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Finding effective treatments for nausea and vomiting in pregnancy
Date: 28 October 2016
Research, published in Health Technology Assessment, has found that over-the-counter and prescription remedies can lead to some improvement in symptoms for women suffering from nausea and vomiting in pregnancy (NVP). However the evidence about what works is limited and of low quality, particularly when it comes to treating women with severe symptoms.
NVP affects around 85 percent of pregnant women to some degree. Hyperemesis gravidarum (HG) is the most severe form of NVP that affects up to 3 percent of pregnant women. Symptoms usually subside in the first half of pregnancy, but in some cases, they can last until the baby is born.
Severe NVP is often very debilitating, and women can become dehydrated, suffer nutritional deficiencies, altered blood chemistry, weight loss (over five percent of their pre-pregnancy body weight) as well as various psychological problems and a reduced quality of life.
There are a number of treatments available for NVP depending on symptom severity. Some women find that lifestyle and dietary changes help. There are well known remedies that may be effective when symptoms are mild, such as ginger preparations and prescribed medicines such as antihistamines, but in moderate-severe cases, women may need to go into hospital for treatment.
Research led by Professors Luke Vale and Stephen Robson of the University of the Newcastle upon Tyne, aimed to discover which interventions helped to improve the symptoms of NVP and HG. More than 200 research studies were identified, but many of these did not investigate how treatments directly improved symptoms. Subsequently, they reviewed almost 80 trials involving over 8,500 pregnant women to see which remedies work the best.
They found that both over-the-counter and prescription remedies can help some women, but effects vary between individual sufferers and depend on the severity of their symptoms. For milder symptoms, ginger, vitamin B6, antihistamines and metoclopramide may have a positive effect. For moderate-severe symptoms metoclopramide and ondansetron may be effective, whilst for the most severe symptoms, corticosteroids may be effective. Information on safety of therapies was sought, but little evidence on the serious harms of treatment was identified.
“Hyperemesis gravidarum is exhausting and has a huge impact on the quality of life of pregnant women with time off work as well as a negative effect on relationships” commented Professor Vale.“Our research shows that the available treatments can work for some women and we hope that this will help to inform the decisions of women and their clinicians. However, this is an under-researched area and more and better quality evidence is needed to help inform women suffering from this condition about treatment choices.”
For more details, please see the article in the Journal of the American Medical Association or the full report in Health Technology Assessment.