Comparing pyridoxine and doxylamine succinate‐pyridoxine HCl for nausea and vomiting of pregnancy: A matched, controlled cohort study

Abstract

Nausea and vomiting of pregnancy (NVP) is a common gestational condition. This is the first study to compare the use of vitamin B6 (pyridoxine) versus Diclectin (doxylamine succinate-pyridoxine HCl) for NVP symptoms. Participants were pregnant women with NVP who used either pyridoxine or doxylamine succinate-pyridoxine HCl for ≥4 days prior to calling the Motherisk NVP Helpline. Women receiving pyridoxine only (n = 80) were matched to a woman taking doxylamine succinate-pyridoxine HCl only (n = 80), accounting for potential confounders and baseline level of NVP, measured by the Pregnancy Unique Quantification of Emesis (PUQE) score. Change in NVP severity after a week of therapy with either pyridoxine or doxylamine succinate-pyridoxine HCl was quantified using the PUQE-24 scale, which describes NVP symptoms 24 hours prior to their call. Doxylamine succinate-pyridoxine HCl use found a significant reduction in PUQE score, compared with pyridoxine (+0.5 versus -0.2, P < .05; negative denotes worsening). This association was especially prominent in women with more severe symptoms, where doxylamine succinate-pyridoxine HCl use saw a mean improvement of 2.6 versus 0.4 with pyridoxine (P < .05). As well, doxylamine succinate-pyridoxine HCl use was associated with fewer women experiencing moderate to severe scores after a week of treatment, compared with the pyridoxine group (7 versus 17, P < .05), despite similar baseline PUQE scores.

Validation of specific questionnaires to assess nausea and vomiting of pregnancy in a French population

“…Assessment of QOL seems important for the care of women who experience NVP [14]. The NVP‐QOL questionnaire has previously been validated and used successfully in other studies [11,12]; however, this tool includes 30 items and can take a long time to complete. Thus, it does not seem appropriate to use the NVP‐QOL score when the modified‐PUQE score is low because there will be only a slight alteration in QOL.…”

“…This score was compared with the 12‐item Short Form Health Survey and found to be effective for use during the first trimester of pregnancy [11]. Other studies have confirmed the utility of this score in the evaluation of QOL during episodes of NVP [7,12,13]. Nevertheless, few studies have been published concerning the use of these two scores among pregnant women [14].…”

Hyperemesis gravidarum – eine interprofessionelle und interdisziplinäre Herausforderung

“…Zu berücksichtigen sind die konträren Ergebnisse aus der kanadischen Kohortenstudie von Berard et al 2019 91 , nach der die Gabe von Doxylamin/ Pyridoxin mit einer leicht signifikanten Erhöhung des Gesamtrisikos für schwere kongenitale Anomalien assoziiert war (aOR 1,07; 95% KI 1,03–1,11), dies betraf insbesondere ein 1,8-fach erhöhtes Risiko für Spina bifida. Die alleinige Anwendung von Pyridoxin wird von der RCOG Leitlinie 2016 nicht empfohlen 95 .…”

Ondansetron compared with doxylamine and pyridoxine for treatment of nausea and vomiting in pregnancy

“…Tan et al [33] pyridoxine usage in HG did not demonstrate any improvement in nausea, vomiting or rehospitalisation in 46 women given 20 mg orally three times a day in addition to intravenous fluids. Pope et al [34] demonstrated that the combination of doxylamine and pyridoxine was significantly more effective than pyridoxine alone.…”