Pregnant women get sick, and sick women get pregnant
November 24, 2015 10:40 PM   Subscribe

Emily Anthes on drug testing and pregnancy
Because it has long been considered unethical to include expectant mothers in clinical trials, scientists simply don’t know whether many common medicines are safe for pregnant women. Of the more than 600 prescription drugs that the US Food and Drug Administration approved between 1980 and 2010, 91 per cent have been so meagrely researched that their safety during pregnancy remains uncertain.
Over the last few years, however, a small, tight-knit group of ethicists, including Lyerly, have become determined to reverse this longstanding scientific neglect of pregnant women. Science and society, they argue, have got it utterly wrong: our efforts to protect women and their fetuses have actually put them both in jeopardy. “Ethics doesn’t preclude including pregnant women in research,” says Lyerly. “Actually, ethics requires it.”
posted by frimble (41 comments total) 30 users marked this as a favorite
 
This is great. I took Tamiflu while pregnant in 2013 and spoke with four different doctors before starting it because I was so conflicted about whether to take it. It would be really great to have hard data about how safe it is to take common drugs. Ultimately pregnancy is so, so hard and feeling like in addition to all the other shit I'm going through I'm also denied most of the advances of modern pharmaceuticals if I want to be extra careful makes it a lot worse. Plus it feels incredibly paternalistic to not allow pregnant women the choice of whether they're willing to enter a clinical trial. But of course on the spectrum of "paternalistic shit pregnant women have to put up with" this isn't an especially egregious offense...

On a pregnancy listserv I'm on, one woman was trying to figure out if she could control her hypothyroidism with diet and exercise or other lifestyle changes. For those not aware, the hormone replacement prescribed to hypothyroid patients is one of a very, very small number of drugs labeled "pregnancy category A" - they are well tested and safe to take during pregnancy, and in fact you put your fetus at risk if you *don't* continue with your levothyroxine. But this poor woman's friend had given her shit about taking a prescription drug during pregnancy, since EVERYONE knows you're not supposed to put anything artificial in your body!

Luckily my listserv shut that line of questioning down pretty fast. But I always kind of worried that she went ahead and quit it anyway.
posted by town of cats at 11:06 PM on November 24, 2015 [10 favorites]


Having had a disaster pregnancy myself (severe preeclampsia/HELLP), one of the biggest shocks was that I wasn't going to be treated with anything that was tested. Literally everything they were giving me was untested (in a formal way) and off label. The explanation I was given at the time was that no drug company would invest in producing drugs for treatment of pregnancy conditions because it would require them to test on pregnant women-- something they were not going to do. There's an interesting article here from the Preeclampsia Foundation on the topic.
posted by frumiousb at 11:37 PM on November 24, 2015 [4 favorites]


It wasn't that long ago (1970s / 1980s) that babies were operated on without anaesthetics, also because no one was keen to perform clinical trials to determine safe doses for babies - effective vs fatal anaesthetic dosages during surgery are variable depending on metabolism and body weight, and newborn babies liver function was not well known and their small size meant extremely precise dosages were required. I suppose no one would be rushing to offer their newborn babies for experimentation.

I feel this issue has similar ethical beats, given the status of unborn babies in the US.
posted by xdvesper at 12:24 AM on November 25, 2015 [3 favorites]


While I agree with Lyerly, I can help but wonder how long it will be before a small mob is standing outside her building with big pictures of Josef Mengele.
posted by Kid Charlemagne at 12:45 AM on November 25, 2015 [1 favorite]


Well, here's the thing. You test on a pregnant woman, baby has a birth defect, you're liable. You don't test on a pregnant woman, woman dies, you're not liable.

People remember Thalidomide.
posted by effugas at 1:09 AM on November 25, 2015 [13 favorites]


Here in Germany, the wonderfully named Pharmakovigilanz- und Beratungszentrums für Embryonaltoxikologie (Pharmacovigilance and Consulting Center for Embryonal Toxicology) is offering the website http://embryotox.de/ with information on any number of medications and what we know about their effects on embryos and foetuses. The intent is to provide a resource with up-to-date information for doctors and pharmacists. It's also very helpful for pregnant women who want to know if common OTC medications such as analgesics and anti-allergens are more or less safe.
posted by brokkr at 2:00 AM on November 25, 2015 [8 favorites]


People remember Thalidomide.

But Thalidomide was not tested. It was never tested on pregnant animals when the tests were conducted, let alone tested on pregnant women. As the article notes, even a tiny trial would have caught how teratogenic it is.
posted by frumiousb at 2:02 AM on November 25, 2015 [22 favorites]


My wife has lupus and has dealt with this through all her pregnancies, and continues to deal with is because she breastfeeds. Breastfeeding is already difficult to manage for many women, so not knowing whst common drugs are safe is just one more stressor that prompts women to quit earlier than when it stops being beneficial for the baby.
posted by Mr.Encyclopedia at 3:00 AM on November 25, 2015 [1 favorite]


People remember Thalidomide.

In my experience of trying to get treatment for horrendously debilitating sickness during pregnancy, thalidomide still looms very large in people's minds. That's one thing I really liked about this article - it changes the focus from "remember thalidomide? That's why we can't risk prescribing drugs during pregnancy" to "remember thalidomide? That's why we need proper clinical testing."

I live in a country where thalidomide was prescribed. (My grandfather was a GP during the thalidomide era, and refused to prescribe it even before it was withdrawn from market after hearing suspicions of the damage it was causing. One of his pregnant patients at the time named her child after him because of this. This is a cool family story but made me feel pretty awful years later when it was me in front of a reluctant GP asking for drugs for pregnancy sickness, let me tell you.) But I think the awfulness of thalidomide contributed to the view I faced, among some medical professionals as well as friends and acquaintances, that drugs in pregnancy are just a huge scary unknown risk which cannot be further understood or quantified. So I got things like, e.g., a medical professional writing in my chart "patient insists on continuing [medication] - have advised of risks", when the only risk advice she had actually given me was "I don't approve of any drugs during pregnancy because you never know. Try ginger instead!"*

I very much didn't want to take any drugs during pregnancy. I think most people would really rather not. But when it comes to the point where we need to, we should have evidence available to the best evidence available to quantify and contextualise the risks that the treatment involves.

* This is a whole other rant really, but it was horrendously difficult to get taken seriously by (some, not all) medical professionals for the 'morning sickness' that eventually got diagnosed as hyperemesis gravidarum. I had periods where I could keep down no food, no fluids, had awful dry retching fits at the sight not only of food but of bright colours or particular shapes, was crawling on my hands and knees from my bed to the bathroom because I didn't have the energy to walk, and got advice like "Instead of eating three large meals a day, try eating three small ones!" or "the trick is to keep something in your stomach all the time, don't let yourself get hungry" or "nibble on crackers, that'll help" or "have you tried ginger?" Gosh yes, ginger - if only I'd thought of the one morning sickness solution that everyone everywhere knows about before trying the anti-sickness drugs they give to chemo patients! Silly me!

There is a special place in my heart for the midwife who did the extra third-trimester growth scan I got because of said sickness, who said "Have you tried -" and then stopped herself and said "oh of course you have, you'll have tried everything by now I'm sure." THANK YOU.

posted by Catseye at 4:08 AM on November 25, 2015 [28 favorites]


It's not that I don't believe the story about the resident being overly concerned with the health of the unborn baby in that story, it's just that it's like, the only time I have ever heard of a resident being overly concerned about an unborn baby: their training is to treat the mom as the patient first. They,by and large, are only concerned with the health outcomes of the mother. The baby always comes second. So it's a kind of odd story since it's far from representative.
posted by MisantropicPainforest at 4:24 AM on November 25, 2015 [2 favorites]


What I mean is it's probably a liability story.
posted by MisantropicPainforest at 4:27 AM on November 25, 2015 [2 favorites]


Let me start with a huge flashing disclaimer: this hits much too close to home for me to be able to approach it completely objectively. My wife was born with a series of major birth defects (on the same spectrum as the thalidomide defects, though not quite as severe). Her mother was prescribed Bendectin while she was pregnant, and I'm 90% sure that the "Maryland girl" mentioned in this article is her. The first seven years of her life contained upward of 25 major surgeries to correct the defects, in an era where infants weren't anesthesized because no one knew how safe anesthesia was for them. The lawsuit against Merrill-Dow was the only reason her family was able to afford those surgeries. When the FDA allowed it back on the shelf a few years ago, it was a gut-punch to both her and her mother.

And yet... the evidence suggests that the FDA is right: there's no noticeable correlation between doxylamine and birth defects. Problem is, all the evidence is retrospective: they looked at epidemiological studies for the five years before and after the drug was pulled from the shelves, and found that there was no change in birth defect rates (though there was a major uptick in hospitalizations for vomiting).

On net, the drug saved thousands of women from hospitalization and the possibility of major complications, up to and including death or loss of pregnancy. It saved millions more from discomfort. Studies on animals performed before the drug went to market the first time didn't show much to hint at teratogenicity. Merrill-Dow followed protocols, and time has vindicated their decisions. And yet. It's hard to put that in context, even for my evidence-based-medicine-cheerleading self, when I actually see, day in and day out, what will happen to thousands of people if Glaxo-Smith-Kline bets on the wrong horse.
posted by Mayor West at 5:57 AM on November 25, 2015 [6 favorites]


While I can agree that women suffering from severe illnesses may want to take part in clinical trials during their pregnancies, I can't see this working, even if ethics committees start allowing pregnant subjects. I'm 6 months pregnant right now and there isn't enough incentive in the world to get me to enroll in a study. Now, granted - I am relatively healthy with no severe pre-existing conditions from before my pregnancy - and have had a *knock on wood* completely normal pregnancy so far. I can't imagine that there would be enough volunteers who would be willing to risk potential damage to their children to have an appropriate sample size for a clinical trial. (Now, i don't suffer from migraines or sickle cell - so my perspective is obviously skewed). Who wants to the guinea pig who killed their baby because they took a class X medication against standard medical advice?
posted by Suffocating Kitty at 6:08 AM on November 25, 2015 [4 favorites]


We are actively working on testing antiretrovirals for HIV in pregnant women. There is a very active federal antiretroviral pregnancy registry and we are currently arguing with our IRB who is being ridiculously paternalistic in excluding pregnant women from a trial (Phase IV) of a drug that many pregnant women have already VERY successfully taken.

This is a really important issue. Thanks for the post frimble.
posted by Sophie1 at 6:13 AM on November 25, 2015 [5 favorites]


Oh, yay! We're involved in this: "In 2013, the troika set out to help close this research gap, joining with Anna Mastroianni, a legal scholar at the University of Washington, to launch a project they called PHASES (Pregnancy and HIV/AIDS: Seeking Equitable Study)."
posted by Sophie1 at 6:22 AM on November 25, 2015


I'm sorry, but if I were ill enough to require medication while pregnant, I'd be part of a study. If the worst happened, at least I could comfort myself knowing that the research will save others. More women would sign up than you think.
posted by domo at 6:28 AM on November 25, 2015 [8 favorites]


I take two prescription drugs daily that are categorized as pregnancy risk category C in the U.S., which means that animal studies have found the drugs may have caused harm to the fetus but there haven't been well-controlled and adequate human studies and the drugs may have more benefit than potential harm.

I looked for alternative drugs that fall under a lower risk profile - no luck. One is an antidepressant. People have been taking antidepressants for decades. In previous bouts of depression, I've had to fight suicidal ideation constantly. Telling me there's no safe (or even safe-ish!) antidepressant I can take during pregnancy is really rough. I feel like I have to choose between potentially harming a fetus with a drug I take to keep myself alive and sane or facing the potential emotional upheaval of pregnancy and depression without medication. I've tried that before and I nearly lost that fight more than once. Hell, I came close to losing that fight while medicated. And I feel lucky - I think most drugs to treat other mental health conditions like bipolar disorder are category D or worse.

Fortunately, I have great doctors. My GP said that the regulatory process makes it nearly impossible for drugs to move from category C to B and that it's an extremely short list of drugs classified as category A (he said water might be category A). The doctor who prescribes the other drug said he's known patients who have taken it through pregnancy and were fine and that the biggest concern is developing high blood pressure while pregnant so watch out for that. Still, how weak is that anecdata? I feel like my OB-GYN wants to ask me if I really need those drugs but they're trying to be nice. My husband has been wonderful and understanding but he's hoping that I'll breastfeed and I don't know about that. I have never been that jazzed about the idea honestly but the idea of feeding a kiddo my pharma juice post-partum is discouraging. And I think it would probably be even worse to drop my antidepressant post-partum than during pregnancy.

I know things happen, everything has risks, nothing is 100% safe for anyone ever but still, I feel like pregnant women and their families deserve better. I work with doctors, researchers and scientists. I have doctors in my family. I love doctors and modern medicine. But this sucks.
posted by kat518 at 6:30 AM on November 25, 2015 [7 favorites]


kat518: The safety of medication during breastfeeding is different than those taken during pregnancy, so just because something is considered risky to take during pregnancy doesn't mean it's equally risky to take while breastfeeding. There's many more barriers in between your meds and your breastmilk than your meds and the placenta. See LactMed or Hale's Medication and Mother's Milk.

That said, if you don't want to breastfeed, you needn't. Just wanted to pass those links along.
posted by soren_lorensen at 6:38 AM on November 25, 2015


Thanks! I'm trying to keep an open mind and planning to see how it goes. Let's hope the person doesn't turn into a mutant while in the womb. Thanks again!
posted by kat518 at 7:16 AM on November 25, 2015


I am so so happy to read this. It was maddening during my pregnancies to not have any data to base decisions on.

Clinical studies are tough but during my pregnancies I would have been more than happy to have my doctor anonymously report what my lifestyle habits are and what medications I'm taking, and follow up with the health of the baby. At least then we'd be able to say 2000 women took this anti migraine drug and then track their outcomes against the general pregnant population.

Really glad there are female doctors and researchers out there who are looking out for the health of women.
posted by betsybetsy at 7:24 AM on November 25, 2015 [6 favorites]


This has been a huge emotional problem for me as I've been pregnant. I've been in such horrible pain for large portions of my pregnancy (like right now!) and even with supportive and sane doctors there's just nothing safe they can do for me anymore. I know I'm not going to breastfeed and I think it's unlikely that I will be willing to be pregnant again as a result. And as selfish as it is, the constant barrage of being told, implicitly and explicitly, that my fetus is more important than I am has been super upsetting and has made it really hard to be excited about any of this. The idea that we actually should support the medical needs of mothers literally makes me cry with joy.
posted by brainmouse at 7:25 AM on November 25, 2015 [16 favorites]


I give credit to any doctor willing to undertake this study, knowing full well that no matter how many release forms and waivers the pregnant mothers sign, some percentage of them are absolutely going to file lawsuits when their child fails (in any small way) to be the rosy-cheeked cherub of their perfect baby fantasy.

AND any developmental problems from birth to puberty. Any bone malformations or organ trouble? Lawsuit. Baby doesn't walk on time? Lawsuit. Toddler develops the dreaded autism? Lawsuit lawsuit lawsuit.
posted by The Pluto Gangsta at 7:31 AM on November 25, 2015


A friend of mine is going through pregnancy induced diabetes. I assumed that she'd be given something to help her control her blood sugar, but reading this, I'm wondering if she was only told to cut down on the carbohydrates and sugars she consumes.

I'm going to pass this on to her, I think she'd appreciate it.
posted by Hactar at 7:46 AM on November 25, 2015


I give credit to any doctor willing to undertake this study, knowing full well that no matter how many release forms and waivers the pregnant mothers sign, some percentage of them are absolutely going to file lawsuits

In what way is this not a potential problem for every clinical trial ever, though? Are pregnant women more likely to sue than the general population?
posted by Catseye at 7:53 AM on November 25, 2015 [2 favorites]


I'm sorry, but if I were ill enough to require medication while pregnant, I'd be part of a study. If the worst happened, at least I could comfort myself knowing that the research will save others. More women would sign up than you think.

But see, what do you mean by "the worst" exactly? Do you mean miscarrying or do you mean delivering and raising/being responsible for a child who is severely impaired/disabled either physically and/or or cognitively?
posted by discopolo at 7:55 AM on November 25, 2015 [3 favorites]


It's not just medications - Google "hair dye and pregnancy" and the depth of arbitrary and opinion-based answers is ridiculous. My OB basically told me, it's probably completely safe to dye your hair, women have been doing it for decades, pregnant hair colorists have never had issues... but no one will do a study on it, so my guideline is not during the first trimester, just in case.

I mean, that's not even ingested, anecdotal evidence suggests it's benign, and no one will study it.

I do think it's more about legal liability than the pro-fetus lobby, though, fwiw.
posted by Mchelly at 8:00 AM on November 25, 2015 [1 favorite]


In what way is this not a potential problem for every clinical trial ever, though? Are pregnant women more likely to sue than the general population?

I don't have any data to answer the second question, but my answer to the first is that if a grown person tried to sue, the release forms would be sufficient to make a successful case unlikely, but I bet if the mother of an affected child were to sue, release or no, her lawyer would advise her to raise such an almighty cry that the doctor's lawyer would want this settled rather than go near a courtroom. And then multiply that by potentially hundreds of mothers.
posted by The Pluto Gangsta at 8:09 AM on November 25, 2015


Catseye: "Are pregnant women more likely to sue than the general population?"

Statistically, yes; and the lawsuits are hella more expensive. Ob/gyn is one of the most-sued specialties and has among the highest payouts and, therefore, the most expensive malpractice insurance.

I don't think that's a persuasive reason NOT to do studies on pregnant women; rather, it suggests we already have malpractice risk for ob/gyns well-studied and well-covered and can surely find ways to fit in studies that will make pregnancies safer AS A WHOLE. There's every incentive for a large medical center to invest in possibly liability-generating studies of pregnant women if the majority of those studies will result in less risk to women in the future; while for an individual doctor the costs don't work out, for a large medical center the cost of litigation now relating to studies of meds in pregnant women is clearly an investment in a less-litigated future and safer pregnancies for future patients.
posted by Eyebrows McGee at 8:11 AM on November 25, 2015 [4 favorites]


Ob/gyn is one of the most-sued specialties and has among the highest payouts and, therefore, the most expensive malpractice insurance.


One of the reasons is the time lag, I believe. An OB (or a midwife) is liable for 18 years after the birth of the child.
posted by MisantropicPainforest at 8:15 AM on November 25, 2015


the constant barrage of being told, implicitly and explicitly, that my fetus is more important than I am has been super upsetting and has made it really hard to be excited about any of this

That sounds extremely difficult and I'm very sorry you are having to deal with this. <3
posted by fiercecupcake at 8:52 AM on November 25, 2015 [2 favorites]


MisantropicPainforest: "One of the reasons is the time lag, I believe. An OB (or a midwife) is liable for 18 years after the birth of the child."

Yes, also, tort payouts consider the "loss of future functioning" and so forth; if you're 70 years old and retired and I malpractice your arm such that you can't use it anymore, it's not a huge payout, since you've got 10 years left of life and I've only got to pay for your medical care for the next 10 years. If you're 40 and I do it, I'm going to be paying for 25 years of lost earnings in your working life plus 40 years of your medical care. If I'm delivering you as an infant and do it, I'm going to be paying for the entirety of your working life and 80 years of your medical care.

Add to that, damage done in utero or during delivery is considerably more likely to be a "whole system" thing that seriously damages neurological development or causes systemic disabilities, while those are fairly hard to do to an adult receiving routine medical treatment.

It also has to do with people's relationships with their providers; GPs, even when they're incompetent, don't get sued very often. Primary pediatricians almost NEVER get sued because everybody loves their pediatrician, and the guy who takes your 3 a.m. calls going "MY CHILD HAS CROUP WHAT DO I DO?" is not a guy you feel no compunction about suing. Specialists get sued far, far more often because patients are less-likely to have ongoing relationships with those providers where they feel cared for and connected to them as people. Ob/gyn practices that take a more holistic approach to patients and build relationships with their patients get sued less-often than ones that swoop in and out. Etc.
posted by Eyebrows McGee at 9:04 AM on November 25, 2015 [4 favorites]


I'd like to see the numbers but I wonder if the "lawsuit lawsuit lawsuit" thinking is more prevalent in the U.S. where if your child needs interventions, it will probably bankrupt you. During my last pregnancy I worried about my baby's health, of course, but not really about the cost if she had health problems. I'm reasonably certain that most medical services would be covered here in Canada and, though it's sometimes a laborious process to get approved, speech therapy, etc. is also usually available.

And as the article stated, doing careful testing is likely to actually prevent harm.
posted by betsybetsy at 9:37 AM on November 25, 2015 [5 favorites]


Yeah, maybe? We do have an increasingly litigious approach to medicine here in the UK, but there is the whole other issue of suing a public service paid for from taxes and how people view that too. I know quite a few people who've gone through formal complaints procedures with the NHS, but nobody who's threatened going to court.

(The breakdown of clinical negligence lawsuits by specialty is also different here than it sounds like in the US - IIRC the most-likely-to-be-sued areas are orthopaedic surgery and accident and emergency, but general practice is getting more and more claims. But I think that has a lot to do with our system being structured differently, so a lot of complaints GPs get are about failure to refer on to specialists.)
posted by Catseye at 10:00 AM on November 25, 2015


I'm going to rush in where angels fear to tread and all that and get my face bitten off (ie Mengele comment) but...I thought that testing on pregnant women violated the legal code of informed consent. Regardless of whether or not you agree, I genuinely thought that was the case.

I used to have to answer questions from women on cosmetics and the pregnancy safetey issue came up constantly and the company reply was "They're not tested on pregnant women because testing is not permitted". Informed consent was not directly mentioned but it was implied.

Related, that's why it's always bothered me that some doctors would publicly say "there are no studies showing that moderate drinking harms the fetus" because no there aren't but that's a deceptive statement.
posted by GospelofWesleyWillis at 12:42 PM on November 25, 2015 [1 favorite]


to clarify, that it was the actual law, not a subjective professional standard that can be determined by an ethics committee.
posted by GospelofWesleyWillis at 12:49 PM on November 25, 2015


the anti-sickness drugs they give to chemo patients!

I'm on this one! There's some evidence that it causes birth defects, and there is a safer drug out there, but my insurance doesn't cover that one. I'm taking it anyway because a) I need to eat occasionally and b) "it may cause birth defects" seems to be true for basically every substance known to man so I have no ability to evaluate that statement.

They have done studies on moderate drinking, though--not where they asked certain women to drink or not drink, but where they looked at data collected from patients. It's not as rigorous but something like that is still better than "well better play it safe and consume only organic nutrients through a feeding tube while wrapped in cotton for nine months."

It's becoming an AskMe cliche but Expecting Better! Read it!
posted by chaiminda at 3:36 PM on November 25, 2015 [1 favorite]


I thought that testing on pregnant women violated the legal code of informed consent. Regardless of whether or not you agree, I genuinely thought that was the case.

Pretty sure this isn't correct on a couple of counts. I literally re-certified today on IRB, informed consent, etc. (perfect thing for a slow day at the office) but I don't do medical research so, grain of salt. Pregnant women are considered part of the 'vulnerable populations' list which includes children, prisoners, the poor, etc. As part of a vulnerable population, their informed consent looks different.

The US CFR covering human subjects research is fairly specific and there is a section on pregnant women, fetuses, and informed consent but it hews pretty closely to the standard lines about beneficence that you'll find elsewhere with added bits about beneficence to the fetus. I'm sure that medical research on pregnant women is a pain to get through IRB (see Sophie1's remarks above and, y'know, the article), but legally? Allowed.
posted by librarylis at 5:03 PM on November 25, 2015 [3 favorites]


I meant the fetus, not the mother. I was not trying to troll, honestly. I thought the Nuremberg Code was international law, but I must've conflated code vs. laws on war crimes. I knew I'd get an RTFA so my bad on that, sorry.
posted by GospelofWesleyWillis at 10:28 PM on November 25, 2015


Again not trolling, but the 'drink or not drink' is specifically what I mean, as in control studies with a control group (I'm not a medical researcher, but neither is the author of "Expecting Better". She's an economist). Especially since there is so much concern over the rise of subtler developmental problems, spectrum disorders, etc. I can't prove this one and I know I'm not going to win this argument and I'm in the minority here, so I'll end it here & go, but:

http://www.npr.org/sections/health-shots/2015/10/19/449931313/pediatricians-say-absolutely-no-drinking-while-pregnant
posted by GospelofWesleyWillis at 10:36 PM on November 25, 2015


on this one! There's some evidence that it causes birth defects, and there is a safer drug out there, but my insurance doesn't cover that one. I'm taking it anyway because a) I need to eat occasionally and b) "it may cause birth defects" seems to be true for basically every substance known to man so I have no ability to evaluate that statement.


Ondansetron (Zofran), yeah? I really, really wish there was a decent clinical study for this - the 'may cause birth defects' thing seems relatively recent with this one on the back of other studies not finding any evidence it did - and my kid is fine, but this is still immensely worrying to me for the future.

There are other drugs they use here for severe NVP/hyperemesis, with ondansetron usually the last call before steroids. I had cyclizine (an antihistamine - the drug I've seen mentioned as safer in US studies is an antihistamine/B6 combo), prochlorperazine, metaclopramide, then ondansetron, then ended up with an ondansetron/cyclizine combo for the last half of pregnancy. Cyclizine was the only other one that was even somewhat effective, but the effect didn't last and it wasn't enough on its own, so even if your insurance did cover the antihistamine drug it still might not have worked for you, if that's any consolation.

(hang in there - it's awful.)
posted by Catseye at 1:01 AM on November 26, 2015


GospelofWesleyWillis, totally see what you're saying about informed consent but a one or two year old can't consent either. A fetus would be treated the same way. I think that's how pregnant women qualify as a "vulnerable population".

I have so many thoughts on the drinking issue. Regarding the npr article....There's a huge gulf between binge drinking and having half a glass of wine. And the "no alcohol, EVER" dictum basically means any premenopausal woman who has sex should not have any alcohol. That's a lot to ask based on little evidence and a "better safe than sorry" attitude. I'm looking forward to more research on this.
posted by betsybetsy at 7:40 AM on November 26, 2015 [1 favorite]


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