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

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 Women’s Reproductive Health • Historical (unsubstantiated) concerns regarding safety of treatments - i.e., the Bendectin story Christina Chambers, PhD, MPH Professor Department of Pediatrics Departments of Family Medicine and Public Health • Recently, ondansetron has and Skaggs School of Pharmacy and Pharmaceutical Sciences been commonly used as an University of California, San Diego “off-label” treatment 1 2 Treatment of Nausea and Vomiting of Pregnancy 3 4 1

2/17/2020 Trends in California What are the alternatives? 5 6 Trends in Marijuana Use In Pregnant Most Pronounced in Pregnant Women Women in California <25 Years of Age • 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. Young-Wolff KC, et al. JAMA . 2017;318(24):2490-91. Brown QL, et al. JAMA . 2017;3187(2):207-209. Brown QL, et al. JAMA . 2017;3187(2):207-209. 7 8 2

2/17/2020 Marijuana Use in Pregnancy Marijuana Use in Pregnancy National Survey on Drug Use and Health 2007-2012 • Safety data are lacking • 7.0% of pregnant respondents used in the last 2-12 months; 16.2% • Data mostly from older studies with no biomarkers of reporting almost daily use exposure and limited numbers of pregnancies • 92% of pregnant respondents thought access to marijuana was easy • Today’s marijuana products are at least 3-4 times more potent (higher concentration of THC) than products available • 70% of pregnant past-year users perceived slight or no risk of harm in the past 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 9 10 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. Ne urotoxicology 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. 11 12 3

2/17/2020 Response to Emerging Epidemics 14 13 14 Response to Emerging Epidemics Response to Emerging Epidemics 15 16 15 16 4

2/17/2020 17 18 17 18 Actual Data on Safety of Prescription Opioids as an Example Medications in Pregnancy and Lactation • Most commonly prescribed opioids are Limited -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 19 20 5

2/17/2020 Thank you • https://betterbeginnings.org/ • https://mommysmilkresearch.org/ • https://mothertobaby.org/ • chchambers@ucsd.edu 21 22 6