General practitioners are wary of treating sickness in pregnancy
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《英国医生杂志》
1 University of Warwick, Coventry CV4 7AL rgadsby@doctors.org.uk
Sickness in pregnancy causes symptoms that vary from mild to so severe that hospital admission is required. It is associated with an appreciable loss of time from work1 and disruption of normal social activities,2 and it has been the stated reason for 25-29 terminations of pregnancy every year in the United Kingdom.3 However, many general practitioners in the United Kingdom feel frightened of suggesting any treatment to women presenting with pregnancy sickness because they believe that it would be ineffective and could cause fetal abnormalities.
There were 20 rapid responses after the first part of the case history, some of which discussed the use of nutritional and complementary therapies. The problem is that few data exist on the effectiveness and safety of such therapies for pregnancy sickness. There were fewer responses after the second part of the history, which perhaps suggests that doctors are not used to the idea of n of 1 trials in general practice.
Pregnancy sickness is difficult to measure, and the methods described in the case report might not have been sensitive enough to detect any improvement resulting from treatment with pyridoxine. One respondent also suggested that the treatment intervals should have been longer.
The Rhodes score, which was first used to assess nausea and vomiting during cancer chemotherapy, has been proposed as the method of choice for assessing treatments for pregnancy sickness.4 This score gives a validated and quantifiable measure of the severity of the condition.
Advice is needed
No drugs are licensed for treating pregnancy sickness in the United Kingdom. However, evidence based guidelines approved by the Society of Obstetricians and Gynaecologists of Canada state that diclectin (pyridoxine 10 mg and doxylamine 10 mg) should be the initial treatment as it has the greatest evidence to support its efficacy and safety in pregnancy.5
In the absence of such a guideline in the United Kingdom, general practitioners are left to give reassurance and general advice. They occasionally resort to prescribing, as in this case history, often using something like prochlorperazine or metoclopramide, for which there are few data on effectiveness or safety in pregnancy.
Competing interests: RG is a trustee of the charity pregnancysicknesssupport, which has received an unrestricted educational grant from Duchesnay of Canada.
References
Gadsby R, Barnie-Adshead AM, Jagger C. A prospective study of nausea and vomiting during pregnancy. Br J Gen Pract 1993;43: 245-8.
Mazzotta P, Stewart DE, Atanackovic G, Koren G, Magee LA. Psychosocial morbidity among women with nausea and vomiting of pregnancy: prevalence and association with anti-emetic therapy. J Psychosom Obstet Gynaecol 2001;22: 7-12.
Use of ICD Code 643 "Excessive vomiting of pregnancy" in Abortion statistics IPSC London UK
Koren G, Magee L, Attard C, Kohli M, Atanackovic G, Bishai R, et al. A novel method for the evaluation of the severity of nausea and vomiting of pregnancy. Eur J Obstet Gynecol Reprod Biol 2001;94: 31-6.
Arsenault M-Y, Lane CA. The management of nausea and vomiting of pregnancy. J Obstet Gynaecol Can 2002;24: 817-23.(Roger Gadsby, senior lect)
Sickness in pregnancy causes symptoms that vary from mild to so severe that hospital admission is required. It is associated with an appreciable loss of time from work1 and disruption of normal social activities,2 and it has been the stated reason for 25-29 terminations of pregnancy every year in the United Kingdom.3 However, many general practitioners in the United Kingdom feel frightened of suggesting any treatment to women presenting with pregnancy sickness because they believe that it would be ineffective and could cause fetal abnormalities.
There were 20 rapid responses after the first part of the case history, some of which discussed the use of nutritional and complementary therapies. The problem is that few data exist on the effectiveness and safety of such therapies for pregnancy sickness. There were fewer responses after the second part of the history, which perhaps suggests that doctors are not used to the idea of n of 1 trials in general practice.
Pregnancy sickness is difficult to measure, and the methods described in the case report might not have been sensitive enough to detect any improvement resulting from treatment with pyridoxine. One respondent also suggested that the treatment intervals should have been longer.
The Rhodes score, which was first used to assess nausea and vomiting during cancer chemotherapy, has been proposed as the method of choice for assessing treatments for pregnancy sickness.4 This score gives a validated and quantifiable measure of the severity of the condition.
Advice is needed
No drugs are licensed for treating pregnancy sickness in the United Kingdom. However, evidence based guidelines approved by the Society of Obstetricians and Gynaecologists of Canada state that diclectin (pyridoxine 10 mg and doxylamine 10 mg) should be the initial treatment as it has the greatest evidence to support its efficacy and safety in pregnancy.5
In the absence of such a guideline in the United Kingdom, general practitioners are left to give reassurance and general advice. They occasionally resort to prescribing, as in this case history, often using something like prochlorperazine or metoclopramide, for which there are few data on effectiveness or safety in pregnancy.
Competing interests: RG is a trustee of the charity pregnancysicknesssupport, which has received an unrestricted educational grant from Duchesnay of Canada.
References
Gadsby R, Barnie-Adshead AM, Jagger C. A prospective study of nausea and vomiting during pregnancy. Br J Gen Pract 1993;43: 245-8.
Mazzotta P, Stewart DE, Atanackovic G, Koren G, Magee LA. Psychosocial morbidity among women with nausea and vomiting of pregnancy: prevalence and association with anti-emetic therapy. J Psychosom Obstet Gynaecol 2001;22: 7-12.
Use of ICD Code 643 "Excessive vomiting of pregnancy" in Abortion statistics IPSC London UK
Koren G, Magee L, Attard C, Kohli M, Atanackovic G, Bishai R, et al. A novel method for the evaluation of the severity of nausea and vomiting of pregnancy. Eur J Obstet Gynecol Reprod Biol 2001;94: 31-6.
Arsenault M-Y, Lane CA. The management of nausea and vomiting of pregnancy. J Obstet Gynaecol Can 2002;24: 817-23.(Roger Gadsby, senior lect)