Treatment of nausea and vomiting in pregnancy: A comparative European study

A. Einarson, G. Koren, U. Bergman
The Motherisk Program, the Hospital for Sick Children, Toronto, Ontario, Canada
Department of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden

Background

In Europe it is estimated that there are more than 18 million women who become pregnant each year. Of that number at least 50% of these women suffer from nausea and vomiting in the first 12-16 weeks of pregnancy. The purpose of this study was to investigate how this condition is treated in different countries.

Study design and methods

Questionnaires were sent out primarily to Teratogen Information Centres and members of the European Drug Utilisation Research Group. A total of 30 were sent, of which 17 were eastern and 13 were western European countries. The participants were asked to rate in order of preference, the treatment of choice in their country. There were three categories of nausea and vomiting: (a) mild (b) moderate (c) severe. Non-medicinal treatments were also requested.

Results

From the 30 countries, we have received 26 completed questionnaires. These include 16 from eastern and 10 from western countries. The main drug used for mild and moderate nausea and vomiting in northern Europe is meclizine, southern Europe, metoclopramide and eastern Europe, thiethylperazine. Four countries used pyridoxine alone, one combined it with meclizine and one doxylamine and one country used the combination of doxylamine, pyridoxine and dicyclomine. Most countries however, treat hyperemesis gravidarum similarly, with hospitalisation, IV fluids and phenothiazines. Non-medicinal treatments reported range from psychotherapy, homeopathy, acupuncture and intravenous multivitamins, to using diathermy in the region of the celiac plexus for hyperemesis gravidarum.

Conclusion

This relatively informal survey, demonstrating wide variations in treatment, suggests that all treatment modalities may be congruent with the modern principles of evidence based medicine. It also suggests, among other reasons, that at times, the rational use of drugs is based on the availability in each particular country.

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