Women shy away from morning-sickness drug
A University of Bergen research fellow says health personnel need to explain more clearly that new medications do not harm their foetus.
A new extensive study shows that many pregnant women who could benefit from anti-nausea medications avoid them, although they are considered safe. Over half of women who take sick leave from work because of morning sickness balked at the idea of using such drugs.
The Norwegian study included 712 women who were pregnant or had recently given birth.
One in three with acute nausea declines
Pregnant women today might be unaware of the thalidomide scandal about 60 years ago, when a drug on the market prescribed to ward off morning sickness turned out to cause severe birth defects. But it would seem that there might be a lingering reluctance to prescribe or to use remedies, which actually have been seen for decades to be safe when used properly.
All the women in the study were more or less afflicted with morning sickness. The majority of them had not taken any anti-nausea drugs to alleviate the problem.
This reluctance was observed in seven out of ten of the women who were moderately troubled by morning sickness. But the more severe the nausea, the more likely they were in general to accept the prescribed drugs.
But even among the women who were most severely affected with nausea, one in three declined to use such medications.
“We were surprised that so many women were not getting this treatment with medication,” says Kristine Heitmann.
60 percent on sick leave took no drug
In total, 60 percent of the women in the study either were, or had been, on sick leave from their jobs because of morning sickness.
Among these, six and ten had been given doctor’s certificates for sick leave without simultaneously or previously receiving prescriptions for such drugs.
This is unusual, as guidelines for physicians in Norway recommend anti-nausea medications for women with moderate to severe morning sickness.
Fears over the foetus
The Bergen researchers also examined the attitudes the women had about such drugs.
Most of the women, eight in ten, explained that their threshold for using prescription drugs was higher during their pregnancies.
Eight in ten of the women who had used prescription nausea suppressants were concerned that the drug could harm their unborn babies.
Six in ten said they used such drugs less than they needed to. This included those among them who had severe cases of morning sickness.
“Health personnel have a responsibility here to ease their minds. They need to make strides in informing the women that the medications are not harmful to the foetus and that it’s better to try the medications early to avert even worse nausea,” says Heitmann.
Taking it seriously from the start
Heitmann fears that the sparse use of such medications could indicate that some doctors and other health personnel tend to consider morning sickness to be a normal condition and they don’t take it particularly seriously. Women’s personal reluctance about using these medications is not the only factor here.
“The condition can pose a threat to a woman’s quality of life, work, and role as both a parent and a partner,” she asserts.
“It can be challenging for many general practitioners to comprehend how serious the nausea is. But a Canadian tool makes it easier to quantify the morning sickness into degrees of severity,” explains Heitmann.
The tool developed in Canada and aptly named PUQE (The Pregnancy Unique Quantification of Emisis/Nause Score), has been translated into Norwegian and given official approval, as well as its own Norwegian acronym – SUKK [sigh]. It is available to Norwegian physicians and can be used to evaluate the need for anti-nausea drugs and assess the effects of treatment with them.
Heitmann thinks that health personnel can also improve on the advice they give, regarding diet and lifestyle.
Established drugs viewed as safe
As the exact reason for morning sickness is unknown, the most that doctors can ordinarily do is to try and treat the symptoms. The most common of the morning sickness remedies is meclizine, (under brand names such as Postafen, Bonine, Dramamine II, etc.). Another medication used is metoclopramide (under brand names such as Reglan in the USA and Afipran in Norway).
Mecizine is an antihistamine which works as an antiemetic – or anti-nausea drug – and is deemed secure. It is the first medication prescribed, often in combination with Vitamin B6, which Heitmann says also has antiemetic properties.
Steinar Madsen, a director at the Norwegian Medicines Agency, confirms that these medications are considered safe.
“We have extensive experience with these drugs and they can be used during pregnancies when necessary,” says Madsen.
Naturally, it would be unethical to test new drugs on pregnant women to see whether they are potentially harmful to the unborn baby.
Should be avoided in last trimester
The prevailing drug in use is meclizine. Its most common side-effects are tiredness, dry mouth, and dizziness.
Metoclopramide has other side-effects, the most serious being uncontrolled movements and shuffling of the legs which can be similar to Parkinson’s, according to Steinar Madsen of the Norwegian Medicines Agency.
“This medication should be avoided in the last part of the pregnancy because the new-born infant can get display spasms or motion problems if the mother has used it,” says Madsen.
Experience is the greatest source of knowledge about whether drugs are safe. Medications which have been in use a long time, without observations of serious side-effects, can be considered safe.
Translated by: Glenn Ostling
- Abstract: Heitmann K, Solheimsnes mf: Treatment of nausea and vomiting during pregnancy —a cross-sectional study among 712 Norwegian women. Eur J Clin Pharmacol. 2016:1-12. European Journal of Clinical Pharmacology