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Balancing Maternal Need for Pain Control and Fetal Risk

Balancing Maternal Need for Pain Control and Fetal Risk

My patient is a 30-year-old woman who has used metoclopramide for years for abdominal pain. Her gastroenterologist advised her to discontinue the medication because she is trying to become pregnant. No other drug controls the pain. Is it safe for her to continue taking metoclopramide?
—MD

In a study of 126 women who took metoclopramide during the first trimester of pregnancy for nausea and vomiting, there was no difference between these women and a control group in the incidence of spontaneous abortions or birth defects in the infants.1 Moreover, no significant difference was noted in the rate of live births, in the birth weight of the infants, in prematurity, or in milestones on the Denver Developmental Scale. Thus, the use of metoclopramide during the first trimester is probably not associated with adverse pregnancy outcomes. In addition, in randomized clinical trials involving 52 women, no adverse effects were observed in infants whose mothers were given metoclopramide just before cesarean delivery.2,3

The data are insufficient to support an assertion that metoclopramide use during pregnancy carries no risk. However, if this patient needs the medication to control abdominal pain, I would allow her to continue it.

Jennifer R. Niebyl, MD
  Professor and Head
  Department of Obstetrics and Gynecology
  University of Iowa Hospitals and Clinics
  Iowa City

References

REFERENCES:
1. Berkovitch M, Elbirt D, Addis A, et al. Fetal effects of metoclopramide therapy for nausea and vomiting of pregnancy. N Engl J Med. 2000;343:445-446.
2. Lussos SA, Bader AM, Thornhill ML, Datta S. The antiemetic efficacy and safety of prophylactic metoclopramide for elective Cesarean delivery during spinal anesthesia. Reg Anesth. 1992;17:126-130.
3. Orr DA, Bill KM, Gillon KR, et al. Effects of omeprazole, with and without metoclopramide, in elective obstetric anaesthesia. Anaesthesia. 1993;48:114-119.

 
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