Treatments for Hyperemesis Gravidarum and Nausea and Vomiting in Pregnancy

Hdl Handle:
http://hdl.handle.net/10149/620569
Title:
Treatments for Hyperemesis Gravidarum and Nausea and Vomiting in Pregnancy
Authors:
McParlin, C. (Catherine); O’Donnell, A. (Amy); Robson, S. C. (Stephen); Beyer, F. (Fiona); Moloney, E. (Eoin); Bryant, A. (Andrew); Bradley, J. (Jennifer); Muirhead, C. (Colin); Nelson-Piercy, C. (Catherine); Newbury-Birch, D. (Dorothy); Norman, J. (Justine); Shaw, C. (Caroline); Simpson, E. (Emma); Swallow, B. (Brian); Yates, L. (Laura); Vale, L. (Luke)
Affiliation:
Teesside University. Health and Social Care Institute
Citation:
McParlin, C., O’Donnell, A., Robson, S. C., Beyer, F., Moloney, E., Bryant, A., Bradley, J., Muirhead, C., Nelson-Piercy, C., Newbury-Birch, D., Norman, J., Shaw, C., Simpson, E., Swallow, B., Yates, L., Vale, L. (2016) 'Treatments for Hyperemesis Gravidarum and Nausea and Vomiting in Pregnancy' JAMA; 316(13):1392-1401 : DOI: 10.1001/jama.2016.14337
Publisher:
American Medical Association
Journal:
JAMA
Issue Date:
4-Oct-2016
URI:
http://hdl.handle.net/10149/620569
DOI:
10.1001/jama.2016.14337
Additional Links:
http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2016.14337
Abstract:
IMPORTANCE Nausea and vomiting affects approximately 85%of pregnant women. The most severe form, hyperemesis gravidarum, affects up to 3%of women and can have significant adverse physical and psychological sequelae. OBJECTIVE To summarize current evidence on effective treatments for nausea and vomiting in pregnancy and hyperemesis gravidarum. EVIDENCE REVIEW Databases were searched to June 8, 2016. Relevant websites and bibliographies were also searched. Titles and abstracts were assessed independently by 2 reviewers. Results were narratively synthesized; planned meta-analysis was not possible because of heterogeneity and incomplete reporting of findings. FINDINGS Seventy-eight studies (n = 8930 participants) were included: 67 randomized clinical trials (RCTs) and 11 nonrandomized studies. Evidence from 35 RCTs at low risk of bias indicated that ginger, vitamin B6, antihistamines, metoclopramide (for mild symptoms), pyridoxine-doxylamine, and ondansetron (for moderate symptoms) were associated with improved symptoms compared with placebo. One RCT (n = 86) reported greater improvements in moderate symptoms following psychotherapy (change in Rhodes score [range, 0 {no symptoms} to 40 {worst possible symptoms}], 18.76 [SD, 5.48] to 7.06 [SD, 5.79] for intervention vs 19.18 [SD, 5.63] to 12.81 [SD, 6.88] for comparator [P < .001]). For moderate-severe symptoms, 1 RCT (n = 60) suggested that pyridoxine-doxylamine combination taken preemptively reduced risk of recurrence of moderate-severe symptoms compared with treatment once symptoms begin (15.4%vs 39.1% [P < .04]). One RCT (n = 83) found that ondansetron was associated with lower nausea scores on day 4 than metoclopramide (mean visual analog scale [VAS] score, 4.1 [SD, 2.9] for ondansetron vs 5.7 [SD, 2.3] formetoclopramide [P = .023]) but not episodes of emesis (5.0 [SD, 3.1] vs 3.3 [SD, 3], respectively [P = .013]). Although therewas no difference in trend in nausea scores over the 14-day study period, trend in vomiting scoreswas better in the ondansetron group (P = .042). One RCT (n = 159) found no difference between metoclopramide and promethazine after 24 hours (episodes of vomiting, 1 [IQR, 0-5] for metoclopramide vs 2 [IQR, 0-3] for promethazine [P = .81], VAS [0-10 scale] for nausea, 2 [IQR, 1-5] vs 2 [IQR, 1-4], respectively [P = .99]). Three RCTs compared corticosteroids with placebo or promethazine or metoclopramide inwomen with severe symptoms. Improvementswere seen in all corticosteroid groups, but only a significant difference between corticosteroids vs metoclopramidewas reported (emesis reduction, 40.9%vs 16.5%at day 2; 71.6%vs 51.2%at day 3; 95.8% vs 76.6%at day 7 [n = 40, P < .001]). For other interventions, evidencewas limited. CONCLUSIONS AND RELEVANCE For mild symptoms of nausea and emesis of pregnancy, ginger, pyridoxine, antihistamines, and metoclopramide were associated with greater benefit than placebo. For moderate symptoms, pyridoxine-doxylamine, promethazine, and metoclopramide were associated with greater benefit than placebo. Ondansetron was associated with improvement for a range of symptom severity. Corticosteroids may be associated with benefit in severe cases. Overall the quality of evidence was low.
Type:
Article
Language:
en
ISSN:
0098-7484
EISSN:
1538-3598
Rights:
Following a 6 month embargo authors may deposit either their post-print (ie final draft post-refereeing) or the published article. For full details see http://www.sherpa.ac.uk/romeo/issn/0360-3199/ [Accessed: 07/10/2016]

Full metadata record

DC FieldValue Language
dc.contributor.authorMcParlin, C. (Catherine)en
dc.contributor.authorO’Donnell, A. (Amy)en
dc.contributor.authorRobson, S. C. (Stephen)en
dc.contributor.authorBeyer, F. (Fiona)en
dc.contributor.authorMoloney, E. (Eoin)en
dc.contributor.authorBryant, A. (Andrew)en
dc.contributor.authorBradley, J. (Jennifer)en
dc.contributor.authorMuirhead, C. (Colin)en
dc.contributor.authorNelson-Piercy, C. (Catherine)en
dc.contributor.authorNewbury-Birch, D. (Dorothy)en
dc.contributor.authorNorman, J. (Justine)en
dc.contributor.authorShaw, C. (Caroline)en
dc.contributor.authorSimpson, E. (Emma)en
dc.contributor.authorSwallow, B. (Brian)en
dc.contributor.authorYates, L. (Laura)en
dc.contributor.authorVale, L. (Luke)en
dc.date.accessioned2016-10-07T10:21:56Z-
dc.date.available2016-10-07T10:21:56Z-
dc.date.issued2016-10-04-
dc.identifier.citationJAMA; 316 (13):1392en
dc.identifier.issn0098-7484-
dc.identifier.doi10.1001/jama.2016.14337-
dc.identifier.urihttp://hdl.handle.net/10149/620569-
dc.description.abstractIMPORTANCE Nausea and vomiting affects approximately 85%of pregnant women. The most severe form, hyperemesis gravidarum, affects up to 3%of women and can have significant adverse physical and psychological sequelae. OBJECTIVE To summarize current evidence on effective treatments for nausea and vomiting in pregnancy and hyperemesis gravidarum. EVIDENCE REVIEW Databases were searched to June 8, 2016. Relevant websites and bibliographies were also searched. Titles and abstracts were assessed independently by 2 reviewers. Results were narratively synthesized; planned meta-analysis was not possible because of heterogeneity and incomplete reporting of findings. FINDINGS Seventy-eight studies (n = 8930 participants) were included: 67 randomized clinical trials (RCTs) and 11 nonrandomized studies. Evidence from 35 RCTs at low risk of bias indicated that ginger, vitamin B6, antihistamines, metoclopramide (for mild symptoms), pyridoxine-doxylamine, and ondansetron (for moderate symptoms) were associated with improved symptoms compared with placebo. One RCT (n = 86) reported greater improvements in moderate symptoms following psychotherapy (change in Rhodes score [range, 0 {no symptoms} to 40 {worst possible symptoms}], 18.76 [SD, 5.48] to 7.06 [SD, 5.79] for intervention vs 19.18 [SD, 5.63] to 12.81 [SD, 6.88] for comparator [P < .001]). For moderate-severe symptoms, 1 RCT (n = 60) suggested that pyridoxine-doxylamine combination taken preemptively reduced risk of recurrence of moderate-severe symptoms compared with treatment once symptoms begin (15.4%vs 39.1% [P < .04]). One RCT (n = 83) found that ondansetron was associated with lower nausea scores on day 4 than metoclopramide (mean visual analog scale [VAS] score, 4.1 [SD, 2.9] for ondansetron vs 5.7 [SD, 2.3] formetoclopramide [P = .023]) but not episodes of emesis (5.0 [SD, 3.1] vs 3.3 [SD, 3], respectively [P = .013]). Although therewas no difference in trend in nausea scores over the 14-day study period, trend in vomiting scoreswas better in the ondansetron group (P = .042). One RCT (n = 159) found no difference between metoclopramide and promethazine after 24 hours (episodes of vomiting, 1 [IQR, 0-5] for metoclopramide vs 2 [IQR, 0-3] for promethazine [P = .81], VAS [0-10 scale] for nausea, 2 [IQR, 1-5] vs 2 [IQR, 1-4], respectively [P = .99]). Three RCTs compared corticosteroids with placebo or promethazine or metoclopramide inwomen with severe symptoms. Improvementswere seen in all corticosteroid groups, but only a significant difference between corticosteroids vs metoclopramidewas reported (emesis reduction, 40.9%vs 16.5%at day 2; 71.6%vs 51.2%at day 3; 95.8% vs 76.6%at day 7 [n = 40, P < .001]). For other interventions, evidencewas limited. CONCLUSIONS AND RELEVANCE For mild symptoms of nausea and emesis of pregnancy, ginger, pyridoxine, antihistamines, and metoclopramide were associated with greater benefit than placebo. For moderate symptoms, pyridoxine-doxylamine, promethazine, and metoclopramide were associated with greater benefit than placebo. Ondansetron was associated with improvement for a range of symptom severity. Corticosteroids may be associated with benefit in severe cases. Overall the quality of evidence was low.en
dc.language.isoenen
dc.publisherAmerican Medical Associationen
dc.relation.urlhttp://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2016.14337en
dc.rightsFollowing a 6 month embargo authors may deposit either their post-print (ie final draft post-refereeing) or the published article. For full details see http://www.sherpa.ac.uk/romeo/issn/0360-3199/ [Accessed: 07/10/2016]en
dc.titleTreatments for Hyperemesis Gravidarum and Nausea and Vomiting in Pregnancyen
dc.typeArticleen
dc.identifier.eissn1538-3598-
dc.contributor.departmentTeesside University. Health and Social Care Instituteen
dc.identifier.journalJAMAen
or.citation.harvardMcParlin, C., O’Donnell, A., Robson, S. C., Beyer, F., Moloney, E., Bryant, A., Bradley, J., Muirhead, C., Nelson-Piercy, C., Newbury-Birch, D., Norman, J., Shaw, C., Simpson, E., Swallow, B., Yates, L., Vale, L. (2016) 'Treatments for Hyperemesis Gravidarum and Nausea and Vomiting in Pregnancy' JAMA; 316(13):1392-1401 : DOI: 10.1001/jama.2016.14337-
dc.eprint.versionPublished Versionen
dc.contributor.institutionNewcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, Tyne and Wear, United Kingdom-
dc.contributor.institutionInstitute of Health and Society, Newcastle University, Newcastle, Tyne and Wear, United Kingdom-
dc.contributor.institutionInstitute of Cellular Medicine, Newcastle University, Newcastle, Tyne and Wear, United Kingdom-
dc.contributor.institutionInstitute of Health and Society, Newcastle University, Newcastle, Tyne and Wear, United Kingdom-
dc.contributor.institutionHealth Economics Group, Institute of Health and Society, Newcastle, Tyne and Wear, United Kingdom-
dc.contributor.institutionInstitute of Health and Society, Newcastle University, Newcastle, Tyne and Wear, United Kingdom-
dc.contributor.institutionInstitute of Health and Society, Newcastle University, Newcastle, Tyne and Wear, United Kingdom-
dc.contributor.institutionInstitute of Health and Society, Newcastle University, Newcastle, Tyne and Wear, United Kingdom-
dc.contributor.institutionWomen's Health Academic Centre, King’s Health Partners, London, United Kingdom-
dc.contributor.institutionInstitute of Health and Society, Newcastle University, Newcastle, Tyne and Wear, United Kingdom6Health and Social Care Institute, Teesside University, Middlesbrough, Cleveland, United Kingdom-
dc.contributor.institutionNorth Tyneside Clinical Commissioning Group, North Shields, Tyne and Wear, United Kingdom-
dc.contributor.institutionInstitute of Health and Society, Newcastle University, Newcastle, Tyne and Wear, United Kingdom-
dc.contributor.institutionInstitute of Health and Society, Newcastle University, Newcastle, Tyne and Wear, United Kingdom-
dc.contributor.institutionFormer Trustee of Pregnancy Sickness Support, Hull, East Yorkshire, United Kingdom-
dc.contributor.institutionUK Teratology Information Service (UKTIS) and Institute of Genetic Medicine, Newcastle, Tyne and Wear, United Kingdom-
dc.contributor.institutionHealth Economics Group, Institute of Health and Society, Newcastle, Tyne and Wear, United Kingdom-
dc.embargo6 monthsen
dc.date.accepted2016-09-06-
All Items in TeesRep are protected by copyright, with all rights reserved, unless otherwise indicated.