Safety considerations surrounding use of treatment options for nausea and vomiting in pregnancy

ABSTRACT

Introduction: Nausea and vomiting of pregnancy (NVP) is the most prevalent medical condition during gestation, affecting up to 85% of pregnant women. Many of them hesitate to use medications due to perceived fetal risks.

Areas covered: There are two main aspects to medication safety in NVP: The fetal safety of drugs used to treat NVP symptoms, and the risks of untreated NVP.

While mild and moderate NVP are not associated with major increase in fetal or maternal risks, and may render protective fetal effects, they have major impact on the quality of life of the mother. In contrast, severe NVP and hyperemesis gravidarum (HG) are associated with increased maternal and fetal risks, from in utero growth restriction to developmental delay.

For the doxylamine/pyridoxine combination, H1blockers and metoclopramide there are large studies documenting fetal safety. There are also large reassuring studies on the fetal safety of ondansetron, but they are contrasted by some studies claiming increased fetal risk.

Expert opinion: Fetal safety of the doxylamine/pyridoxine combination, H1blockers and for metoclopramide has been documented. Reassuring studies on the fetal safety of ondansetron, are contrasted by some studies claiming increased teratogenicity. More studies are needed to quantify fetal risks of HG.

KEYWORDS:

• Pregnancy
• nausea and vomiting
• antiemetic medications
• doxylamine-pyridoxine
• H1 blockers
• metoclopramide
• ondansetron

Article Highlights

• Women express high levels of anxiety regarding fetal safety of medications used to treat NVP

• The fetal safety of several anti emetic medications includng doxylamine/pyridoxine, H1 blockers and metoclopramide has been documented

• The data on ondansetron are still inconclusive due to opposing results

• Hyperemesis Gravidarum may pose serious fetal risks and needs to be managed early and aggressively

This box summarizes key points contained in the article.

Declaration of interest

The author has been a consultant for Duchesnay Inc, Canada, and Novertis Inc Switzerland. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.