Getting through the day: a pilot qualitative study of U.S. women’s experiences making decisions about anti-nausea medication during pregnancy

Abstract

BackgroundNausea during pregnancy affects 80% of pregnant women and can severely affect women’s functioning and quality of life. Women often have difficulty deciding whether to take anti-nausea medications due to concern about medication risks. This paper foregrounds U.S. women’s voices as they share their experiences making decisions about anti-nausea medication use.MethodsAs a pilot study, we conducted two focus groups including 20 women who had filled at least one prescription for an anti-nausea medication during pregnancy. Topics included deciding about and taking anti-nausea medications. Transcripts were analyzed by two medical anthropologists using an inductive or open coding approach.ResultsWomen in our pilot study carefully considered whether to take anti-nausea medications. Most women preferred not to take medications, in general, but were willing to do so for severe symptoms. When considering medications, they expressed concerns about risks to fetal health. They considered information from internet research, their health care provider, and the experiences of friends and family. While some women in our study decided against taking medications, many did take a prescription medication, and they reported substantial improvement in their symptoms and sense of well-being.ConclusionsWomen weighed various sources of evidence to assess the risks and benefits of taking anti-nausea medication and ultimately made a range of choices. More research is needed about the effectiveness and risks of anti-nausea medication, to help support women in their decision-making process, and also about the best methods to communicate scientific evidence to women.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-2093-6) contains supplementary material, which is available to authorized users.

The Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum (Green‐top Guideline No. 69)

“…Women may be reluctant to take, and non-specialist clinicians may be reluctant to prescribe, pharmacological treatments owing to concerns about teratogenic risk. 35,36 Women should be counselled that the benefits of antiemetics outweigh the risks, and that the absolute risk is low. Antiemetics are therefore appropriate and should be offered (see section 6.2.2).…”

“…In areas where ‘acute care at home’ or ‘hospital at home’ services are operating to provide IV treatment in the community, these services can be utilised for IV rehydration at home for women who are unable to maintain hydration orally but who do not have co‐morbidities or complications. Women may be reluctant to take, and non‐specialist clinicians may be reluctant to prescribe, pharmacological treatments owing to concerns about teratogenic risk 35,36 . Women should be counselled that the benefits of antiemetics outweigh the risks, and that the absolute risk is low.…”

Interpersonal Influences on the Choice to Treat Nausea during Pregnancy with Medication or Cannabis

“…It is possible that in the 18 years since the Baggley et al study was published, the use of prescription anti-nausea medications has become more widely considered routine care, consistent with evidence from Schrager and colleagues, 28 who found that the use of several prescription and over-the counter antiemetics has increased over time. Figueroa Gray et al 3 found that pregnant women deciding whether to take prescription anti-nausea medication relied on both the opinions of medical providers and the experiences of friends and family. It is also possible that if participants took medication during a previous pregnancy, that they may have been less likely to seek out feedback on their medication decision for the current pregnancy.…”

“…2 Those experiencing nausea and vomiting during pregnancy need to decide if and how to treat their symptoms, weighing the potential impacts of untreated symptoms against the potential risks of a chosen treatment for the pregnant person and fetus. 3,4 A small amount of existing research has explored how pregnant individuals experiencing nausea and vomiting choose whether to use anti-nausea medication, 1,3 and how people may choose to self-treat their nausea and vomiting during pregnancy with cannabis. 5 Cannabis use during pregnancy is increasingly common, 6 and several studies show an association between nausea and vomiting during pregnancy and cannabis use.…”

Detection and evaluation of signals associated with exposure to individual and combination of medications in pregnancy: a signal detection study protocol

“…Pregnant and breast-feeding women are further inclined to become ‘therapeutic orphans’, by their routine exclusion from clinical trials, given the struggle to insure such trials involving pregnant women. Pregnant women are further disadvantaged by having to arduously navigate through multifarious social influences, some losing their autonomy in medical decision making around taking medications or in their choice to participate in a clinical trial during pregnancy 3 4…”