妇产科学
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用于治疗妊娠期恶心和呕吐的药物 - 安全性和有效性回顾

Binny Thomas、Palli Valappila Abdul Rouf、Moza Al-Hail、Doua al Saad、Asma Tharannum、Wessam elKassem 和 Nora Al-hail

恶心和呕吐是 50-90% 的女性在怀孕早期经历的常见症状。“孕吐”是一个经常用来描述妊娠期恶心和呕吐 (NVP) 的误用词，尽管症状可能会持续一整天和/或晚上。孕妇主要在妊娠前三个月（即妊娠 6 至 12 周）出现这些症状，少数会持续到妊娠 20 周，也有少数会持续整个妊娠期。该问题在妊娠 9 周时达到高峰，大约 60% 的 NVP 在妊娠前三个月末得到解决。其中极少数患者的症状会变得严重，导致脱水、体重减轻、过度呕吐并强制入院；这种情况被称为妊娠剧吐。

Fairweather DV 提出了最广泛使用的妊娠剧吐 (HG) 定义。他根据以下症状定义 HG：每天呕吐超过 3 次，伴有显着的酮尿或体重减轻超过或等于孕前体重的 5%，电解质不平衡或液体不足，发病发生在怀孕 4 至 8 周直至 14 岁至 16 周。妊娠期恶心和呕吐的病因多种多样（孕激素、雌激素、促甲状腺激素 (TSH) 水平波动、胃肠 (GI) 道蠕动缓慢）；然而，确切的机制仍不清楚。

鉴于 NVP 治疗的不确定性，患者和医疗保健从业者常常担心在怀孕期间使用止吐药物，因为这对胎儿和母亲存在潜在风险。孕期恶心呕吐的表现因人而异，因此应对方法也应有所区别。恶心和呕吐的早期治疗非常重要且有益，因为它可以防止更严重的情况发生或可能的住院治疗，并防止情绪和心理问题。对于妇女和医疗保健提供者来说，了解安全有效的 NVP 治疗对胎儿和母亲都有好处非常重要，因此所有治疗方案都应该开放和考虑。

Nonetheless, given the widespread prevalence of nausea and vomiting, its adverse effects and effects on psychological conditions of pregnant women, it is necessary to be treated effectively and safely during embryonic and fetal developmental stages. First trimester exposure is important to be assessed to monitor the teratogenic potential of the drug; however, randomized control trials are rarely conducted for pregnant women for ethical reasons. Whereas the epidemiological studies done are observational and lack population strength to establish safety and risk involved. This review will mainly focus on pharmacological drugs used in treatment of NVP, and explore their safety and efficacy and evidence based practice. There have been many studies examining the safety of drugs used in NVPs and few of them are covered in this review. The dietary, lifestyle modifications, and nonpharmacological approaches are not covered in this section.