The teratogenicity of drugs for nausea and vomiting of pregnancy: perceived versus true risk

Abstract

Women and health care providers commonly overestimate the teratogenic risk of medications in pregnancy. With regard to nausea and vomiting of pregnancy, this leads to an underutilization of pharmacologic therapy. Pregnancy termination has even been elected in some circumstances when safe and effective alternatives for nausea have not been attempted. The misperception of teratogenic risk is partly the result of the way data on safety are presented. An awareness of this can lead to more balanced patient and physician educational materials. To facilitate rational use of medicinal and nonmedicinal therapy for nausea and vomiting of pregnancy, we have developed an algorithm based on a recent systematic review of safety and efficacy in management of the problem. The hierarchical use of medication is based on strength of evidence of fetal safety.