help finding supportive research

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help finding supportive research

Postby JasmineHG » Aug 24, 2006 4:33 pm

here is my question- i need to find a place that supports certian meds/therapies for HG. I cheated and increased my zofran dose to 32mg/day (after hearing from all of the other ladies....but was 100% my chioce/decision) and had some positive effects- only vomitting once a day for the majority of the time. well i had to come clean with my dirty secret because i needed a refill and my doc was not too happy that i did that. I am already on IV fluids every other day and his next step is TPN. ( i can not afford the zofran pump) So how, where can i find info to show him that this is a possibility. do you offer a place- have i overlooked it? i have shouted the name of this website to anyone who has listened and I swear it has gotten me through the darkest hours! Please let me know where i can find supportive data- thank you very much.
Severe HG survivor and major Colts fan!
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Postby aaronsmommy » Aug 24, 2006 8:42 pm

There are lots of good medical references here http://www.helpher.org/health-professio ... -links.php

Unfortunately most of the published protocols suggest doses of Zofran up to 24 mgs per day (like the Motherisk protocol here http://www.motherisk.org/prof/updatesDe ... d=348#fig1 ) which is virtually identical to the protocol in the ACOG bulletin on NVP.

This is the only published data on the safety of Zofran in pregnancy. I believe the doses used by women in the study were up to 34 mgs per day, but I do not have the full study available.

BJOG. 2004 Sep;111(9):940-3.
The safety of ondansetron for nausea and vomiting of pregnancy: a prospective comparative study.

Einarson A,
Maltepe C,
Navioz Y,
Kennedy D,
Tan MP,
Koren G.
The Motherisk Program, The Hospital for Sick Children, The University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8.
OBJECTIVE: Ondansetron (Zofran) is a drug used for the treatment of nausea and vomiting caused by cancer chemotherapy. Despite the fact that it is not indicated, women are being prescribed this drug for the treatment of nausea and vomiting of pregnancy (NVP). There is a paucity of information on fetal safety for this indication. The objective of this study is to determine whether this drug increases the baseline rate of major malformations. DESIGN: A prospective comparative observational study. SETTING: Teratogen Information Services (TIS). POPULATION: Pregnant women. METHODS: Our three groups included women who were exposed to ondansetron and women exposed to (1) other anti-emetics and (2) non-teratogen exposures. All of the women called either our NVP Helpline or TIS at The Motherisk Program in Toronto, Canada, or The Mothersafe Program in Sydney, Australia. MAIN OUTCOME MEASURE: Rates of major malformation. RESULTS: We have completed 176 pregnancy outcomes in each group. In the ondansetron cohort, there were 169 live births, 5 miscarriages, 2 therapeutic abortions, 6 (3.6%) major malformations and the mean birthweight was 3362 g [SD 525]. There were no statistical differences in any of the study endpoints between the ondansetron and the comparison groups. CONCLUSIONS: This drug does not appear (although the sample size is limited) to be associated with an increased risk for major malformations above baseline.
PMID: 15327608 [PubMed - indexed for MEDLINE]


You should be able to get a copy of the complete study by calling motherisk 18004368477

There is certainly a place for it, but the risks of TPN are well documented in pregnancy, so it is certainly worth avoiding if possible.

J Reprod Med. 2004 Jul;49(7):497-502.
Hyperemesis gravidarum: outcomes and complications with and without total parenteral nutrition.

Folk JJ,
Leslie-Brown HF,
Nosovitch JT,
Silverman RK,
Aubry RH.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York Upstate Medical University, Syracuse 13210, USA. folkj@upstate.edu
OBJECTIVE: To evaluate the obstetric and medical complications with hyperemesis gravidarum, comparing those who were supported with total parenteral nutrition (TPN group) and those who did not receive TPN (non-TPN group). STUDY DESIGN: The medical records of women with a diagnosis of hyperemesis gravidarum (ICD-9 code 643) admitted to Crouse Hospital, Syracuse, New York, between January 1995 and December 1998, were reviewed. A total of 166 subjects were identified and 192 admissions reviewed. Information was gathered for age, gestational age, gravity and parity, marital status, length of stay and number of admissions, and a review of electrolyte, albumin and thyroid function was performed. An assessment of pregnancy complications and outcomes was undertaken. RESULTS: Of the cases reviewed, 16% (27/166) were treated with TPN. The 2 groups were similar regarding incidence of pregnancy-related and maternal medical complications. The groups were similar when comparing objective measures, such as serum potassium, bicarbonate, albumin and thyroid function. The TPN group had a significantly increased incidence of complications directly attributable to parenteral therapy. Among multiparous patients in both groups, 69% had a prior pregnancy that had ended in spontaneous or induced abortion. CONCLUSION: The TPN group had a marked and significant increase in serious complications directly related to TPN use. These data suggest that great care should be taken to assess the need for parenteral therapy in patients with hyperemesis gravidarum. A history of loss in the antecedent pregnancy may be a risk factor for a subsequent pregnancy complicated by hyperemesis gravidarum.
PMID: 15305820 [PubMed - indexed for MEDLINE]
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