Pubdate: Sun, 01 May 2005
Source: Mothering (US)
Section: Issue 124, May/June 2004
Copyright: 2005 Mothering Magazine
Contact:  http://mothering.com/
Details: http://www.mapinc.org/media/3358
Author: Peggy O'Mara, Editor
Bookmark: http://www.mapinc.org/mmj.htm (Cannabis - Medicinal)
Bookmark: http://www.mapinc.org/women.htm (Women)
Related: Cannabis and the Law
Related: Is Marijuana a Valuable Treatment for Autism?
Related: Medical Marijuana: A Surprising Solution To Severe Morning Sickness
Related: Marijuana Use during Pregnancy

COMMON TREATMENTS FOR HYPEREMESIS GRAVIDARUM

Nausea and vomiting, the most common conditions of pregnancy, affect up to 
80 percent of all pregnant women.

Commonly called "morning sickness," nausea and vomiting can occur 
throughout the day. Rarely does this cause problems for mother or baby, and 
most often it resolves itself around the 12th week of pregnancy, when 
levels of the pregnancy hormone Human Chorionic Gonadotropin (hCG) plateau.

Ninety percent of nausea and vomiting is relieved by the 22nd week of 
pregnancy.

For a small percentage of pregnant women, however, there is no relief.

For these women, the severe nausea and vomiting, in such cases called 
hyperemesis gravidarum, never abate, and sometimes require hospitalization 
with intravenous (IV) fluids and medications. In many cases, a home health 
nurse can administer IV fluids, so that the pregnant woman can stay at home.

Hyperemesis gravidarum can be related to hyperthyroidism, gall-bladder 
disease, pregnancy-induced hypertension, appendicitis, or irritable bowel 
syndrome. Smaller, more frequent meals that are low in fat and sugar and 
contain plenty of vegetables and fruits can help. Caffeine should be avoided.

Acupressure has proven successful in relieving the nausea of pregnancy.

The NeiGuan Pressure Point (P6) is located about two inches below the wrist 
crease dividing the wrist from the hand, on the underside of the wrist, 
between the two tendons.

Apply direct pressure either with fingers or with a wristband.

Ginger root has been used for centuries for nausea; it can be taken raw or 
in the form of tea, tinctures, capsules, or candy.

It is often suggested that the intake of foods containing B vitamins be 
increased. These include whole grains, leafy greens, dried beans, almonds, 
peanuts, broccoli, and cabbage.

Antiemetic drugs are prescribed for some women who suffer from pernicious 
nausea and vomiting.

Medications are taken rectally, orally, or through an IV line, and may 
include pyridoxine (vitamin B6). These drugs include Promethazine 
(phenergan), Compazine, Haloperidol, and even Thorazine (chlorpromazine). 
Newer antinausea drugs, such as Zofran (ondansetron), were designed for 
cancer patients and are expensive.

Nor are they always covered by insurance, as they are not labeled as 
approved for use by pregnant women.

In one study, two thirds of the women surveyed believed that drug use was 
more likely to increase their baby's risk for birth defects.1 These fears 
are fueled by memories of such drugs as thalidomide, which was prescribed 
to pregnant women for nausea in the 1950s. Thalidomide was withdrawn from 
the market in 1961, when it was discovered that the drug was a human 
teratogen; i.e., a substance that would cause developmental malformations 
in the fetus.

Approximately 5,000 to 7,000 malformed infants were born to women who 
ingested thalidomide during pregnancy.

Bendectin, a combination of vitamin B6 (pyridoxine) and the antihistamine 
Doxylamine, was commonly prescribed for nausea in pregnancy.

Because of repeated accusations that Bendectin caused fetal malformations, 
its manufacturer, Merrell Dow Pharmaceuticals, voluntarily removed the drug 
from the market in 1983. According to its supporters, Bendectin was never 
proven to be teratogenic. It is still marketed in Canada, under the name 
Diclectin.

Hyperemesis is a serious condition-the dehydration that results from 
repeated nausea and vomiting can put both baby and mother at risk. However, 
the drugs commonly prescribed for severe nausea and vomiting have never 
been tested on pregnant women.

In some cases, the results of animal trials are available, but there simply 
have been no tests on pregnant women. Although no animal or human 
teratogenicity has been reported regarding Zofran (ondansetron), arguably 
the most effective drug for nausea and vomiting, Zofran's package insert 
cautions: "There are, however, no adequate or well-controlled studies in 
pregnant women.

Because animal reproductive studies are not always predictive of human 
response, this drug should be used during pregnancy only if clearly needed."

For some women, nothing seems to work. One mother reported vomiting 10 to 
30 times a day, sometimes every 15 minutes.

Steroids are used to control the vomiting.

In addition, the antiemetic drug Zofran is prescribed, as well as the 
antipsychotic Zyprexa. These drugs can be taken as tablets dissolved under 
the tongue, or by IV. In one study of 267 pregnancies, preliminary survey 
data reported that medical marijuana was 34 to 40 percent effective in 
relieving the symptoms of hyperemesis gravidarum-at least as effective as 
Antivert (meclizine), corticosteroids, and Diclectin.

NOTE 1. Paolo Mazzotta, MSc, et al., "The Perception of Teratogenic Risk by 
Women with Nausea and Vomiting of Pregnancy," Reproductive Toxicology 13, 
no. 4 (Jul-Aug 1999): 313--319.
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MAP posted-by: Beth