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 Ginger, vitamin B6 or antihistamines, for example, may ease mild
nausea, while severe vomiting that carries a risk of dehydration and
malnutrition can sometimes be improved by corticosteroids, the study
found.
The trouble is there’s scant evidence to suggest how one treatment
might stack up against available alternatives, said lead study
author Catherine McParlin of Newcastle University in the U.K.
“Women react differently and may need to try different treatment
options before they find something that is effective for them,”
McParlin said by email.
“When it comes to evidence of the effectiveness of specific
treatments for different levels of condition severity, the research
to date has mostly been of low quality, with many trials badly
designed and/or badly reported, with few direct comparisons between
treatments especially in severe cases,” McParlin added.
Nausea and vomiting are common during pregnancy, affecting up to 85
percent of women, the researchers note in JAMA.
Sometimes called morning sickness, in reality it can occur
throughout the day. Often, symptoms may be mild and ease up after
the first few months of pregnancy.
The most severe form, hyperemesis gravidarum, affects up to 3
percent of pregnant women and can require hospitalization to provide
nutrition through a feeding tube.
To assess the effectiveness of a variety of treatments for nausea
and vomiting during pregnancy, researchers analyzed data from 78
previously published studies with 8,930 patients combined.
For mild symptoms, ginger, vitamin B6, antihistamines and
metoclopramide (Reglan) were all more effective than a placebo pill,
the study found. Pyridoxine-doxylamine (Diclectin) and ondansetron (Zofran)
both beat a placebo for moderate symptoms.
When women have moderate to severe symptoms, they may get better
results by taking pyridoxine-doxylamine preemptively to reduce the
risk of recurrent vomiting instead of waiting to take this medicine
until symptoms return, one study of 60 women in the analysis
suggests.
Another study found ondansetron more effective at curbing moderate
to severe nausea in the first few days of use than metoclopramide,
but no difference in how many times women vomited.
With hyperemesis gravidarum, women have fewer options and there’s
even less evidence, the study authors note.
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Corticosteroids appeared superior to metoclopramide for reducing
vomiting episodes in an analysis of three studies of women with the
most severe symptoms.
One limitation of the analysis is that researchers lacked data to
compare side effects for babies associated with different treatments
the authors note.
The findings aren’t surprising because ethics limit testing
experimental drugs in pregnancy, particularly during the early
months when medications might harm fetal development, said Angela
Lupattelli, a pharmacy researcher at the University of Oslo in
Norway who wasn’t involved in the study.
Complicating matters, there aren’t good objective tests to assess
nausea symptoms, Lupattelli added by email.
“In case of mild symptoms, women are recommended to change their
dietary habits first, and then try non-pharmacological options,”
Lupattelli said.
Some women do well with small, frequent meals that are high in
protein and avoiding strong odors or other identifiable triggers for
nausea, while others respond well to ginger, said Dr. Siripanth
Nippita, a researcher at Harvard University in Boston who wasn’t
involved in the study.
“Other women may need medication,” Nippita added by email. “Pregnant
women should let their obstetricians know early on how nausea and
vomiting are affecting them, so they can get the help they need.”
SOURCE: http://bit.ly/2dP9RJi and http://bit.ly/2dQbTFj JAMA, online
October 4, 2016.
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