Injectable pyridoxine improves treatment of hyperemesis of pregnancy

NEW ORLEANS (Reuters Health) – Adding injectable pyridoxine (vitamin B6) to a standard anti-emetic is somewhat more effective in treating pregnancy-associated hyperemesis than is treatment only with an anti-emetic, according to Dr. Lucy Bayer-Zwirello, speaking at the 22nd annual meeting of the Society for Maternal-Fetal Medicine.

"Pregnant patients who have to be hospitalized for ketones receive a lot of anti-emetic medication," Dr. Bayer-Zwirello told Reuters Health. "When you add an injection of pyridoxine to an oral anti-emetic, such as metoclopramide, patients have fewer vomiting episodes and also report a subjective improvement in well-being."

Dr. Bayer-Zwirello is an associate professor of medicine in obstetrics and gynecology at Tufts University School of Medicine in Boston, and she is a practicing perinatologist in Springfield, Massachusetts. She and her colleagues randomized 174 women with singleton pregnancies who had hyperemesis into three groups, after excluding patients with significant medical conditions, such as hyperthyroidism.

One group received a single injection of pyridoxine initially, and then oral metoclopramide. The other two groups received monotherapy consisting of either prochlorperazine or promethazine, two commonly used anti-emetics.

All groups reported some improvement with anti-emetic treatment. However, improvement seemed to be more marked for the combination therapy group, which reported a decrease in vomiting episodes from 2.5 per day to .7 per day.

After seeing the benefits of adjunctive pyridoxine, Dr. Bayer-Zwirello and her colleagues have begun to intervene earlier in the treatment of pregnancy-induced vomiting. "We've started using pyridoxine in the office," she told Reuters Health. "When we notice a patient going in the direction of hyperemesis, we give them a pyridoxine shot and see how they do. It's a useful addition. I think we'll always have to have anti-emetics as well, though."

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