severe nausea and vomiting in pregnancy

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Effect of Ginger on Relieving Nausea and Vomiting in Pregnancy: A Randomized, Placebo-Controlled Trial

Effect of Ginger on Relieving Nausea and Vomiting in Pregnancy: A Randomized, Placebo-Controlled Trial

Nausea and vomiting are the most prevalent and prob- ably the most unpleasant complications in pregnancy. It is reported by 50% to 80% of pregnant women (1). There is no known cause for this problem; however, hormonal changes as well as psychological factors may play a role in this con- dition (2). Approximately, a quarter of all pregnant women have to leave their work because of this problem (3). In less than 2% of cases, this problem escalates to severe nausea and vomiting (hyperemesis gravidarum), and that leads to an im- balance of water and electrolytes, malnutrition, and loss of 5% of body weight (4). This condition may result in the mal- function of different body systems and organs, including the kidneys, and an imbalance of water and electrolytes. In addi- tion, it may also have adverse effects on the fetus (5). Nausea and vomiting in pregnancy (NVP) may lead to depression, feelings of incompetence, loss of work hours, hospitalization and termination of the pregnancy (6). For this reason, an ef-
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Optimal management of severe nausea and vomiting in migraine: improving patient outcomes

Optimal management of severe nausea and vomiting in migraine: improving patient outcomes

treatment of acute migraine attacks, 1,000 mg of paracetamol (acetaminophen), preferably as a suppository, is considered the first-choice drug treatment. The risks associated with use of aspirin and NSAIDs are considered to be small when the agents are taken episodically and if they are avoided during the last trimester of pregnancy (risks of maternal or fetal bleeding and premature closure of the fetal ductus arterio- sus). There is limited evidence about triptan safety during pregnancy, therefore they should be avoided in these patients. DHE and ergotamine are contraindicated in women who are pregnant. Prochlorperazine and promethazine hydrochloride for treatment of nausea are unlikely to be harmful during pregnancy. Metoclopramide is probably acceptable to use during the second and third trimesters. Domperidone is also safe in pregnant women. Prophylactic treatment is rarely indicated because of potential teratogenicity. When pro- phylactic treatment is used, beta-blockers are the preferred treatment (stopping 2 weeks before partum). 77–79 Ondanse-
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The burden of nausea and vomiting during pregnancy: severe impacts on quality of life, daily life functioning and willingness to become pregnant again – results from a cross sectional study

The burden of nausea and vomiting during pregnancy: severe impacts on quality of life, daily life functioning and willingness to become pregnant again – results from a cross sectional study

demonstrates that NVP has adverse effects on the global quality of life measured by the QOLS. The total QOLS score among women who were pregnant or who experi- enced NVP at time of participation were 72 and 68, re- spectively. This is low compared to other populations such as women in the general Norwegian population with an average score of 85 [14]; patients with various chronic diseases such as rheumatic disease groups, psor- iasis and chronic obstructive pulmonary disease, who score above 80 on the QOLS [18]; fibromyalgia patients with scores around 70–73 [18, 25, 26]; and Israeli pa- tients with posttraumatic stress disorder with a score of 61 [18]. Furthermore, we found that global quality of life was significantly associated with the severity of NVP. The mean total QOLS score among women with severe NVP symptoms that were pregnant or were experiencing NVP at time of participation was 67 and 64, respectively, demonstrating that severe NVP affects global quality of life to a great extent. However, when only the new mothers were included in the analyses, no association with severity of NVP was detected. Furthermore, the mean QOLS score among the new mothers was above 80, and higher than for the two other sub-groups, ap- proaching that of the general Norwegian population [14]. This is reassuring as it may imply that the severity of NVP experienced while pregnant does not affect qual- ity of life after birth, and that global quality of life nor- malises after birth for most women, despite having suffered from severe NVP while pregnant.
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Pharmacogenetic predictors of nausea and vomiting of pregnancy severity and response to antiemetic therapy: a pilot study

Pharmacogenetic predictors of nausea and vomiting of pregnancy severity and response to antiemetic therapy: a pilot study

and all seem to be safe for use in pregnancy [7-10]. How- ever, response to these medications in the treatment of NVP is highly variable [7,11-13]. While pharmacologic intervention may ameliorate symptoms in many women, some women improve dramatically while others continue to experience severe NVP despite treatment. As such, pharmacogenetic polymorphisms become an important consideration in evaluating variability in responsiveness to pharmacologic intervention. Many antiemetics are sub- strates for serotonin receptors and transporters—which are known to have clinically relevant genetic polymor- phisms. Previous studies have shown that variations in the HTR3B gene predict the efficacy of antiemetics in cancer patients [14] and the occurrence of selective serotonin reuptake inhibitor (SSRI)-induced nausea [15]. However, there have been limited studies which have investigated the effects of the serotonin receptor gene polymorphisms on the efficacy of antiemetics used in the treatment of NVP [16].
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Maternal safety of the delayed release doxylamine and pyridoxine combination for nausea and vomiting of pregnancy; a randomized placebo controlled trial

Maternal safety of the delayed release doxylamine and pyridoxine combination for nausea and vomiting of pregnancy; a randomized placebo controlled trial

commonly used for NVP and was the only drug ap- proved by the FDA until the manufacturer’s voluntary removal of it from the market in 1983 [3]. In 1983 [4] and 1999 [5], the FDA determined that this drug com- bination was not withdrawn from sale for reasons of safety and effectiveness. In fact, its removal from the American market was temporally associated with a 2- fold increase in rates of hospitalization of pregnant women for the most severe form of NVP, hyperemesis gravidarum [6,7]. Over the last 3 decades a large body of evidence corroborated the fetal safety of this drug com- bination [8,9].
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Validation of the nausea and vomiting of pregnancy specific health related quality of life questionnaire

Validation of the nausea and vomiting of pregnancy specific health related quality of life questionnaire

The NVPQOL questionnaire has been previously reported to be suitable for all women with mild to severe NVP as well as having a good external validity [12]. Our study population is comparable to the Montreal population of pregnant women. The majority of women in our study cohort were Caucasians, which consequently improves the external validity of our results to Canadian popula- tion. Indeed, in 2001 less than 15% of the Canadian pop- ulation belonged to a visible minority group [26]. Conclusion

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Nausea and vomiting during pregnancy associated with lower incidence of preterm births: the Japan Environment and Children’s Study (JECS)

Nausea and vomiting during pregnancy associated with lower incidence of preterm births: the Japan Environment and Children’s Study (JECS)

The overall rate of preterm births (< 37 weeks) was 4.6% (4397/96,056). Rates of extremely (26–27 weeks), very (28–31 weeks), and moderately (32–36 weeks) preterm births were 0.09% (88/96,056), 0.38% (364/96,056), and 4.1% (3929/96,056), respectively. Median gestational age was not statistically influenced by NVP status. However, the prevalence of preterm birth was slightly higher in women without NVP (Table 2). When compared to women without NVP, women with mild or moderate NVP had lower odds for overall preterm births (aOR 0.87, 95% CI 0.80–0.95 and aOR 0.85, 95% CI 0.78–0.93, respect- ively), and women with severe NVP had the lowest odds (aOR 0.84, 95% CI 0.74–0.95; Table 3). Differences be- tween women with and without NVP were more obvious when the risk of very preterm birth and extremely pre- term birth was analyzed. When compared to women with- out NVP, women with mild or moderate NVP had lower
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Demonstration of early efficacy results of the delayed release combination of doxylamine pyridoxine for the treatment of nausea and vomiting of pregnancy

Demonstration of early efficacy results of the delayed release combination of doxylamine pyridoxine for the treatment of nausea and vomiting of pregnancy

This is a secondary analysis of a double-blind, random- ized, multicenter, placebo-controlled study of the delayed-release combination of doxylamine succinate (10 mg) and pyridoxine hydrochloride (10 mg) (Dicle- gis®) for the treatment of NVP]. The full details of the study have been previously published [15]. Briefly, the subjects were at least 18 years of age, pregnant in the gestational age range of 7–14 weeks, suffered from NVP, and had a PUQE score ≥6 [20–22]. The PUQE score in- corporates the number of daily vomiting episodes, num- ber of daily retching, and length of daily nausea in hours, for an overall score of symptoms rated from 3 (no symptoms) to 15 (most severe). Score of 1 on each of the 3 symptoms-nausea, vomiting and retching, de- notes “no symptoms”, and goes as high as 15 (5, or max- imum for each symptom). Scores of 4–6 denote mild NVP. Scores of 7–11 denote moderate NVP, and scores of 12–15 denote severe NVP.
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A randomized crossover trial on the effect of compression stockings on nausea and vomiting in early pregnancy

A randomized crossover trial on the effect of compression stockings on nausea and vomiting in early pregnancy

This randomized, single-center, open, crossover study was conducted in Wunstorf, Germany, from November 2013 to March 2015 (trial registration no DRKS00009679 in the German Clinical Trials Register). Pregnant women aged 18 years and with mild to moderate NVP were eligible to participate. Exclusion criteria included severe hyperem- esis; a history of thrombosis, edema, or skin changes typical of chronic venous insufficiency; no palpable arterial pulses, deep, or superficial reflux on ultrasound; requirement for custom-made stockings; regular prior use of compression stockings; and inability to read and complete a questionnaire in German. Women who reported leg pain were referred for specialist medical advice to rule out venous disorders. The study was approved by the Ethics Committee of the Medical Chamber of Lower Saxony (BO/28/2013), and all participants provided written informed consent.
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Optimal management of nausea and vomiting of pregnancy

Optimal management of nausea and vomiting of pregnancy

most commonly used 5-HT 3 antagonist for the treatment of severe NVP, usually when other types of therapy prove ineffective. A limited number of case series and one study from Motherisk which included 176 women exposed to ondansetron in the 1st trimester, failed to find an association between exposure in first trimester and increased risk for major malformations. 38,42,43 Although it may help with reduc-

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Pregnancy complications and birth outcomes among women experiencing nausea only or nausea and vomiting during pregnancy in the Norwegian Mother and Child Cohort Study

Pregnancy complications and birth outcomes among women experiencing nausea only or nausea and vomiting during pregnancy in the Norwegian Mother and Child Cohort Study

nausea and vomiting during pregnancy requiring hospi- talisation before week 25 of gestation. Q3 also provided data regarding history of high blood pressure prior to pregnancy (yes or no), PGP (defined as self-reported mild or severe pain in the anterior and bilateral poster- ior pelvis, experiences of ≥3 weeks; yes or no), severe PGP (defined as PGP in addition to the pubic bone region with severe pain reported in all three pelvic lo- cations), high blood pressure in pregnancy (≥3 weeks; yes or no), and proteinuria (≥3 weeks with protein in urine; yes or no). Women answering Q3 also had an option to report their highest recorded systolic and dia- stolic pressure readings. We included one question, an- swered 6 months postpartum in questionnaire four (Q4), regarding reasons for caesarean delivery (breech, previous caesarean delivery, pregnancy complication/ill mother, poor growth/fetus complication, own prefer- ence, or other).
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Investigating the Effect of GingerPill on the Treatment of Nausea and Vomiting of Pregnancy (NVP) in Pregnancy Women

Investigating the Effect of GingerPill on the Treatment of Nausea and Vomiting of Pregnancy (NVP) in Pregnancy Women

Dealing with the significance of this issue is because women with mild to moderate NVP experience suffer depression, reduced function of employment, home activity, parental roles, and other physical and social activities. NVP increases the cost and use of health care resources. In addition, in some cases, pregnant women decide to terminate their pregnancy due to the complications of these symptoms [6]. It has been shown that preterm birth in the group with severe longing is clearly more prevalent than the patients with mild longing [7]. The risk factors for NVP include low maternal age, first pregnancy, female embryo, and twins [8]. In other studies, fetal abnormalities, history of nausea and vomiting in the previous pregnancy are related to mental and psychological conditions of the individuals, and the increase and decrease in BMI before pregnancy and the economic and social status associated with NVP [9]. Overall, the most important and commonly used NVP treatments include non-pharmaceutical treatments, such as special diets and the use of medication treatments. The popularity of complementary and alternative medicine, such as non-pharmaceutical treatments and herbal extracts has grown significantly in recent years, and the prevalence of using complementary and alternative therapies during pregnancy have been significant. In Iranian traditional medicine, one of the common treatments for NVP has been the use of ginger [10]. Ginger is an herb used in traditional medicine to treat all types of nausea and vomiting, such as NVP [11]. The precise mechanism of ginger as an anti-nausea and vomiting agent has not been completely known. Ginger seems to control the mechanism of the transmission of serotonin messages at the gastrointestinal system [12] that can be due to its direct effect on the intestinal duct. Its antiemetic effect through the central nervous system is debatable because there are compounds in ginger that inhibit type 3 serotonin receptors that have not been known well [13].
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The use of CAM by women suffering from nausea and vomiting during pregnancy

The use of CAM by women suffering from nausea and vomiting during pregnancy

Demographic data were collected for all of the survey re- spondents including the number of previous children, previous experience with NVP, pregnancy-related medica- tion as well as any adverse experiences related to pregnan- cy-related medication. In addition, all respondents were asked to describe the severity of their NVP on a scale of 0– 10, with 10 being the most severe, as well as whether or not they had previously used CAM. Survey respondents who reported non-use of CAM to alleviate NVP were asked to agree or disagree with a series of possible reasons why they did not use CAM to alleviate their NVP. The level of agreement was measured by a 5-point Likert Scale, where 1 = strongly disagree, 2 = disagree somewhat, 3 = undecided, 4 = somewhat agree and 5 = strongly agree. Re- spondents who reported using CAM to alleviate their NVP were asked which CAM therapies they had used. They were also asked how they found out about CAM therapies, and whether or not their CAM use was supervised by a li- censed health care practitioner who practiced CAM either as part of their practice or in whole. Users of CAM were also asked 9 possible reasons why they chose to use CAM to alleviate their NVP, using the same Likert Scale used for non-CAM users.
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Nausea and vomiting in pregnancy – association with pelvic girdle pain during pregnancy and 4 6 months post partum

Nausea and vomiting in pregnancy – association with pelvic girdle pain during pregnancy and 4 6 months post partum

providing detailed access to maternal health during preg- nancy. The MoBa cohort specifically addressed NVP- related issues, providing the opportunity to differentiate between NP and NVP women [5, 24, 33]. Likewise, the detailed questions regarding PGP formed a basis for the robust definition of PGP used [21]. As this is a large cohort, numerous significant associations tend to appear, yet the merit of these in the clinical setting are not always relevant. Furthermore, the responses in the MoBa ques- tionnaires do not allow for an easy assessment of the severity of NVP symptoms. Retrospective evaluation of NVP symptoms has previously been reported as a possible source of bias [50]. We attempted to address this by excluding cases with inconsistencies in NVP symptoms reported between questionnaires (n = 15,791) to have as much confidence as possible in the remaining study sample. When we performed sensitivity analyses with the excluded cases included in the sample, the results were mostly unaffected. Women excluded from the present study had similar ages at delivery, BMI and energy intake, while there tended to be more women with a lower educa- tion (29.2% vs 30.5%) as well as a higher parity (48.4% vs 52.7%), findings consistent with non-compliance present in other studies [34, 51, 52]. The slightly higher number of daily smokers in the excluded group (5.7% vs 5.1%) is most likely a product of the high number of missing values for this variable. Other weaknesses include the reli- ance on self-reports of PGP, nausea, and vomiting. The diagnosis of PGP in our study would have benefited from a clinical assessment, as has been suggested elsewhere [13], in order to support the women’s self-reports. How- ever, this is not feasible in a large cohort study. Categoris- ing the difference between retching and actual vomiting (defining NP and NVP) may also have led to misclassifica- tions and affected the results. Another weakness is the lack of information on biomarkers (e.g. hormones).
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Common medical conditions during pregnancy: Therapies to consider

Common medical conditions during pregnancy: Therapies to consider

The etiology of NVP remains unknown, but a number of possible causes have been implicated. Some reports indicate that there is a relationship between the levels of human chorionic gonadotropin (hCG) and the size of the placental mass, suggesting the placental products, rather than the foetus, may be associated with presence of nausea and vomiting. 10

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Hyperemesis gravidarum: current perspectives

Hyperemesis gravidarum: current perspectives

vomiting in early pregnancy not resulting from other causes (eg, gastroenteritis) and requiring any of the following: inpatient admission, day stay with intravenous fluids, nasogastric feeding (at home or in hospital), or vomiting associated with loss of more than 5% of her booking weight. Women with hospitalized HG were considered as having severe HG. Secondary outcomes included spontaneous pre- term birth, preeclampsia, birthweight, small-for-gestational age infants, and infant sex ratio. Women with severe HG had an increased risk of having a spontaneous preterm birth com- pared with women without HG (adjusted OR, 2.6; 95% CI, 1.2–5.7). 21 No significant associations were observed among
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Preventing nausea and vomiting in women undergoing regional anesthesia for cesarean section: challenges and solutions

Preventing nausea and vomiting in women undergoing regional anesthesia for cesarean section: challenges and solutions

SPA or EDA. In addition, CSE analgesia is frequently used. Established medications used for an SPA or EDA (local anesthetics and opioids) have a regional effect; they do not pass the placenta to a large extent and presumably do not cause major unintended (adverse) effects to the fetus. But there are also disadvantages regarding neuraxial techniques: The injected local anesthetic does not only specifically block the pain fibers but also leads to a vasodilatation by affecting sympathetic efferences. Due to the induced temporary sym- pathicolysis, blood pressure fluctuation in terms of significant hypotension can occur. On top of that, the increased vagal tone entails bradycardia which is often accompanied with nausea and vomiting. 11,12
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Effect Of Ginger Supplement On Chemotherapy Induced Nausea And Vomiting Among Patients Receiving Cisplatin Attending Chemotherapy Unit Of Aims, Kochi

Effect Of Ginger Supplement On Chemotherapy Induced Nausea And Vomiting Among Patients Receiving Cisplatin Attending Chemotherapy Unit Of Aims, Kochi

A study was conducted by Balci .C.A, Ayse.O, Nuran.E, Songul .Y Meltem.A Acikgoz,et al to investigate the effects of ginger on chemotherapy-induced nausea and vomiting in cancer patients in the haematology clinic of a training hospital, Alahabad in 2011 The study group was composed of intervention (n=15) and control (n=30) patients. Control patients received antiemetic drugs for ethical reasons and intervention patients received ginger tablets (800 mg). Statistical analysis revealed no differences in the characteristics of the intervention and control groups (p>0.05). A significant difference was found between the groups receiving ginger and antiemetic, suggesting that ginger is effective for treatment of nausea and vomiting (p<0.05). Results of the present study suggest that ginger is effective for reducing chemotherapy-induced nausea and/or vomiting and they should be confirmed in future studies that include more patients with a hematological cancer. 19
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Resident obstetricians' awareness of the oral health component in management of nausea and vomiting in pregnancy

Resident obstetricians' awareness of the oral health component in management of nausea and vomiting in pregnancy

The management of nausea and vomiting is dependent upon its impact on the affected woman’s health, quality of life and the safety of maternal treatment on the developing fetus. Management includes both non-pharmacological and pharmacological therapy. Professional guidelines and policy statements have been formulated for perinatal oral health care [6,26-31]. To help reduce the erosion of tooth surfaces in women experiencing frequent nausea and vomiting, the following guidelines have been proposed: eating small quantities of nutritious yet non-cariogenic foods and/or snacks which are rich in protein such as cheese throughout the day, using a solution of a teaspoon of baking soda (sodium bicarbonate) in a cup of water for mouth rinses, avoiding tooth brushing immediately after vomiting as the effect of erosion can be exacerbated by brushing an already demineralized tooth surface. Other guidelines include using gentle tooth brushing with medium-texture bristle toothbrush and fluoride tooth- paste twice daily when nausea is minimal to prevent damage to demineralized tooth surfaces and using a fluoride-containing mouth rinse immediately before bedtime to help remineralize teeth.
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Doxylamine succinate&ndash;pyridoxine hydrochloride (Diclegis) for the management of nausea and vomiting in pregnancy: an overview

Doxylamine succinate&ndash;pyridoxine hydrochloride (Diclegis) for the management of nausea and vomiting in pregnancy: an overview

The reintroduction of doxylamine and pyridoxine as a delayed-release combination pill with US FDA Category A status emphasizes its favorable safety profile and bolsters the recommendation that it be used as first-line treatment in the pharmacologic management of NVP. Given the history of thalidomide and Bendectin, it is important to address concerns and alleviate fears about the safety of medications taken in early pregnancy so that quality of life may not be unnecessarily compromised. Doxylamine and pyridoxine have become the most studied drugs for NVP, and their use may alleviate many women’s symptoms without the need for escalation to other medications that, while also effective, do not have as robust a safety profile.
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