Antiemetic in Pregnancy

Morning sickness is a common condition associated with pregnancy and can be effectively managed with antiemetic in pregnancy such as metoclopramide and lifestyle changes.

Commonly known as the "morning sickness", the earliest symptoms experienced during pregnancy are nausea and vomiting which are brought about by the hormonal changes taking place within the body. Up to 90% of women complain of this condition.

Pregnant women develop nausea and vomiting early on during the first trimester of pregnancy. The symptoms peak between six and eight weeks, eventually receding around 12 weeks of pregnancy.

Morning sickness rarely persists after 20 weeks of pregnancy. If it does, the condition is known as "Hyperemesis Gravidarum", a disorder that affects about 35% of the pregnant women, proving to be quite debilitating with profound physical and psychosocial consequences.

Nausea and vomiting can be adequately managed in most of the women by drinking plenty of water and by avoiding the foods that bring on the bouts of nausea and vomiting. If the symptoms preserve even after these measures, antiemetic drugs are prescribed to the pregnant women.

Is It Safe to Use Antiemetic in Pregnancy?

It is quite a common notion that taking antiemetics can turn out to be dangerous during pregnancy. However, this myth needs to be busted as many of the antiemetic drugs have been proven to be safe for use in pregnant women. Contrary to the widespread idea, antiemetics are not associated with any increased risk of birth defects, low birth weight in neonates, preterm delivery and still births, if they are taken during the first 13 weeks of pregnancy.

Since the symptoms peak during the first trimester, the ideal time to start the treatment of morning sickness is during that time. It has been clinically proven that prompt drug treatment with antiemetics yields better results.

Usually, Hyperemesis Gravidarum can be adequately managed in the outpatient department. However, such cases often get neglected resulting in severe dehydration and weight loss. Such patients require immediate intravenous fluid therapy

Safe Antiemetic in Pregnancy

Despite the lifestyle changes and conservative management, nearly 10% of the pregnant women continue to experience severe nausea and vomiting. Numerous antiemetic drugs have been proven to be safe and effective for use during pregnancy. However, these drugs are prescribed only after weighing their advantages against their potential hazards. Following antiemetic drugs are commonly prescribed for the treatment of nausea and vomiting in pregnant women.

1.      Metoclopramide

The first line antiemetic agent prescribed for nausea and vomiting is metoclopramide, prescribed at a dose of 10 milligrams to be taken thrice daily. The effectiveness of metoclopramide has been proven through rigorous clinical trials. The dose of this drug should, however, be tightly regulated since it is associated with adverse effects including extrapyramidal symptoms like involuntary muscle spasms, movement disorders, etc.

2.      Prochlorperazine

The second drug of choice for nausea and vomiting, if metoclopramide fails to yield favorable results, is Prochlorperazine which belongs to the family of phenothiazines. It is commonly given at a dose of 5 milligrams three times a day. The side effects of Prochlorperazine to watch out for include excessive sedation and nervous system disorders.

3.      Cyclizine

The next drug preferred for the management of excessive nausea and vomiting is Cyclizine, which is an antihistaminic drug, taken at a dose of 50 milligrams three times a day. Cyclizine can also cause excessive sedation.

4.      Promethazine

Another effective and safe antiemetic in pregnancy that should be used if the above mentioned drugs fail to control the symptoms of nausea and vomiting is Promethazine. The drug is started at a dose of 25 milligrams to be taken before going to bed and the dose is gradually stepped up till it reaches the maximal allowed dosage of 100 milligrams. Promethazine is associated with the side effects of sedation and nervous disorders (extrapyramidal symptoms).

5.      Ondansetron

In women suffering from hyperemesis gravidarum, ondansetron is the drug of choice which is taken twice or thrice daily at a dose of four to eight milligrams. The common side effects of ondansetron include fatigue, headache, drowsiness, constipation, bloating and abdominal discomfort.

6.      Corticosteroids

If all other measures fail, corticosteroids are used as a last measure for treating severe nausea and vomiting. Despite the fact that the symptoms improve dramatically with the use of corticosteroids, therapy with corticosteroids should not be initiated before 10 weeks of pregnancy since its use is associated with congenital malformations like cleft palate in the neonates.

When to See a Doctor

Severe nausea and vomiting that cannot be managed with lifestyle changes and medications can lead to complications like malnutrition and dehydration which can turn out to be dangerous if not treated immediately. Contact the doctor at once if you notice the following signs and symptoms.

  • Dark colored urine
  • No passage of urine for more than eight hours
  • Inability to keep the foods and fluids down for more than 1 day
  • Excessive weakness, dizziness or even fainting on standing up
  • Abdominal ache
  • High grade fever
  • Blood in vomitus

A common cause of intractable nausea and vomiting are urinary tract infections (UTIs) which are associated with accompanying symptoms of painful urination and blood in urine. If you experience such symptoms, start taking plenty of fluids orally in order to dilute the urine and to relieve the pain. Prompt treatment should be initiated as delay can cause the infection to spread to the kidneys.

What Increases Your Risk?

Numerous risk factors increase the risk of developing nausea and vomiting during pregnancy. These include:

  • Previous history of nausea and vomiting during a former pregnancy
  • Family history of morning sickness
  • Motion sickness
  • Use of estrogen based contraceptive agents
  • Obesity (Body Mass Index of 30 or more)
  • Stress
  • Multiple pregnancies
  • First pregnancy

Since morning sickness occurs during the first trimester, a time when the baby’s development is taking place, using an antiemetic in pregnancy should always follow thorough consultation with the obstetrician to avoid any adverse effects. With proper care and caution, the symptoms of nausea and vomiting can be effectively managed.

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