Nausea in Pregnancy: Factors Influencing Decisions About Medication

More than 3 million women in the United States experience nausea related to pregnancy. Nausea and vomiting can be debilitating and interfere with a women’s personal and professional life.

Researchers at Kaiser Permanente Washington conducted a qualitative pilot study to understand the experiences and decision-making women face as they contemplate the use of antinausea medications during pregnancy. The results were published December 2018 in BMC Pregnancy and Childbirth.

Researchers conducted 2 focus groups with a total of 20 women who filled at least 1 antinausea prescription during their pregnancies. The women in the focus groups expressed that they preferred not to take medication while pregnant. However, 90% of these women did take medication at some point while pregnant, and many reported significant symptom reduction. Overall, women wanted symptom relief so they could function socially and professionally.

Some women assumed their experience was a normal part of pregnancy, and because of the infrequency of prenatal visits during the first trimester, many women did not receive medication when symptoms were worse. Unfortunately, many women did not receive medication until they were in the emergency department due to dehydration.

Doxylamine/pyridoxine is the only medication that is FDA approved for nausea and vomiting during pregnancy. Doxylamine/pyridoxine is expensive and rarely covered by insurance. Ondansetron is not FDA approved, however it is used in about 1 in 4 pregnant women. The limited safety data on ondansetron in pregnant women leaves those who experience severe nausea and vomiting uncertain when decision-making. Providers often followed current clinical guidelines and suggested options such doxylamine/pyridoxine prior to ondansetron.

Women received information from sources that included published literature, consulting websites, doctors, family and friends. Women felt reassured when friends or family had personal experiences with antinausea medication while pregnant.

Health care professionals must present information in ways that are meaningful and helpful to women. Further evaluation of risks and benefits of antinausea medications in a diverse population will aid discussions with these patients.

Sonya Kremenchugsky is a 2019 PharmD Candidate at the University of Connecticut in Storrs, Connecticut.

Reference

Figueroa Gray M, Hsu C, Kiel L, Dublin S. Getting through the day: a pilot qualitative study of U.S. women's experiences making decisions about anti-nausea medication during pregnancy. BMC Pregnancy Childbirth. 2018 Dec 4;18(1):475.