Managing hyperemesis gravidarum: a multimodal challenge

Jueckstock, JK; Kaestner, Ralph; Mylonas, Ioannis

doi:10.1186/1741-7015-8-46

Cited by 85 publications

(67 citation statements)

References 88 publications

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“…In this population of pregnant women, we believe that these will account for the vast majority of indications for such prescriptions. Hyperemesis gravidarum is rarely treated with diazepam in the UK and this occurs among only 0.5–2% of pregnant women [44]. Our findings that risks were similar when compared to women in the general population and women with diagnosed but un-medicated depression or anxiety are reassuring.…”

Section: Discussionsupporting

confidence: 52%

First Trimester Exposure to Anxiolytic and Hypnotic Drugs and the Risks of Major Congenital Anomalies: A United Kingdom Population-Based Cohort Study

et al. 2014

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BackgroundDespite their widespread use the effects of taking benzodiazepines and non-benzodiazepine hypnotics during pregnancy on the risk of major congenital anomaly (MCA) are uncertain. The objectives were to estimate absolute and relative risks of MCAs in children exposed to specific anxiolytic and hypnotic drugs taken in the first trimester of pregnancy, compared with children of mothers with depression and/or anxiety but not treated with medication and children of mothers without diagnosed mental illness during pregnancy.MethodsWe identified singleton children born to women aged 15–45 years between 1990 and 2010 from a large United Kingdom primary care database. We calculated absolute risks of MCAs for children with first trimester exposures of different anxiolytic and hypnotic drugs and used logistic regression with a generalised estimating equation to compare risks adjusted for year of childbirth, maternal age, smoking, body mass index, and socioeconomic status.ResultsOverall MCA prevalence was 2.7% in 1,159 children of mothers prescribed diazepam, 2.9% in 379 children with temazepam, 2.5% in 406 children with zopiclone, and 2.7% in 19,193 children whose mothers had diagnosed depression and/or anxiety but no first trimester drug exposures. When compared with 2.7% in 351,785 children with no diagnosed depression/anxiety nor medication use, the adjusted odds ratios were 1.02 (99% confidence interval 0.63–1.64) for diazepam, 1.07 (0.49–2.37) for temazepam, 0.96 (0.42–2.20) for zopiclone and 1.27 (0.43–3.75) for other anxiolytic/hypnotic drugs and 1.01 (0.90–1.14) for un-medicated depression/anxiety. Risks of system-specific MCAs were generally similar in children exposed and not exposed to such medications.ConclusionsWe found no evidence for an increase in MCAs in children exposed to benzodiazepines and non-benzodiazepine hypnotics in the first trimester of pregnancy. These findings suggest that prescription of these drugs during early pregnancy may be safe in terms of MCA risk, but findings from other studies are required before safety can be confirmed.

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Section: Discussionsupporting

confidence: 52%

First Trimester Exposure to Anxiolytic and Hypnotic Drugs and the Risks of Major Congenital Anomalies: A United Kingdom Population-Based Cohort Study

et al. 2014

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“…The management of HEG involves resuscitation, identification and treatment of any cause of the vomiting, [11] correction of electrolyte imbalance, symptomatic support such as rehydration, administration of antiemetics, thiamine supplementation, and nutritional as well as psychological support. It is not certain why the serum electrolytes were not assessed in the DH despite the availability of a functional laboratory.…”

Section: Discussionmentioning

confidence: 99%

Clinical awareness for health care professionals: Fatal encephalopathy complicating persistent vomiting in pregnancy

Ngene

Moodley

2016

S Afr Med J

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“…It is associated with high circulating hCG levels and its treatment usually requires hospital admission, rehydration and antiemetic drugs. [1][2][3][4] Drug treatment is based on a range of different molecules active as antiemetics, which includes anticholinergics, antihistamines (H1 receptor antagonists), dopamine agonists such as metoclopramide and domperidone, selective 5-hydroxytryptamine receptor antagonist (ondansetron) or any combination of these agents. Proton pump inhibitors and H2 blockers may also be used as useful adjunctive treatments in women with frequent vomiting or retching.…”

Section: Introductionmentioning

confidence: 99%

Transdermal clonidine in the treatment of severe hyperemesis. A pilot randomised control trial: CLONEMESI

Maina

Arrotta

Cicogna

et al. 2014

BJOG

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Objective To study the efficacy of transdermal clonidine in the treatment of severe refractory hyperemesis gravidarum (HG), the most severe illness of pregnancy.Design The study had a randomised, double -blind, placebo-controlled, cross-over design (RCT).Setting Single tertiary referral hospital after admission of patients.Sample Twelve women of gestational age 6-12 weeks and a major grade of HG clinical severity who were unresponsive to standard antiemetic treatment.Methods The patients were randomly treated with and without the active drug (5 mg patch) for two consecutive periods of 5 days. The patients were allocated to a random list to receive first placebo and then active drug or the other way round. Other antiemetic drugs were administered on a scheduled or as-needed basis. All patients received intravenous hydration and thiamine supplementation. Main outcome measures Pregnancy Unique Quantification of Emesis (PUQE) and visual analog scale (VAS) clinical scores,positive morning urine ketonuria, number of doses of standard antiemetic drugs required, and number of days off intravenous therapy were compared in the two periods.Results Transdermal clonidine led to a significantly greater improvement compared with placebo of the primary (PUQE score P = 0.026 CI 0.43-3.24; VAS score P = 0.010 CI 2.17-12.83) and secondary outcome measures. A reduction of blood pressure was reported for systolic 6 mmHg P = 0.01 and diastolic 3 mmHg P = 0.055.Conclusions This preliminary RCT demonstrates the efficacy of transdermal clonidine in the treatment of severe HG, leading to a significant reduction of symptoms and reducing the need for other supportive measures and medications.

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Managing hyperemesis gravidarum: a multimodal challenge

Cited by 85 publications

References 88 publications

First Trimester Exposure to Anxiolytic and Hypnotic Drugs and the Risks of Major Congenital Anomalies: A United Kingdom Population-Based Cohort Study

First Trimester Exposure to Anxiolytic and Hypnotic Drugs and the Risks of Major Congenital Anomalies: A United Kingdom Population-Based Cohort Study

Clinical awareness for health care professionals: Fatal encephalopathy complicating persistent vomiting in pregnancy

Transdermal clonidine in the treatment of severe hyperemesis. A pilot randomised control trial: CLONEMESI

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