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Taking medications during pregnancy can be very upsetting for women as the general belief is that they will hurt their baby(ies). Compliance issues may result. However, it is important to for mothers to understand that the stress and risks of chronic dehydration, malnutrition, metabolic and emotional stress, as well as reduced mobility will generally develop. These have been demonstrated to increase the risk of complications in mothers and possibly even in their child(ren). Conversely, most studies of medications commonly used for HG have not been found to significantly increase the risk of malformations in the baby. Mothers are acutely aware of the risks medications may pose and will generally avoid them unless necessary, so it is unecessary for health professionals to try and determine if a mother is exaggerating her symptoms to obtain medication.

It is important to not only decide on the correct medication, or combination as is most common, but also to make sure a medication is being tolerated and taken correctly for optimal effectiveness. If a mother cannot swallow a pill or vomits it back up before it dissolves, then oral medications need to be replaced with medications that can be given a different route until a mother is more stable. Some medications can be made into a different form, such as a cream or suppository, by a compounding pharmacy. Others are available as oral dissolvable tablets, patches, or rapidly dissolving films. Trying the most effective medications in different forms is important before trying different medications.

MEDICATION STRATEGIES Brochure

Keep in mind, the primary goal is to reduce nausea and vomiting so the mother can increase her intake and stay as mobile as possible. Risks and benefits must be considered in every case as each mother is unique.

Kimber MacGibbon, RN

  1. Be cautious with medication changes. Medications may seem ineffective until the medication is removed and symptoms dramatically worsen. Consider adding medications instead, unless there are significant side effects.
  2. More than one prescription medication is typically required to adequately manage HG and minimize weight loss.
  3. Most medications are more effective in higher amounts (e.g. Zofran/ondansetron), and if taken on a consistent schedule, not as needed (prn).
  4. Dispensing medications more frequently (e.g. every 2 hours instead of every 4 hours) or continuously (by IV or sub Q infusion) may be more advantageous.
  5. Changing the route a medication is given (e.g. oral to IV or subQ pump, compounded Rx, etc.) can dramatically enhance its performance. Oral medications are generally unproductive in the presence of intractable vomiting.
  6. If a medication yields minimal improvement after 3-5 days, its benefit may only be found if trialed via another route and/or in combination with another medication.
  7. Adequate hydration and correction of electrolyte and micronutrient deficiencies (e.g. thiamine) are critical for symptom relief. Until these are corrected, actual medication response cannot be determined.
  8. Educate on treatment and prevention of medication side-effects that are worsened by pregnancy or HG (e.g. constipation, anxiety), which prevents additional complications and unnecessary discomfort.
  9. Treat co-occurring conditions such as reflux and constipation early.
  10. OB consults should be done before pregnancy and again as soon as pregnancy is confirmed to establish a plan of care when HG risk is high.
  11. Women who present with symptoms before 8 weeks are likely to get worse before the next scheduled visit. Set up contingent treatment in advance (e.g. earlier follow up, prescriptions on hold, direct contact number, guidelines on going to ER, etc.).
  12. Every pregnancy is different so medication effectiveness varies, but the severity of hyperemesis, as well as the duration, most often is similar.
  13. Proactively treat if there is early onset, greater severity, or prolonged duration of symptoms.
  14. Minimizing changes to doses and regimen when women are improving can prevent relapse, especially during initial recovery.
  15. Once symptoms have resolved and the mother is past her first trimester, it is important to wean medications slowly over a few weeks to avoid relapse. If symptoms reappear, return to the dose that was effective and consider weaning again after a few more weeks of stabilization.
  16. Even women who have returned to normal eating and activity may benefit from a low dose of medication throughout pregnancy to avoid relapse or constant fluctuations, and resultant debility.
  17. Women are very helpful in determining their medication needs, especially if they had HG previously. Most prefer to take none and will discontinue them as soon as possible.
  18. HG is traumatic and women are comforted by having access to medication early to alleviate symptoms at onset rather than when severe. Women may take less medication knowing they can get relief when needed, thus decreasing risk and cost.

 

RESOURCES:

Ondansetron in Pregnancy and Risk of Adverse Fetal Outcomes. N Engl J Med 2013; 368:814-823.
Risk factors, treatments, and outcomes associated with prolonged hyperemesis gravidarum. J Matern Fetal Neo Med. 2012 Jun;25(6):632-6.
Posttraumatic stress symptoms following pregnancy complicated by hyperemesis gravidarum. J Matern Fetal Neo Med. 2011 Nov;24(11):1307-11.
Symptoms and pregnancy outcomes associated with extreme weight loss among women with HG. J Women’s Health. 2009 Dec;18(12):1981-7.
For more information: www.HelpHER.org/HER-Research

 

 

Updated on: Nov. 08, 2015

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