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Practical Neurology Jun 2022
Topics: Female; Humans; Hyperemesis Gravidarum; Pregnancy; Wernicke Encephalopathy
PubMed: 35121650
DOI: 10.1136/practneurol-2021-003241 -
The American Journal of Emergency... Jun 2022
Topics: Cannabinoids; Female; Humans; Hyperemesis Gravidarum; Marijuana Abuse; Pregnancy; Syndrome; Vomiting
PubMed: 34607735
DOI: 10.1016/j.ajem.2021.09.021 -
Nutrients Nov 2020Polyunsaturated fatty acids (PUFAs) have been studied in relation to pregnancy. However, there is limited knowledge on PUFAs and their metabolites in relation to... (Review)
Review
Polyunsaturated fatty acids (PUFAs) have been studied in relation to pregnancy. However, there is limited knowledge on PUFAs and their metabolites in relation to hyperemesis gravidarum (HG), a pregnancy complication associated with nutritional deficiencies and excessive vomiting. In order to survey the field, a systematic review of the literature was performed, which also included nausea and vomiting of pregnancy (NVP) due to its close relationship with HG. In the very few published studies found, the main subjects of the research concerned free fatty acids (four records), lipid profiles (three records), and bioactive lipids (one article about prostaglandin E and one about endocannabinoids). The authors of these studies concluded that, although no cause-and-effect relationship can be established, HG is linked to increased sympathetic responsiveness, thermogenic activity and metabolic rate. In addition, NVP is linked to a metabolic perturbance (which lasts throughout pregnancy). The low number of retrieved records underlines the need for more research in the area of PUFAs and HG, especially with regard to the underlying mechanism for the detected effects, potentially involving growth differentiation factor 15 (GDF15) since evidence for GDF15 regulation of lipid metabolism and the role for GDF15 and its receptor in nausea and vomiting is emerging.
Topics: Databases as Topic; Fatty Acids, Unsaturated; Female; Humans; Hyperemesis Gravidarum; Metabolome; Pregnancy
PubMed: 33158081
DOI: 10.3390/nu12113384 -
Obstetrics and Gynecology May 2016The American College of Obstetricians and Gynecologists recommends early treatment of nausea and vomiting of pregnancy to stop progression to hyperemesis gravidarum....
The American College of Obstetricians and Gynecologists recommends early treatment of nausea and vomiting of pregnancy to stop progression to hyperemesis gravidarum. Nausea and vomiting and hyperemesis gravidarum typically occur during the first trimester, the sensitive time for exposure to teratogens because organogenesis is occurring in the embryo. An efficacious treatment used widely across the United States for both nausea and vomiting of pregnancy and hyperemesis gravidarum is ondansetron. Recent studies have provided conflicting findings on the safety of ondansetron during pregnancy. There are numerous limitations in the current literature on ondansetron safety including exposure to the medication is not limited to sensitive windows of organogenesis, there is a lack of information on dosing and compliance, self-reports of exposure are commonly used, an inadequate accounting exists for other factors that may explain the relationship between ondansetron exposure and the adverse outcome, and there exists a lack of biologic plausibility by which ondansetron might cause harm. It is the authors' opinion that current data do not support a reluctance to treat women with ondansetron in clinical practice.
Topics: Antiemetics; Female; Humans; Hyperemesis Gravidarum; Ondansetron; Pregnancy; Prenatal Care
PubMed: 27054931
DOI: 10.1097/AOG.0000000000001375 -
Thrombosis Research Feb 2015The brain and the placenta synthesize identical peptides and proteins, such as brain-derived neurotrophic factor, oxytocin, vascular endothelial growth factor, cortisol,... (Review)
Review
The brain and the placenta synthesize identical peptides and proteins, such as brain-derived neurotrophic factor, oxytocin, vascular endothelial growth factor, cortisol, and matrix metalloproteinases. Given the promiscuity between neurochemistry and the mechanism of placentation, it would be expected that mental disorders occurring during pregnancy would increase the risk of adverse obstetric and neonatal outcomes. Indeed, expectant mothers with anxiety disorders, post-traumatic stress disorder, schizophrenia, or depressive disorders are at higher risk of preterm birth, low-birth-weight and small-for-gestational-age infants than controls. These mental illnesses are accompanied by a procoagulant phenotype and low activity of tissue plasminogen activator, which may contribute to placental insufficiency. Another risk factor for pregnancy complications is hyperemesis gravidarum, more common among women with eating disorders or anxiety disorders than in controls. Severe hyperemesis gravidarum is associated with dehydration, electrolyte imbalance and malnutrition, all of which may increase the risk of miscarriages, of low-birth-weight babies and preterm birth. This paper reviews some aspects of mental disorders that may influence pregnancy and neonatal outcomes.
Topics: Abortion, Spontaneous; Causality; Female; Humans; Hyperemesis Gravidarum; Mental Disorders; Placental Insufficiency; Pregnancy; Pregnancy Outcome; Prevalence; Risk Factors
PubMed: 25903540
DOI: 10.1016/S0049-3848(15)50446-5 -
The Journal of Obstetrics and... Jun 2024Kikuchi-Fujimoto disease (KFD) is rare during pregnancy. It is characterized by necrotizing lymphadenitis and often occurs in young Asian women. We report a case of KFD...
Kikuchi-Fujimoto disease (KFD) is rare during pregnancy. It is characterized by necrotizing lymphadenitis and often occurs in young Asian women. We report a case of KFD during pregnancy, which was difficult to diagnose. A 37-year-old pregnant female (gestational week [GW] 7) was admitted to our hospital because of hyperemesis gravidarum. On the eighth day of hospitalization (GW 8), she suddenly developed a fever (38.0°C) with skin rash and posterior pharynx redness. Blood tests showed pancytopenia and abnormal liver function. The patient was misdiagnosed with severe Epstein-Barr virus infection and administered with prednisolone. Subsequently, cervical lymphadenopathy was observed, and biopsy results led to the diagnosis of KFD. Thereafter, her symptoms improved, and she was discharged at GW 13. KFD must be included as a differential diagnosis for patients with fever, abnormal liver function, and pancytopenia during pregnancy.
Topics: Humans; Female; Histiocytic Necrotizing Lymphadenitis; Pregnancy; Adult; Pregnancy Complications; Hyperemesis Gravidarum
PubMed: 38511280
DOI: 10.1111/jog.15928 -
Obstetrics and Gynecology May 2016To examine the risk of birth defects in children born to women who used ondansetron early in pregnancy for nausea and vomiting of pregnancy or hyperemesis gravidarum. (Review)
Review
OBJECTIVE
To examine the risk of birth defects in children born to women who used ondansetron early in pregnancy for nausea and vomiting of pregnancy or hyperemesis gravidarum.
DATA SOURCES
PubMed, EMBASE, Cochrane, Scopus, Web of Science, Journals@Ovid Fulltext, ClinicalTrials.gov, and Google Scholar databases.
METHODS OF STUDY SELECTION
Studies were included for review if they were written in English, included a comparison population of patients not exposed to ondansetron, and reported human data, original research, exposure to ondansetron during the first trimester, and structural birth defects as an outcome.
TABULATION, INTEGRATION, AND RESULTS
A total of 423 records were identified. After accounting for duplicate records and including only relevant articles, a total of eight records met criteria for review. Data from the various studies were conflicting: whereas the three largest studies showed no increased risk of birth defects as a whole (36 malformations, 1,233 exposed compared with 141 malformations and 4,932 unexposed; 58/1,248 exposed compared with 31,357/895,770 unexposed; and 38/1,349 exposed compared with 43,620/1,500,085 unexposed; with odds ratios [ORs] of 1.12 (95% confidence interval [CI] 0.69-1.82), 1.3 [95% CI 1.0-1.7], and 0.95 [95% CI 0.72-1.26], respectively), two of these studies demonstrated a slightly increased risk of cardiac defects specifically (OR 2.0 [95% CI 1.3-3.1] and 1.62 [95% CI 1.04-2.14]), a finding that was not replicated in other studies. The most consistent association (if any) appears to be a small increase in the incidence of cardiac abnormalities, the bulk of which are septal defects.
CONCLUSION
The overall risk of birth defects associated with ondansetron exposure appears to be low. There may be a small increase in the incidence of cardiac abnormalities in ondansetron-exposed neonates. Therefore, ondansetron use for nausea and vomiting of pregnancy should be reserved for those women whose symptoms have not been adequately controlled by other methods.
Topics: Abnormalities, Drug-Induced; Antiemetics; Female; Humans; Hyperemesis Gravidarum; Infant, Newborn; Ondansetron; Pregnancy; Pregnancy Complications; Pregnancy Outcome
PubMed: 27054939
DOI: 10.1097/AOG.0000000000001388 -
Clinics in Perinatology Jun 2019Many conditions that require frequent medication use are common during pregnancy. The purpose of this article is to list some of the most common of these disorders and... (Review)
Review
Many conditions that require frequent medication use are common during pregnancy. The purpose of this article is to list some of the most common of these disorders and to discuss the risk to the developing fetus of the medications used most frequently to treat them. Included are drugs used for the treatment of asthma, nausea and vomiting, hyperthyroidism, pain and fever, and depression during pregnancy.
Topics: Abnormalities, Drug-Induced; Acetaminophen; Adrenal Cortex Hormones; Adrenergic beta-Agonists; Analgesics, Non-Narcotic; Anti-Asthmatic Agents; Antidepressive Agents; Antiemetics; Antithyroid Agents; Asthma; Congenital Abnormalities; Depressive Disorder; Female; Humans; Hyperthyroidism; Leukotriene Antagonists; Maternal-Fetal Exchange; Methimazole; Morning Sickness; Ondansetron; Pregnancy; Pregnancy Complications; Propylthiouracil; Teratogens
PubMed: 31010556
DOI: 10.1016/j.clp.2019.02.003 -
The Journal of Clinical Psychiatry Jun 2020Ondansetron is a 5-HT₃ receptor antagonist that has been approved for the prevention of nausea and vomiting associated with cancer chemotherapy, radiotherapy, and... (Review)
Review
Ondansetron is a 5-HT₃ receptor antagonist that has been approved for the prevention of nausea and vomiting associated with cancer chemotherapy, radiotherapy, and surgery. Ondansetron has also been studied in the treatment of many neuropsychiatric and medical conditions. The drug is commonly used off-label to treat nausea and vomiting of pregnancy (NVP) and hyperemesis gravidarum (HG). Ondansetron crosses the placental barrier, and concerns have been expressed that using ondansetron for NVP/HG during the first trimester of pregnancy may increase the risk of major congenital malformations (MCMs) in the offspring. In this context, findings from a meta-analysis of 6 cohort and 2 case-control studies, read along with the results of subsequently published cohort (n = 3) and case-control (n = 1) studies, suggest that a signal does exist to associate early gestational exposure to ondansetron with an increased risk of heart defects and orofacial defects. Arguments both for and against confounding by indication have been proposed to explain these findings. Nevertheless, even if ondansetron is causally implicated in MCM risk, the absolute increase in risk, such as for orofacial clefts (by 0.03%) and ventricular septal defect (by 0.3%), is small. These small risks should be balanced against the risks associated with inadequately treated NVP/HG, and decision-making must be shared between clinician and patient. Repeated fetal scanning during the second trimester can help in the early detection of malformations, if present.
Topics: Abnormalities, Drug-Induced; Administration, Intravenous; Administration, Oral; Antiemetics; Female; Humans; Morning Sickness; Ondansetron; Pregnancy; Pregnancy Trimester, First; Risk Factors
PubMed: 32526103
DOI: 10.4088/JCP.20f13472 -
Seminars in Perinatology Dec 2014With 50-90% of pregnant women experiencing nausea and vomiting of pregnancy (NVP), the burden of illness can become quite significant if symptoms are under-treated... (Review)
Review
With 50-90% of pregnant women experiencing nausea and vomiting of pregnancy (NVP), the burden of illness can become quite significant if symptoms are under-treated and/or under-diagnosed, thus allowing for progression of the disease. The majority of these women will necessitate at least one visit with a provider to specifically address NVP, and up to 10% or greater will require pharmacotherapy after failure of conservative measures to adequately control symptoms. As a result, initiation of prompt and effective treatment in the outpatient setting is ideal. Once NVP is diagnosed and treatment is started, it is crucial to track symptoms in order to assess for a decrease in or resolution of symptoms as well as an escalation in symptoms requiring additional therapy. Of note, co-existing gastroesophageal reflux disease (GERD), Helicobacter pylori infection, and psychosocial factors may have a negative impact on the management of NVP. Ultimately, every woman has her own perception of disease severity and desire for treatment. It is critical that both the provider and patient be proactive in the diagnosis and management of NVP.
Topics: Ambulatory Care; Antiemetics; Diet Therapy; Doxylamine; Female; Fluid Therapy; Gastroesophageal Reflux; Histamine H1 Antagonists; Humans; Hyperemesis Gravidarum; Metoclopramide; Morning Sickness; Ondansetron; Pregnancy; Promethazine; Pyridoxine; Severity of Illness Index; Vitamin B Complex
PubMed: 25267280
DOI: 10.1053/j.semperi.2014.08.014