Main Category: Pregnancy / Obstetrics
Also Included In: Women's Health / Gynecology
Article Date: 18 Apr 2011 - 5:00 PDT email to a friend � printer friendly � opinions �
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Severe nausea and vomiting of pregnancy (NVP) affects approximately 30% of pregnant women and can be treated with appropriate medication says a new review published today in The Obstetrician & Gynaecologist (TOG).
NVP can have a profound impact on a woman's quality of life and can cause feelings of depression, difficulties between partners and concern for the health of the unborn child.
Some women have such severe NVP that they are less likely to have another child, or they consider terminating subsequent pregnancies. In some women the condition is so intolerable that they actually elect to have a termination of the current pregnancy.
'Morning sickness' however is a misleading name for the condition, as only 13% of women have symptoms exclusively in the morning. The majority of women have symptoms before and after midday.
The review states that women with severe symptoms should be considered for safe, effective medication after trying lifestyle measures and looks at a number of studies into different treatments for NVP.
Antihistamines can be used in the management of NVP says the review. The National Institute for Health and Clinical Excellence (NICE) state in their antenatal care guideline that if a woman requests or would like to consider treatment for NVP, antihistamines should be used.
There is also evidence that Pyridoxine (Vitamin B6) can reduce nausea and no association has been found between pyridoxine and malformations of the fetus. The review says that many women find nausea to be the most distressing part of NVP and therefore it should be a high priority in its management.
However there are concerns about the possible toxicity of pyridoxine in high doses and NICE does not recommend pyridoxine for the treatment for NVP. Both Canadian and American guidelines however recommend that pyridoxine at up to 40 mg per day in combination with an antihistamine is an effective treatment.
If a woman has suffered from severe NVP in a previous pregnancy, pre-emptive treatment with medication started as soon as symptoms develop in the current pregnancy can reduce the risk of severe NVP, according to one study looked at in the review.
The review concludes that there is good evidence for the safety and effectiveness of an antihistamine with pyridoxine in the treatment of NVP.
Roger Gadsby, General Practitioner, Associate Clinical Professor at the University of Warwick and co-author of the review said:
"Nausea and vomiting during pregnancy can cause significant illness. However, early treatment can be an effective way of preventing the onset of severe symptoms and can reduce the number of hospital admissions."
TOG's Editor -in-Chief, Jason Waugh added:
"This review looks back over a number of important studies assessing the use of different treatments and highlights the need for pre-emptive treatment. Severe symptoms of the condition can lead to women being unable to undertake their normal day-to-day activities."
Reference
Gadsby R, Barnie-Adshead T. Severe nausea and vomiting of pregnancy: should it be treated with appropriate pharmacotherapy? The Obstetrician & Gynaecologist 2011;13:107-111.
Source:
Royal College of Obstetricians and Gynaecologists
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