Attitudes, management and consequences of nausea and vomiting of pregnancyin the United States and Canada

Background: Nausea and vomiting of pregnancy (NVP) affects a large: proport ion of pregnant women. In 1983, Bendectin(R), the only FDA-approved drug fo r NVP, was removed from the market by its manufacturer due to legal costs b ased on claims of teratogenicity, which were subsequently proven to be unsu bstantiated. In Canada, a generic form of Bendectin(R) (Diclectin(R); a dox ylamine/pyridoxine combination) has continued to be available, with increas ing use over the last few years. Objective: To characterize the attitudes, management and consequences of NVP among pregnant women in the USA, where n o approved drug for NVP is available, and in Canada, where such a drug is a vailable. Design: Prospective, observational study. Results: Women sufferin g from NVP (N = 1444) were interviewed, of which 42% were American and 58% were Canadian. The two groups had similar maternal characteristics and a si milar distribution of severity of NVP, although among Canadian women the NV P continued for slightly longer. American respondents were treated signific antly more often by an obstetrician as their primary caregiver, were more c ommonly advised by their caregiver to change their diet and/or lifestyle an d to use non-pharmacological agents to manage their NVP, and more often per ceived anti-emetics as posing an increased risk for malformations (all P < 0.001). Canadian respondents reported a family physician as their primary c aregiver significantly more often, were more commonly advised to take anti- emetic medications and perceived their NVP as causing a concern to their un born (all P < 0.001). American women experienced significantly larger weigh t loss, more hospitalizations and more time lost from paid work. Conclusion s: Lack of an approved drug for symptoms of NVP may be associated with unwa rranted and preventable adverse health effects. Because this is an observat ional study, these associations do not necessarily prove causation. (C) 200 0 International Federation of Gynecology and Obstetrics.