaecol 2009;29(1):13- 16.
24. Product monograph. Diclectin. Blainville (QC): Duchesnay Inc.; 2014 Jul 2 [cited 2014 Oct 13] . Available from: http://webprod5.hc - sc.gc.ca/dpd -bdpp/item -iteme.do?pm - mp=00025684
25. Atanackovic G, Navioz Y, Moretti ME, et al. The safety of higher than standard dose of doxylamine -pyridoxine (Diclec tin) for nausea and vomiting of pregnancy. J Clin Pharmacol 2001;41(8):842- 845.
26. Nulman I, Rovet J, Barrera M, et al. Long- term neurodevelopment of children exposed to maternal nausea and vomiting of pregnancy and diclectin. J Pediatr 2009;155(1):45 -50.
27. Ko ren G, Clark S, Hankins GD, et al. Effectiveness of delayed -release doxylamine and pyridoxine for nausea and vomiting of pregnancy: a randomized placebo controlled trial. Am J Obstet Gynecol 2010;203(6):571.e1- 7. doi: 10.1016/j.ajog.2010.07.030. Epub 2010 Sep 16.
28. Seto A, Einarson T, Koren G. Pregnancy outcome following first trimester exposure to antihistamines: meta -analysis. Am J Perinatol 1997;14(3):119- 124.
29. Gill SK, Einarson A. The safety of drugs for the treatment of nausea and vomiting of pregnancy. Expert Opin Drug Saf 2007;6(6):685- 694.
30. Matok I, Gorodischer R, Koren G, et al. The safety of metoclopramide use in the first trimester of pregnancy. N Engl J Med 2009 [cited 2014 Jul 26];360(24):2528- 2535. Available from: http://www.nejm.org/doi/pdf/10.1056/NEJMoa0 807154
31. Pasternak B, Svanström H, Mølgaard -Nielsen D, et al. Metoclopramide in pregnancy and risk of major congenital malformations and fetal death. JAMA 2013 [cited 2014 Jul 26];310(15):1601- 1611. Available from: http://jama.jamanetwork.com/article.aspx?doi=1 0.1001/jama.2013.278343
32. Anderka M, Mitchell MM, Louik C, et al. Medications used to treat nausea and vomiting of pregnancy and the risk of selected birth defects. Birth Defects Res A Clin Mol Teratol 2012 [cited 2014 Jul 26];94(1):22-30. Available from: http://www.ncbi.nlm.nih. gov/pmc/articles/PMC 3299087
33. Pasternak B, Svanström H, Hviid A. Ondansetron in pregnancy and risk of adverse fetal outcomes. NEJM 2013 [cited 2014 Jul 26];368(9):814- 823. Available from: htt p://www.nejm.org/doi/pdf/10.1056/NEJMoa1 211035
34. Andersen JT, Espen J -S, Andersen N, et al. Ondansetron use in early pregnancy and the risk of congenital malformations - A register based nationwide cohort study. Abstracts of the 29th International Conferenc e on Pharmacoepidemiology & Therapeutic Risk Management; 2013 Aug 25– 28, 2013; Montréal, Canada. Malden (MA): John Wiley & Sons, Inc., c2013, 541 p. (Pharmacoepidemiology and Drug Safety V ol 22). http://www.motherisk.org/documents/studies/On dansetron -Use -In-Early -Pregnancy.pdf
35. FDA Drug Safety Communication: Abnormal heart rhythms may be associated with use of Zofran (ondansetron) [Internet]. Silver Spring (MD ): U.S. Food and Drug Administration; 2011 Sep 15 [cited 2014 Jul 26]. Available from: http://www.fda.gov/drugs/drugsafety/ucm27191 3.htm
36. Koren G. Scary science: ondansetron safety in pregnancy -two opposing results from the same Danish registry. Ther Drug Monit 2014 Jan 9 ; [Epub ahead of print; cited 2014 Oct 13]. Available from: http:// www.helpher.org/blog/wp -nt content/uploads/2014/01/2014 -Koren - Ondansetron- Safety -TDM.pdf 37. Park -Wyllie L, Mazzotta P, Pastuszak A, et al. Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta -analysis of epidemiological st udies. Teratology 2000;62(6):385- 392.
38. Carmichael SL, Shaw GM, Ma C, et al. Maternal corticosteroid use and orofacial clefts. Am J Obstet Gynecol 2007;197(6):585.e1- 7.
39. Gur C, Diav -Citrin O, Shechtman S, et al. Pregnancy outcome after first trimester exposur e to corticosteroids: a prospective controlled study. Reprod Toxicol 2004;18:93- 101.
40. Bottomley C, Bourne T. Management strategies for hyperemesis. Best Pract Res Clin Obstet Gynaecol 2009;23(4):549- 564.
41. Mattiuzzi GN, Cortes JE, Blamble DA, et al. Daily pal onosetron is superior to ondansetron in the prevention of delayed chemotherapy -induced nausea and vomiting in patients with acutemyelogenous leukemia. Cancer 2010;15;116(24):5659- 5666.
42. Gil A, Nachum Z, Tal D, et al. A comparison of cinnarizine and transde rmal scopolamine for the prevention of seasickness in naval crew: a double -blind, randomized, crossover study. Clin Neuropharmacol 2012;35(1):37- 39.
43. Hejaz, RA, McCallum RW. Review article: cyclic vomiting syndrome in adults - rediscovering and redefining an old entity. Aliment Pharmacol Ther 2011;34(3):263- 273.