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Bonne Starks
5/9/2017
Topic:
Hyperemesis in pregnancy
This database search covers literature from 1966 to the present. Unless otherwise noted below, MEDLINE was searched using
the OVID CD-ROM system located in the library. This system is also available to staff via modem. MEDLINE is produced by the
NATIONAL LIBRARY OF MEDICINE.
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Notes: Results include: last 5 years, reviews or what is on site.
1: Am J Obstet Gynecol. 2008 Jan;198(1):71.e1-7.
Validity of a modified Pregnancy-Unique Quantification of Emesis and Nausea
(PUQE) scoring index to assess severity of nausea and vomiting of pregnancy.
Lacasse A, Rey E, Ferreira E, Morin C, Bérard A.
Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada.
OBJECTIVE: The only validated nausea and vomiting of pregnancy (NVP) severity
index is the Motherisk Pregnancy-Unique Quantification of Emesis and Nausea
(PUQE) index that covers symptoms in the previous 12 hours. We sought to assess
the validity of a modified-PUQE index that covers the entire first trimester of
pregnancy by comparing NVP severity scores between the 12-hour PUQE index and our
modified-PUQE index and by measuring the extent of the association between the
modified-PUQE score and quality-of-life (QOL) score during the first trimester of
pregnancy. STUDY DESIGN: A prospective study that included women who attended the
Centre Hospitalier Universitaire Sainte-Justine or René-Laennec clinic for their
prenatal visits was conducted from 2004-2006. Women were eligible if they were >
or = 18 years old and < or = 16 weeks of gestation at the time of their first
prenatal visit. Women who reported NVP were asked to fill out the 12-hour PUQE,
the modified PUQE index, and the Short-Form Health Survey QOL index
simultaneously. Intraclass correlation coefficients were calculated to determine
concordance between the 2 scores. Linear regression models were built to measure
the association between the modified-PUQE score and Short-Form Health Survey QOL
scores. RESULTS: Among participants (n = 287), the mean NVP severity score was
5.7 vs 6.7 on the 12-hour PUQE and modified PUQE, respectively (P < .05). There
was substantial concordance between the indices (intraclass correlation
coefficient, 0.71). Severity of NVP that was measured by the new modified index
was associated with QOL. CONCLUSION: We are confident that, on the basis of the
modified-PUQE, the relationship between QOL and severity of NVP justify the use
of this new index.
Publication Types: Research Support, Non-U.S. Gov't Validation Studies
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PMID: 18166311 [PubMed - indexed for MEDLINE]
2: Am J Obstet Gynecol. 2008 Jan;198(1):56.e1-4.
Hyperemesis in pregnancy: an evaluation of treatment strategies with maternal and
neonatal outcomes.
Holmgren C, Aagaard-Tillery KM, Silver RM, Porter TF, Varner M.
Department of Obstetrics and Gynecology, University of Utah Health Sciences
Center, Salt Lake City, UT, USA. [email protected]
OBJECTIVE: The objective of the study was to evaluate the use of interventions
such as a peripherally inserted central catheters (PICC) line or nasogastric
(NG)/nasoduodenal (ND) tube with the use of medications alone in the management
of pregnancies with hyperemesis. STUDY DESIGN: Subjects were identified with
confirmed intrauterine pregnancy, admitted with hyperemesis gravidarum (HEG)
between 1998 and 2004. Medical records were then abstracted for information with
regard to therapy. Subjects were assigned on the basis of the management plan:
medication alone, PICC line, or NG/ND tube. Outcomes were compared between
groups. RESULTS: Ninety-four patients met study criteria and had complete outcome
data available. Of those, 33 had a PICC line placed (35.1%), 19 had a NG/ND
placed (20.2%), and 42 were managed with medication alone (44.7%). These groups
were similar with respect to gestational age at delivery, Apgar score, and mean
birthweight. Maternal complications were significantly higher among those with
PICC lines. Of patients managed with PICC lines, 66.4% (P < .001) required
treatment for infection, thromboembolism, or both. Adjusted odds ratio for a PICC
line complication was 34.5 (5.09, 233.73). CONCLUSION: Maternal complications
associated with PICC line placement are substantial despite no difference in
neonatal outcomes, suggesting that the use of PICC lines for treatment of HEG
patients should not be routinely used.
PMID: 18166306 [PubMed - indexed for MEDLINE]
3: Dig Dis Sci. 2007 Oct;52(10):2840-3. Epub 2007 Apr 12.
Helicobacter pylori stool antigen assay in hyperemesis gravidarum: a risk factor
for hyperemesis gravidarum or not?
Aytac S, Türkay C, Kanbay M.
Department of Gastroenterology, Güven Hospital, Ankara, Turkey.
Objective: To test the hypothesis that Helicobacter pylori (H. pylori) infection
may cause hyperemesis gravidarum (HG). Materials and methods: A
prospective-comparative study was performed on 107 pregnant patients from October
2002 to December 2003 in a university-based prenatal care clinic. Blood and stool
samples were obtained from 52 patients diagnosed as HG and 55 matched
asymptomatic pregnant women. H. pylori stool antigen (HpSA) status of the
participants was evaluated using a commercially available enzyme
immunoassay-based kit. Results: The overall prevalence of HpSA positivity
appeared as 41.1%. Twenty-two of 52 (42.3%) HG patients and 22 of 55 (40.0%)
control subjects were positive for HpSA. The difference was not significant
(p>.05). Conclusion: HG seemed to be not associated with H. pylori infection, as
indicated by specific stool antigen assay.
PMID: 17431779 [PubMed - indexed for MEDLINE]
4: Aust Fam Physician. 2007 Sep;36(9):698-701.
Hyperemesis gravidarum--assessment and management.
Sheehan P.
Maternity Care Program, Royal Women's Hospital, Melbourne, Victoria, Australia.
[email protected]
BACKGROUND: Nausea and vomiting are common symptoms in early pregnancy. In most
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women the condition is mild and self limiting. A small percentage of women
experience severe nausea and vomiting. This is known as hyperemesis gravidarum.
Outcomes have improved with intravenous rehydration therapy. Consequences include
decreased quality of life, time off work and secondary depression. OBJECTIVE:
This article outlines the aetiology, outcomes, history and examination of women
with hyperemesis gravidarum. Treatment modalities are discussed together with
evidence regarding use. DISCUSSION: It is important to exclude other causes of
nausea and vomiting such as urinary tract infection and thyrotoxicosis.
Assessment of severity by checking for ketones is important as severity
determines management. Management will include rehydration (intravenous or oral).
Evidence is lacking regarding dietary and lifestyle recommendations but some
women find them useful. Pyridoxine and metoclopramide (category A) are first line
in treatment of hyperemesis gravidarum followed by prochlorperazine (category C),
prednisolone (category A), promethazine (category C) and ondansetron (category
B1). Benefit has been reported with the use of ginger. Evidence is mixed
regarding acupressure and acupuncture.
Publication Types: Review
PMID: 17885701 [PubMed - indexed for MEDLINE]
5: Obstet Gynecol. 2007 Sep;110(3):695-703.
Hyperemesis gravidarum and Helicobacter pylori infection: a systematic review.
Golberg D, Szilagyi A, Graves L.
Department of Family Medicine, SMBD Jewish General Hospital, McGill University,
Montreal, Canada. [email protected]
OBJECTIVE: To systematically review studies examining the relationship between
hyperemesis gravidarum and Helicobacter pylori (H pylori) infection. DATA
SOURCES: A 1966 to January 2007 search using MEDLINE/PubMed, EMBASE, and Web of
Science included MeSH terms: "Helicobacter pylori," "Helicobacter infections,"
"hyperemesis gravidarum," and the text words "nausea," "vomit," "pregnancy," and
"Helicobacter." References of selected papers were examined for additional
relevant studies. METHODS OF STUDY SELECTION: We evaluated studies investigating
a relationship between hyperemesis gravidarum and H pylori infection. Studies
were included in which the diagnosis of hyperemesis gravidarum was made at or
before entry into the study, and H pylori diagnosis was made by serum antibody
sample, gastric biopsy, saliva test, or stool sample. The search produced 169
titles; 22 were reviewed in further detail. TABULATION, INTEGRATION, AND RESULTS:
Fourteen case-control studies met established criteria, involving 1,732
participants and controls tested for H pylori infection. Studies were evaluated
according to patient demographics and study methodology (case definition,
exclusion criteria, H pylori testing). An estimate of the odds ratios with 95%
confidence intervals was calculated by using a random effects model for
dichotomous variables with review article software. Ten studies showed a
significant association between hyperemesis gravidarum and H pylori infection.
Odds ratios varied from 0.55 to 109.33; three results were less than 1.0. Tests
for heterogeneity applied to several subgroups were considerable with values
above 75% for all groups. CONCLUSION: An association between hyperemesis
gravidarum and H pylori infection is suggested by this systematic review.
However, the considerable heterogeneity among studies highlights study
limitations.
Publication Types: Review
PMID: 17766620 [PubMed - indexed for MEDLINE]
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6: Crit Care Med. 2006 Nov;34(11):2781-3.
Pulsed steroid therapy is an effective treatment for intractable hyperemesis
gravidarum.
Bondok RS, El Sharnouby NM, Eid HE, Abd Elmaksoud AM.
Department of Anaesthesiology and Intensive Care, Ain-Shams University Hospitals,
Cairo, Egypt.
OBJECTIVE: Intractable hyperemesis gravidarum remains a serious cause of
morbidity among pregnant women. If not controlled, hyperemesis gravidarum can
lead to severe disability, electrolyte and acid base imbalance, and even various
organ system dysfunctions. From the successful use of steroids for
chemotherapy-induced emesis, corticosteroids might prove useful in hyperemesis
gravidarum. The purpose of this study was to compare the efficacy of pulsed
hydrocortisone therapy with that of metoclopramide for the management of
intractable hyperemesis gravidarum. DESIGN: Prospective, double-blind study.
SETTING: Intensive care unit of Ain Shams University Maternity Hospital.
PATIENTS: Forty patients aged 19-34 yrs having a normal appearing intrauterine
pregnancy, of < or =16 wks gestation, admitted to the intensive care unit with
intractable hyperemesis meeting the study criteria. INTERVENTIONS: Patients were
randomly assigned to receive either intravenous hydrocortisone 300 mg as a daily
dose or intravenous metoclopramide 10 mg 3 times daily. After 3 days the
hydrocortisone was tapered completely during the course of 1 wk, whereas the
metoclopramide was continued without change for 1 wk. Patients were followed up
daily during the therapy course and for 2 wks following intensive care unit
discharge. MEASUREMENTS AND MAIN RESULTS: There was a significant reduction in
vomiting episodes in the hydrocortisone group compared with the metoclopramide
group (p < .0001). Within-patient analyses showed a significant reduction in mean
vomiting episodes in the hydrocortisone group within the first 3 days (p <
.0001). No patients from the hydrocortisone group but six of the patients
receiving metoclopramide were readmitted for intractable vomiting within 1 wk
from discharge. Five of them showed improvement on intravenous hydrocortisone
therapy. CONCLUSIONS: A short course of hydrocortisone is an effective treatment
for intractable hyperemesis gravidarum.
Publication Types: Comparative Study Randomized Controlled Trial
PMID: 16957638 [PubMed - indexed for MEDLINE]
7: Scand J Caring Sci. 2006 Jun;20(2):169-76.
Tactile massage and severe nausea and vomiting during pregnancy--women's
experiences.
Agren A, Berg M.
Department of Obstetrics and Gynaecology, Hospital of Skövde, Sweden.
[email protected]
Nausea and vomiting during pregnancy is a condition with an obscure aetiology.
The treatment is symptomatic but there is a lack of alternative treatments.
Tactile massage is known to give relaxation and increased well-being in
connection with different illnesses, but has never been studied on women with
severe nausea and vomiting during pregnancy (SNVP). The aim of this study was to
describe hospitalized women's experiences of SNVP and of tactile massage. A
phenomenological method was used. Ten hospitalized women with SNVP were included.
Each woman was given tactile massage on three separate occasions. After the final
massage an open interview was used covering both the experience of severe nausea
and vomiting, and of tactile massage. The findings revealed an essential meaning
summarizing the experience: to obtain a relieving moment of rest and access to
the whole body when nausea rules life. When nausea is experienced as controlling
a woman's life, tactile massage is experienced as promoting relaxation and gives
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her an opportunity to regain access to her body. The findings suggest that
tactile massage is a good alternative and complement to traditional treatment of
SNVP.
Publication Types: Research Support, Non-U.S. Gov't
PMID: 16756522 [PubMed - indexed for MEDLINE]
8: Obstet Gynecol Surv. 2006 Apr;61(4):255-68.
Hyperemesis gravidarum complicated by Wernicke encephalopathy: background, case
report, and review of the literature.
Chiossi G, Neri I, Cavazzuti M, Basso G, Facchinetti F.
Obstetrics and Gynecology Residency Program, Modena Policlinico Hospital,
University of Modena and Reggio Emilia, Modena, Italy.
Wernicke encephalopathy (WE) is a rare but known complication of severe
hyperemesis gravidarum caused by thiamine deficiency. This article presents an
unusual case that occurred at our institution and reviews the 48 previously
published cases of WE in pregnancy. Considering all the 49 cases, the mean
(+/-standard deviation) patients' age was 26.7 +/- 4.9 years, the mean
gestational age when WE manifested was 14.3 +/- 3.4 weeks, and the mean duration
of vomiting and feeding difficulties was 7.7 +/- 2.8 weeks. Wernicke's classic
triad (confusion, ocular abnormalities, and ataxia) manifested in only 46.9% (23
of 49) of the patients. Confusion affected 63.3% (31 of 49) of the patients,
ocular signs 95.9% (47 of 49) and symptoms 57.1% (28 of 49), and ataxia 81.6% (40
of 49). Deterioration of consciousness affected 53.1% (26 of 49) of the subjects
and memory impairment 61.2% (30 of 49). Complete remission of the disease
occurred in only 14 of 49 cases. Symptom resolution required months and permanent
impairments were common. The overall pregnancy loss rate, directly (spontaneous
fetal loss) and indirectly (planned abortion) attributable to WE, was 47.9% (23
of 49). The diagnosis of WE is clinical and can be rapidly confirmed by magnetic
resonance imaging. We emphasize the importance of thiamine supplementation to
women with prolonged vomiting in pregnancy, especially before intravenous or
parenteral nutrition. We also underline the necessity to promptly replace vitamin
B1 when neurologic symptoms and/or signs develop in a patient with hyperemesis
gravidarum.
Publication Types: Case Reports Review
PMID: 16551377 [PubMed - indexed for MEDLINE]
9: Am J Obstet Gynecol. 2006 Mar;194(3):815-20.
Acupressure for the in-patient treatment of nausea and vomiting in early
pregnancy: a randomized control trial.
Heazell A, Thorneycroft J, Walton V, Etherington I.
Maternal and Fetal Health Research Centre, St. Mary's Hospital, Manchester, UK.
[email protected]
OBJECTIVE: The purpose of this study was to evaluate the efficacy of acupressure
at the P6 point for the in-patient treatment of severe nausea and vomiting in
early pregnancy. STUDY DESIGN: This was a prospective single-blind randomized
control trial that involved 80 patients with nausea and vomiting plus ketonuria
before 14 weeks of gestation. RESULTS: There was no difference between length of
stay, amount of medication, or fluid required between the acupressure and placebo
groups, although acupressure reduced the number of patients who stayed > or =4
nights in the hospital. Acupressure was well tolerated and not associated with an
increase in perinatal morbidity or death. CONCLUSION: The use of acupressure at
the P6 point does not reduce the amount of antiemetic medication that is
required, the requirement for intravenous fluid, and median duration of
in-patient stay more than the use of placebo. A small reduction was seen in the
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number of women who required > or =4 days in the hospital.
Publication Types: Randomized Controlled Trial
PMID: 16522418 [PubMed - indexed for MEDLINE]
10: J Infus Nurs. 2006 Mar-Apr;29(2):89-100.
Hyperemesis gravidarum and the role of the infusion nurse.
Lamondy AM.
Intravenous Therapy Department, Day Kimball Hospital, Putnam, CT, USA.
[email protected]
Hyperemesis gravidarum is a potentially serious complication of pregnancy that
can result in severe maternal malnutrition, affects the normal growth and
development of the fetus, can precipitate preterm birth, and in extreme cases,
causes fetal death. The article uses a case study to review the disease process
and outline the benefits of a team approach to the care of the pregnant woman and
her unborn child. Treatment interventions, from dietary modifications to total
parenteral nutrition, are reviewed, with a focus on the effects that normal
pregnancy physiology has on infusion device selection and the total parenteral
nutrition formula prescribed.
Publication Types: Case Reports Review
PMID: 16569998 [PubMed - indexed for MEDLINE]
11: Obstet Gynecol. 2006 Feb;107(2 Pt 2):486-90.
Wernicke's encephalopathy with hyperemesis and ketoacidosis.
Selitsky T, Chandra P, Schiavello HJ.
Department of Obstetrics and Gynecology, Wyckoff Heights Medical Center,
Brooklyn, New York 11237, USA.
BACKGROUND: Avitaminosis can result from the acute malnutrition associated with
prolonged pregnancy-related hyperemesis. Serious complications may arise from
thiamine deficiency under these circumstances. CASE: We review the relevant
literature and describe a case with central nervous system involvement presenting
with typical manifestations of Wernicke's encephalopathy, apparently precipitated
by a combination of hyperemesis gravidarum, diabetic ketoacidosis, and
intravenous glucose administration. CONCLUSION: While this life-threatening
complication is rare, it is important for all who care for obstetric patients to
be aware of it and alert to its development. Early recognition is critical given
the need to treat affected women expeditiously to help avoid potentially fatal
adverse consequences. Prophylactic thiamine supplementation should be considered
in the care of gravidas with hyperemesis.
Publication Types: Case Reports Review
PMID: 16449159 [PubMed - indexed for MEDLINE]
12: Obstet Gynecol. 2006 Feb;107(2 Pt 1):285-92.
Outcomes of pregnancies complicated by hyperemesis gravidarum.
Dodds L, Fell DB, Joseph KS, Allen VM, Butler B.
Perinatal Epidemiology Research Unit, Department of Obstetrics and Gynaecology,
Dalhousie University, Halifax, Nova Scotia, Canada. [email protected]
OBJECTIVE: To evaluate maternal and neonatal outcomes among women with
hyperemesis during pregnancy. METHODS: A population-based retrospective cohort
study was conducted among women with singleton deliveries between 1988 and 2002.
Hyperemetic pregnancies were defined as those requiring one or more antepartum
admissions for hyperemesis before 24 weeks of gestation. Severity of hyperemesis
was evaluated according to the number of antenatal hospital admissions (1 or 2
versus 3 or more) and according to weight gain during pregnancy (< 7 kg [15.4 lb]
versus > or = 7 kg). Maternal outcomes evaluated included weight gain during
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pregnancy, gestational diabetes, gestational hypertension, labor induction, and
cesarean delivery. Neonatal outcomes included 5-minute Apgar score of less than
7, low birth weight, small for gestational age, preterm delivery, and perinatal
death. Logistic regression was used to generate adjusted odds ratios for all
outcomes, and the odds ratios were converted to relative risks. RESULTS: Of the
156,091 singleton pregnancies, 1,270 had an admission for hyperemesis. Compared
to women without hyperemesis, infants born to women with hyperemesis and with low
pregnancy weight gain (< 7 kg [15.4 lb]) were more likely to be low birth weight,
small for gestational age (SGA), born before 37 weeks of gestation, and have a
5-minute Apgar score of less than 7. Compared with infants born to women without
hyperemesis, rates of low birth weight and preterm delivery were substantially
higher among infants born to women with hyperemesis and low pregnancy weight gain
(4.2% versus 12.5% and 4.9% versus 13.9%, respectively). The outcomes among
infants born to women with hyperemesis with pregnancy weight gain of 7 kg (15.4
lb) or more were not different from the outcomes among women without hyperemesis.
CONCLUSION: The results of this study suggest that the adverse infant outcomes
associated with hyperemesis are a consequence of, and mostly limited to, women
with poor maternal weight gain. LEVEL OF EVIDENCE: II-2.
PMID: 16449113 [PubMed - indexed for MEDLINE]
13: Obstet Gynecol. 2006 Feb;107(2 Pt 1):277-84.
Risk factors for hyperemesis gravidarum requiring hospital admission during
pregnancy.
Fell DB, Dodds L, Joseph KS, Allen VM, Butler B.
Perinatal Epidemiology Research Unit, Department of Obstetrics and Gynaecology,
Dalhousie University, Halifax, Nova Scotia, Canada.
OBJECTIVE: To identify risk factors for hyperemesis requiring hospital admission
during pregnancy. METHODS: Data from a population-based cohort of all deliveries
in Nova Scotia, Canada between 1988 and 2002 were obtained from the Nova Scotia
Atlee Perinatal Database. Women with 1 or more antepartum admissions for
hyperemesis were compared with women with no admissions for hyperemesis. Relative
risks (RRs) and 95% confidence intervals (CIs) were estimated using logistic
regression and used to determine a set of independent risk factors for
hyperemesis. RESULTS: The overall rate of admission for hyperemesis was 0.8% (n =
1,301) among 157,922 deliveries. In the adjusted analysis, hyperthyroid disorders
(RR 4.5, 95% CI 1.8-11.1), psychiatric illness (RR 4.1, 95% CI 3.0-5.7), previous
molar pregnancy (RR 3.3, 95% CI 1.6-6.8), preexisting diabetes (RR 2.6, 95% CI
1.5-4.7), gastrointestinal disorders (RR 2.5, 95% CI 1.8-3.6), and asthma (RR
1.5, 95% CI 1.2-1.9) were all statistically significant risk factors for
hyperemesis, whereas maternal smoking and maternal age older than 30 were
associated with decreased risk. Compared with singleton male pregnancies,
singleton female pregnancies, pregnancies with multiple male fetuses, and male
and female combinations were associated with statistically significant increased
risk of hyperemesis. CONCLUSION: Although hospitalization for hyperemesis occurs
in less than 1% of pregnant women, this translates to a large number of hospital
admissions. The factors associated with hyperemesis are primarily medical and
fetal factors that are not easily modifiable, but identification of these factors
may be useful in determining those women at high risk for developing hyperemesis.
LEVEL OF EVIDENCE: II-2.
PMID: 16449112 [PubMed - indexed for MEDLINE]
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14: Ann Pharmacother. 2005 Oct;39(10):1710-3. Epub 2005 Aug 30.
Treating pregnancy-related nausea and vomiting with ginger.
Boone SA, Shields KM.
Raabe College of Pharmacy, Ohio Northern University, Ada, OH 45810-1078, USA.
OBJECTIVE: To review literature assessing the safety and efficacy of the use of
ginger to treat nausea and vomiting in pregnancy. DATA SOURCES: Iowa Drug
Information Service (1966-September 2004), International Pharmaceutical AB: s
(1971-September 2004), MEDLINE (1966-September 2004), and EMBASE (1966-September
2004) were searched. Key terms included ginger, nausea, vomiting, emesis, and
pregnancy. DATA SYNTHESIS: Studies evaluating the safety and efficacy of ginger
in the management of nausea and vomiting in pregnancy were reviewed. Various
doses and forms of ginger were used to treat women during their first and second
trimesters of pregnancy. Ginger has been shown to improve the symptoms of nausea
and vomiting compared with placebo in pregnant women. CONCLUSIONS: While data are
insufficient to recommend ginger universally and there are concerns with product
quality due to limited regulation of dietary supplements, ginger appears to be a
fairly low-risk and effective treatment for nausea and vomiting associated with
pregnancy. In low doses, this may be appropriate for patients not responding to
traditional first-line therapies.
Publication Types: Review
PMID: 16131535 [PubMed - indexed for MEDLINE]
15: Hum Reprod Update. 2005 Sep-Oct;11(5):527-39. Epub 2005 Jul 8.
Erratum in: Hum Reprod Update. 2007 Mar-Apr;13(2):207.
Hyperemesis gravidarum, a literature review.
Verberg MF, Gillott DJ, Al-Fardan N, Grudzinskas JG.
Academic Unit of Reproductive Physiology, Obstetrics and Gynaecology, St.
Bartholomew's Hospital, West Smithfield, London, UK.
Hyperemesis gravidarum (HG) is a condition causing severe nausea and vomiting in
early pregnancy often resulting in hospital admission. The incidence of HG is
approximately 0.5% of live births, said to be higher in multiple pregnancies,
hydatidiform mole and other conditions associated with increased pregnancy
hormone levels. Both the aetiology and pathogenesis of HG remain unknown. We
conducted a literature review (1966-now) to summarize the current evidence on the
aetiology and pathogenesis of HG. The potential role of pregnancy-related
hormones such as progesterone, estrogen and HCG has been widely studied; however,
various other hormones such as leptin, placental growth hormone, prolactin,
thyroid and adrenal cortical hormones have been implicated in the aetiology of
HG. In addition to endocrinological hypotheses, the rationale and evidence
considering infectious, immunological, psychological, metabolic and anatomical
causes for HG have been analysed here. Many studies suffer from the low number of
patients included, the variable definition used for HG and varying assay
methodology used in studies of hormone measurement. This review highlights the
need for more extensive studies addressing the pathogenesis and aetiology of HG.
Publication Types: Review
PMID: 16006438 [PubMed - indexed for MEDLINE]
16: Obstet Gynecol. 2005 Apr;105(4):849-56.
Comment in: Obstet Gynecol. 2005 Sep;106(3):640; author reply 640-1.
Effectiveness and safety of ginger in the treatment of pregnancy-induced nausea
and vomiting.
Borrelli F, Capasso R, Aviello G, Pittler MH, Izzo AA.
Department of Experimental Pharmacology, University of Naples Federico II,
Naples, Italy. [email protected]
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OBJECTIVE: Conventional antiemetics are burdened with the potential of
teratogenic effects during the critical embryogenic period of pregnancy. Thus, a
safe and effective medication would be a welcome addition to the therapeutic
repertoire. This systematic review was aimed at assessing the evidence for or
against the efficacy and safety of ginger (Zingiber officinale) therapy for
nausea and vomiting during pregnancy. DATA SOURCES: Systematic literature
searches were conducted in 3 computerized databases (MEDLINE, EMBASE, and
Cochrane Library), and the reference lists of all papers located were checked for
further relevant publications. METHODS OF STUDY SELECTION: For the evaluation of
efficacy, only double-blind, randomized controlled trials (RCTs) were included.
All retrieved clinical data, including uncontrolled trials, case reports,
observational studies, and RCTs, were included in the review of safety.
TABULATION, INTEGRATION, AND RESULTS: Six double-blind RCTs with a total of 675
participants and a prospective observational cohort study (n = 187) met all
inclusion criteria. The methodological quality of 4 of 5 RCTs was high. Four of
the 6 RCTs (n = 246) showed superiority of ginger over placebo; the other 2 RCTs
(n = 429) indicated that ginger was as effective as the reference drug (vitamin
B6) in relieving the severity of nausea and vomiting episodes. The observational
study retrieved and RCTs (including follow-up periods) showed the absence of
significant side effects or adverse effects on pregnancy outcomes. There were no
spontaneous or case reports of adverse events during ginger treatment in
pregnancy. CONCLUSION: Ginger may be an effective treatment for nausea and
vomiting in pregnancy. However, more observational studies, with a larger sample
size, are needed to confirm the encouraging preliminary data on ginger safety.
LEVEL OF EVIDENCE: I.
Publication Types: Review
PMID: 15802416 [PubMed - indexed for MEDLINE]
5/9/2017
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