Dr. Ron’s Research Review – April 5, 2017

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This week’s research review focuses on vitamin K3 and B6 for nausea and vomiting of pregnancy.

Vitamin K3

I.M. of vitamin K3 works great for nausea and vomiting of pregnancy. 70 women with mild to severe nausea and vomiting of pregnancy took 5 mg of menadione (vitamin K3) and 25 mg of ascorbic acid simultaneously each day. 64 women reported complete remission of symptoms within 72 hours. 3 women were relieved of vomiting, but remained nauseated despite increased doses. 3 obtained no relief. (Merkel, 1952) (Wright, 1984)

Vitamin B6

Fifty-nine women completed a randomized, double-blind placebo-controlled study of pyridoxine hydrochloride (vitamin B6) for the treatment of nausea and vomiting of pregnancy. Thirty-one patients received vitamin B6, 25-mg tablets orally every 8 hours for 72 hours, and 28 patients received placebo in the same regimen. Following therapy, there was a significant difference in the mean "difference in nausea" score (ie, baseline - post-therapy nausea) between patients with severe nausea receiving vitamin B6 (mean 4.3 +/- 2.1) and placebo (mean 1.8 +/- 2.2) (P less than .01). (Sahakian et al., 1991)
There was a significant decrease in the mean of post-therapy minus baseline nausea scores in the pyridoxine compared with that in the placebo group (t test, p = 0.0008). There was also a greater reduction in the mean number of vomiting episodes, but the differences did not reach statistical significance (p = 0.0552). (Vutyavanich et al., 1995)

 

Dr. Ron


 

Articles

The use of menadione bisulfite and ascorbic acid in the treatment of nausea and vomiting of pregnancy; a preliminary report
            (Merkel, 1952) Download
70 women with mild to severe nausea and vomiting of pregnancy took 5 mg of menadione (vitamin K3) and 25 mg of ascorbic acid simultaneously each day. 64 women reported complete remission of symptoms within 72 hours. 3 women were relieved of vomiting, but remained nauseated despite increased doses. 3 obtained no relief.

Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: a randomized, double-blind placebo-controlled study
            (Sahakian et al., 1991) Download
Fifty-nine women completed a randomized, double-blind placebo-controlled study of pyridoxine hydrochloride (vitamin B6) for the treatment of nausea and vomiting of pregnancy. Thirty-one patients received vitamin B6, 25-mg tablets orally every 8 hours for 72 hours, and 28 patients received placebo in the same regimen. Patients were categorized according to the presence of vomiting: severe nausea (score greater than 7) or mild to moderate nausea (score of 7 or less). The severity of nausea (as graded on a visual analogue scale of 1-10 cm) and the number of patients with vomiting over a 72-hour period were used to evaluate response to therapy. Twelve of 31 patients in the vitamin B6 group had a pre-treatment nausea score greater than 7 (severe) (mean 8.2 +/- 0.8), as did ten of 28 patients in the placebo group (mean 8.7 +/- 0.9) (not significant). Following therapy, there was a significant difference in the mean "difference in nausea" score (ie, baseline - post-therapy nausea) between patients with severe nausea receiving vitamin B6 (mean 4.3 +/- 2.1) and placebo (mean 1.8 +/- 2.2) (P less than .01). In patients with mild to moderate nausea and in the group as a whole, no significant difference between treatment and placebo was observed. Fifteen of 31 vitamin B6-treated patients had vomiting before therapy, compared with ten of 28 in the placebo group (not significant). At the completion of 3 days of therapy, only eight of 31 patients in the vitamin B6 group had any vomiting, compared with 15 of 28 patients in the placebo group (P less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)


 

Pyridoxine for nausea and vomiting of pregnancy: a randomized, double-blind, placebo-controlled trial
            (Vutyavanich et al., 1995) Download
OBJECTIVE: Our purpose was to determine the effectiveness of pyridoxine for nausea and vomiting of pregnancy. STUDY DESIGN: During an 11-month period 342 women who first attended Chiang Mai University Hospital antenatal clinic at < or = 17 weeks' gestation were randomized to received either oral pyridoxine hydrochloride, 30 mg per day, or placebo in a double-blind fashion. Patients graded the severity of their nausea by a visual analog scale and recorded the number of vomiting episodes over the previous 24 hours before treatment and again during 5 consecutive days on treatment. RESULTS: There was a significant decrease in the mean of posttherapy minus baseline nausea scores in the pyridoxine compared with that in the placebo group (t test, p = 0.0008). There was also a greater reduction in the mean number of vomiting episodes, but the differences did not reach statistical significance (p = 0.0552). CONCLUSION: Pyridoxine is effective in relieving the severity of nausea in early pregnancy.

 

References

Merkel, R. L. (1952), ‘The use of menadione bisulfite and ascorbic acid in the treatment of nausea and vomiting of pregnancy; a preliminary report’, Am J Obstet Gynecol, 64 (2), 416-18. PubMed: 14952541
Sahakian, V., et al. (1991), ‘Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: a randomized, double-blind placebo-controlled study’, Obstet Gynecol, 78 (1), 33-36. PubMed: 2047064
Vutyavanich, T., S. Wongtra-ngan, and R. Ruangsri (1995), ‘Pyridoxine for nausea and vomiting of pregnancy: a randomized, double-blind, placebo-controlled trial’, Am J Obstet Gynecol, 173 (3 Pt 1), 881-84. PubMed: 7573262
Wright, J. V. (1984), ‘Therapy of nausea and vomiting of pregnancy’, Am J Obstet Gynecol, 149 (1), 107. PubMed: 6720766