2/17/2020 Treatment of Nausea and Vomiting of Pregnancy Nausea - - PDF document

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2/17/2020 Treatment of Nausea and Vomiting of Pregnancy Nausea - - PDF document

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2/17/2020 Treatment of Nausea and Vomiting of Pregnancy Nausea and vomiting affect up Emerging Policy and Preparedness Issues to 80% of pregnant women for Common Concerns Regarding Womens Reproductive Health Historical

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Emerging Policy and Preparedness Issues for Common Concerns Regarding Women’s Reproductive Health

Christina Chambers, PhD, MPH Professor Department of Pediatrics Departments of Family Medicine and Public Health and Skaggs School of Pharmacy and Pharmaceutical Sciences University of California, San Diego

Treatment of Nausea and Vomiting of Pregnancy

  • Nausea and vomiting affect up

to 80% of pregnant women

  • Historical (unsubstantiated)

concerns regarding safety of treatments - i.e., the Bendectin story

  • Recently, ondansetron has

been commonly used as an “off-label” treatment

Treatment of Nausea and Vomiting of Pregnancy 1 2 3 4

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What are the alternatives? Trends in California

  • 241,952 pregnancies Kaiser

Northern California

  • From 2009-2016, increase in

use across all age groups from 4.2% to 7.1%

Young-Wolff KC, et al. JAMA. 2017;318(24):2490-91. Brown QL, et al. JAMA. 2017;3187(2):207-209.

Trends in Marijuana Use In Pregnant Women in California

Young-Wolff KC, et al. JAMA. 2017;318(24):2490-91. Brown QL, et al. JAMA. 2017;3187(2):207-209.

Most Pronounced in Pregnant Women <25 Years of Age 5 6 7 8

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National Survey on Drug Use and Health 2007-2012

  • 7.0% of pregnant respondents used in the last 2-12 months; 16.2%

reporting almost daily use

  • 92% of pregnant respondents thought access to marijuana was easy
  • 70% of pregnant past-year users perceived slight or no risk of harm

from using marijuana 1-2 times a week in pregnancy

Ko JY et al. American Journal of Obstetrics and Gynecology. 2015;213(2):201 e1- e10 ElSohly MA et al. Biological Psychiatry. 2016;79(7):613-9

Marijuana Use in Pregnancy

  • Safety data are lacking
  • Data mostly from older studies with no biomarkers of

exposure and limited numbers of pregnancies

  • Today’s marijuana products are at least 3-4 times more

potent (higher concentration of THC) than products available in the past

Marijuana Use in Pregnancy

Fried PA and Makin JE. Neurotoxicology and Teratology. 1987;9(1):1-7. Fried PA et al. Neurotoxicology and Teratology. 1998;20(3):293-306. Fried PA et al, Neurotoxicology and Teratology. 2003;25(4):427-36. Smth AM et al. Neurotoxicology and Teratology. 2016;26(4):532-42. Day NL et al. Neurotoxicology and Teratology. 1994;16(2):169-75. Goldschmidt L et al. Journal of the American Academy of Child and Adolescent Psychiatry. 2008;47(3)254-63. Leech SL et al. Journal of the American Academy of Child and Adolescent Psychiatry. 2006;45(2):223-30. El Marroun H et al. Drug and Alcohol Dependence. 2011;118(2-3)470-4.

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Response to Emerging Epidemics

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Response to Emerging Epidemics

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Response to Emerging Epidemics 13 14 15 16

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Actual Data on Safety of Prescription Medications in Pregnancy and Lactation are Limited

  • Most commonly prescribed opioids
  • Hydrocodone
  • Codeine
  • Oxycodone
  • >25% privately insured and >33% of Medicaid-enrolled women of

childbearing age filled a prescription for an opioid each year between 2008-2012

  • Limited information on effects of early pregnancy exposure on

pregnancy outcome, infant and child health

  • Why and what can be done?

Ailes et al; MMWR Morb Mortal Wkly Rep. 2015;64

Opioids as an Example 17 18 19 20

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  • https://betterbeginnings.org/
  • https://mommysmilkresearch.org/
  • https://mothertobaby.org/
  • chchambers@ucsd.edu

Thank you 21 22