Women's perspectives on the management and consequences of hyperemesis gravidarum - a descriptive interview study.

OBJECTIVE: Hyperemesis gravidarum (HG) affects 0.3-3% of pregnant women and is a leading cause of hospitalization in early pregnancy. The aim of the study was to investigate women's treatment and management of HG, as well as the consequences of HG on women's daily life. DESIGN AND SETTING: A cross-sectional study based on a structured telephone interview and an online questionnaire. Participants were recruited by social media and by the Norwegian patient's organization for HG. SUBJECTS: Norwegian women that experienced HG. MAIN OUTCOME MEASURE: Women's perspectives on management and consequences of HG. RESULTS: The study included 107 women. Maternal morbidity was profound; about 3/4 of participants were hospitalized due to HG, and the majority showed clinical signs of dehydration (79%), ketonuria (75%), and >5% weight loss (84%). Antiemetics were used by >90% and frequently prescribed "as needed". Metoclopramide (71%) and meclozine (51%) were most commonly used. Participants described HG as having severe psychosocial consequences and profound impact on daily activities. Almost two out of five reported thoughts of elective abortion, and 8 women had at least one elective pregnancy termination due to HG. Overall, 20 women (19%) changed GPs due to dissatisfaction with HG management. CONCLUSION: Despite the high psychosocial burden and major impact on daily activities, many women with HG reported a lack of support from healthcare professionals and suboptimal management. Greater awareness and knowledge among healthcare professionals is needed to improve care for women with HG. Key Points There is a paucity of studies on management and the consequences of HG on women's daily lives and psychosocial burden. We found that: • Many women described HG as one of their worst life experiences with profound morbidity. • Many women reported suboptimal management of HG and lack of support from healthcare professionals. • Greater understanding of patient perspectives among healthcare professionals is important to improve care and management for HG patients.

The burden of nausea and vomiting during pregnancy: severe impacts on quality of life, daily life functioning and willingness to become pregnant again - results from a cross-sectional study.

BACKGROUND: Though nausea and vomiting is very common during pregnancy, no studies have investigated the impact of this condition on the women's daily lives in a Scandinavian population. The aim of this study was to describe the burden of nausea and vomiting during pregnancy (NVP) on global quality of life, daily life functioning and willingness to become pregnant again according to the severity of NVP symptoms. METHODS: This study is a cross-sectional population-based study conducted in Norway. Pregnant women and mothers with children <1 year of age with current or prior NVP were eligible to participate. Data were collected through an anonymous on-line questionnaire accessible from November 10th, 2014 to January 31st, 2015. Severity of NVP was measured using the 24-h Pregnancy Unique Quantification of Emesis Scale (PUQE). Associations between severity of NVP, daily life functioning and willingness to become pregnant again were tested using chi-square tests. Associations with global quality of life measured in terms of the Quality of Life Scale (QOLS) were estimated using generalized linear models and reported as unstandardized regression coefficients (ß) with 95% confidence intervals (CI). RESULTS: 712 women with NVP were included in the study. NVP was significantly associated with several characteristics, including daily life functioning, quality of life and willingness to become pregnant again. The negative impact was greater the more severe the symptoms were, although considerable adverse effects were also seen among women with mild and moderate NVP symptoms. Over one fourth of the women with severe NVP considered terminating the pregnancy due to NVP, and three in four considered not to get pregnant again. Severity of NVP remained significantly associated with reduced global quality of life when adjusting for maternal characteristics and illnesses with ß (95% CI) = -10.9 (-16.9, -4.9) for severe versus mild NVP. CONCLUSIONS: NVP as measured by PUQE had a major impact on various aspects of the women's lives, including global quality of life and willingness to become pregnant again.

Treatment of nausea and vomiting during pregnancy -a cross-sectional study among 712 Norwegian women.

PURPOSE: The purposes of this study were to investigate the treatments used for nausea and vomiting of pregnancy (NVP) according to NVP severity among Norwegian women and to assess whether maternal characteristics and attitudes were related to the use of pharmacological treatment of NVP. METHODS: This is a cross-sectional Web-based study. Pregnant women and mothers with children ≤1 year of age were eligible to participate. Data were collected through an anonymous online questionnaire accessible from November 10th, 2014 to January 31st, 2015. RESULTS: In total, 712 women were included in the study, of which 62 (8.7 %), 439 (61.7 %) and 210 (29.5 %) had mild, moderate and severe NVP, respectively, according to the Pregnancy-Unique Quantification of Emesis (PUQE) classification. A total of 277 (38.9 %) women had used one or more antiemetics, of which meclizine, closely followed by metoclopramide, was the most commonly used. Different drug utilisation patterns were found between the groups of women with mild, moderate and severe NVP. Many with moderate or severe symptoms did not use any pharmacological treatment (70.2 and 32.9 %, respectively). Sick leave was given without initiating medical treatment in 266 (62.1 %) women. The women's beliefs about medicines had an important impact on their use of medicines for NVP. CONCLUSIONS: A large proportion of women suffered from moderate to severe symptoms of NVP, many of whom did not receive any pharmacological treatment. Many women, who had been on sick leave due to NVP, were not prescribed medicines.

Breastfeeding women in need of information about antiemetics for nausea and vomiting during pregnancy: a review of inquiries to a medicines information service.

Introduction: The medicines information service, SafeMotherMedicine, regularly receives inquiries from breastfeeding women asking about antiemetics for nausea and vomiting during pregnancy (NVP) or hyperemesis gravidarum (HG). However, treatment guidelines for NVP or HG do not address the use of antiemetics in women who are breastfeeding while becoming pregnant again. Our objective was to characterize inquiries to describe the need for lactation risk information among women with NVP or HG and also to raise awareness of this topic. Method: We conducted a review of inquiries to the Norwegian web-based medicines information service, SafeMotherMedicine. Results: In total, 97 inquiries addressing the use of antiemetics for NVP or HG during breastfeeding were identified. The following medications were addressed in the inquiries (n = 97): meclizine (51%), metoclopramide (33%), promethazine (16%), ondansetron (9%), and others (6%). The breastfed child was older than 6 months and 1 year in 96% and 71% of the inquiries, respectively. There was a preponderance of general inquiries (unclear motivation/double checking) (64%); however, one-third of the inquiries were generated by restrictive information from sources such as product information. Conclusion: Based on our small review of spontaneous inquiries, there seems to be an information need about the use of antiemetics during lactation among women breastfeeding an older infant whilst suffering from NVP or HG. Addressing such use in guidelines for NVP and HG and/or other easily available information sources may be considered in order to balance out the restrictive information provided by the manufacturers. This could avoid potential unnecessary weaning of breastfeeding in an otherwise challenging situation.

Drug use and breastfeeding.

BACKGROUND: This article describes the principles of drug transfer into breast milk and how drugs may affect breast-fed infants, and provides practical advice about what should be considered when prescribing medication for a lactating woman. MATERIAL AND METHOD: The article is a review based on a discretionary selection of articles found after a search in PubMed, recommendations from Norwegian and international expert groups, and the authors' own studies and experience. RESULTS: Recommendations concerning the use of drugs among breast-feeding women tend to be based on studies in which the degree of drug transfer to the mother's milk has been measured or on case studies, sometimes in combination with pharmacokinetic or pharmacodynamic considerations. The toxicity and dosage of the medication, duration of treatment, as well as the infant's age and health condition need to be considered. Psychotropic drugs are the drug group for which most studies have been published. This is also the group for which individual risk/benefit evaluations are most often required, since a risk of pharmacological effects on the infant cannot be excluded. INTERPRETATION: Most drugs can be used by breast-feeding women, since the amount transferred to the breast milk is too small to have any pharmacological effects on the infant. In most cases, the sum of available information in combination with clinical experience will be sufficient to provide specific advice about the use of medication during breast-feeding.

Echinacea and elderberry-should they be used against upper respiratory tract infections during pregnancy?

This review evaluates the safety of echinacea and elderberry in pregnancy. Both herbs are commonly used to prevent or treat upper respiratory tract infections (URTIs) and surveys have shown that they are also used by pregnant women. The electronic databases PubMed, ISI Web of Science, AMED, EMBASE, Natural Medicines Comprehensive Database, and Cochrane Library were searched from inception to November 2013. Relevant references from the acquired articles were included. No clinical trials concerning safety of either herb in pregnancy were identified. One prospective human study and two small animal studies of safety of echinacea in pregnancy were identified. No animal- or human studies of safety of elderberry in pregnancy were identified. Twenty clinical trials concerning efficacy of various echinacea preparations in various groups of the population were identified between 1995 and 2013. Three clinical trials concerning efficacy of two different elderberry preparations were identified between 1995 and 2013. The results from the human and animal studies of Echinacea sp. are not sufficient to conclude on the safety in pregnancy. The prospective, controlled study in humans found no increase in risk of major malformations. The efficacy of Echinacea sp. is dubious based on the identified studies. Over 2000 persons were given the treatment, but equal amounts of studies of good quality found positive and negative results. All three clinical trials of Elderberry concluded that it is effective against influenza, but only 77 persons were given the treatment. Due to lack of evidence of efficacy and safety, health care personnel should not advice pregnant women to use echinacea or elderberry against upper respiratory tract infection.

Impact of socio-demographic factors, knowledge and attitude on the use of herbal drugs in pregnancy.

BACKGROUND: Herbal drugs are often promoted as 'natural' and 'safe'. These claims may especially attract pregnant women who are often concerned about their unborn child's well-being. Few studies have assessed the use of herbal drugs in pregnancy and the factors related to this use. OBJECTIVE: To investigate the impact of socio-demographic factors, knowledge and attitude on the use of herbal drugs in pregnancy. METHODS: A total of 400 postpartum women at Ulleval University Hospital in Oslo, Norway were interviewed within 3 days after giving birth by using a structured questionnaire in the period from February to June 2001. RESULTS: In all, 36% of the women reported herbal use during their pregnancy. Both women who had used herbal drugs in pregnancy and those not, had a positive attitude toward the use of herbal drugs in pregnancy. Echinacea was the most well known herb among both groups of women. The factors associated with the use of herbal drugs in pregnancy were: prior use of herbs, high knowledge about herbal drugs and age between 26 and 35 years. There was a non-significant higher frequency of herbal drugs use in pregnancy among women with a higher education level. CONCLUSION: The widespread use and positive attitude toward herbal drugs in pregnancy indicates an increased need for documentation about both the efficacy and safety of herbal drugs in pregnancy. Women between 26 and 35 years with a prior history of herbal drug use and high knowledge about herbs, are more prone to using herbal drugs in pregnancy.

Use of herbal drugs in pregnancy: a survey among 400 Norwegian women.

PURPOSE: To investigate the use of herbal drugs by pregnant women. METHODS: We interviewed 400 postpartum women at Ullevål University Hospital in Oslo, Norway about the use of herbal drugs, within 3 days after giving birth by using a structured questionnaire in the period from February to June 2001. RESULTS: We found that 36% of the pregnant women had used herbal drugs during pregnancy with an average of 1.7 products per woman. The proportion of women using herbal drugs increased throughout the first, second and third pregnancy trimester. The most commonly used herbs were echinacea, iron-rich herbs, ginger, chamomile and cranberry. Among the women having used herbal drugs in pregnancy, 39% had used herbal drugs that were considered possibly harmful or herbs where information about safety in pregnancy was missing. Herbal galactagogues had been used by 43% of the women who had breastfed a prior child during their breast-feeding period. Use of herbal drugs in pregnancy had most commonly been recommended by family or friends. CONCLUSION: The widespread use of herbal drugs during pregnancy indicates an increased need for documentation about the safety of herbal drugs in pregnancy. To meet the needs of pregnant women, it is necessary for health care personnel to have knowledge about herbal drugs during pregnancy.