Pregnancy support- Vitamin Deficiencies

B6 - updated: 03 November 2008

Interventions for nausea and vomiting in early pregnancy

Cochrane Database Syst Rev. 2003;(4):CD000145

Jewell D, Young G.

BACKGROUND: Nausea and vomiting are the most common symptoms experienced in early pregnancy, with nausea affecting between 70 and 85% of women. About half of pregnant women experience vomiting. OBJECTIVES: To assess the effects of different methods of treating nausea and vomiting in early pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (December 2002) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2002). SELECTION CRITERIA: Randomised trials of any treatment for nausea and/or vomiting in early pregnancy. DATA COLLECTION AND ANALYSIS: Two reviewers assessed the trial quality and extracted the data independently. MAIN RESULTS: Twenty-eight trials met the inclusion criteria. For milder degrees of nausea and vomiting, 21 trials were included. These trials were of variable quality. Nausea treatments were: different antihistamine medications, vitamin B6 (pyridoxine), the combination tablet Debendox (Bendectin), P6 acupressure and ginger. For hyperemesis gravidarum, seven trials were identified testing treatments with oral ginger root extract, oral or injected corticosteroids or injected adrenocorticotropic hormone (ACTH), intravenous diazepam and acupuncture. Based on 12 trials, there was an overall reduction in nausea from anti-emetic medication (odds ratio 0.16, 95% confidence interval 0.08 to 0.33). REVIEWER'S CONCLUSIONS: Anti-emetic medication appears to reduce the frequency of nausea in early pregnancy. There is some evidence of adverse effects, but there is very little information on effects on fetal outcomes from randomised controlled trials. Of newer treatments, pyridoxine (vitamin B6) appears to be more effective in reducing the severity of nausea. The results from trials of P6 acupressure are equivocal. No trials of treatments for hyperemesis gravidarum show any evidence of benefit. Evidence from observational studies suggests no evidence of teratogenicity from any of these treatments.

Publication Types:

• Cochrane Database Syst Rev. 2002;(1):CD000145.

Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: a randomized, double-blind placebo-controlled study

Obstet Gynecol. 1991 Jul;78(1):33-6

Sahakian V, Rouse D, Sipes S, Rose N, Niebyl J.

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)

Publication Types:

• randomized, double-blind placebo-controlled study

Pyridoxine for nausea and vomiting of pregnancy: a randomized, double-blind, placebo-controlled trial

Am J Obstet Gynecol. 1995 Sep;173(3 Pt 1):881-4

Vutyavanich T, Wongtra-ngan S, Ruangsri R.

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

Publication Types:

• randomized, double-blind, placebo-controlled trial

Acupressure and vitamin B6 to relieve nausea and vomiting in pregnancy: a randomized study

Arch Gynecol Obstet. 2007 Sep;276(3):245-9. Epub 2007 Feb 21

Jamigorn M, Phupong V.

OBJECTIVE: To compare the effectiveness of acupressure and vitamin B6 in the outpatient treatment of nausea and vomiting in early pregnancy. STUDY DESIGN: Pregnant volunteers with symptoms of mild to moderate nausea and vomiting between 6 and 12 weeks' gestation participated in a 7-day clinical trial. Participants were randomly assigned to receive a device for acupressure therapy and placebo drug or an otherwise identical but non-stimulating placebo device and vitamin B6. The primary outcome measure was self-recorded symptoms according to Rhodes index. Secondary outcome measures were weight gain and medication use. RESULTS: The mean change in Rhodes index was not significantly different between the two groups. There were no statistically significant differences in weight gain and medication use between the two groups. CONCLUSION: Acupressure therapy is not more effective than vitamin B6 in reducing nausea and vomiting in symptomatic women in the first trimester of pregnancy.

Publication Types:

• placebo controlled

Comparison of the effectiveness of ginger and vitamin B6 for treatment of nausea and vomiting in early pregnancy: a randomized double-blind controlled trial

J Med Assoc Thai. 2007 Jan;90(1):15-20

Chittumma P, Kaewkiattikun K, Wiriyasiriwach B.

OBJECTIVE: To compare the effectiveness of ginger and vitamin B6 for treatment of nausea and vomiting in pregnancy. DESIGN: Randomized double-blind controlled trial. SETTING: Department of Obstetrics and Gynecology, Bangkok Metropolitan Administration Medical College and Vajira Hospital. MATERIAL AND METHOD: One hundred and twenty-six pregnant women, with a gestational age of < or = 16 weeks who had nausea and vomiting, required anti-emetics, had no medical complication, and were not hospitalized. Pregnant women were randomly allocated to receive either 650 mg of ginger or 25 mg of vitamin B6. They were given three times per day for 4 days. The degree of nausea and vomiting were assessed by three physical symptoms of Rhode's score (episodes of nausea, duration of nausea and number of vomits). These were recorded 24 hours before treatment for baseline and each subsequent day of treatment. Difference of baseline and post-treatment nausea vomiting scores were calculated for both groups during 4 days of treatment. RESULTS: One hundred and twenty-three women returned to follow-up. Ginger and vitamin B6 significantly reduced nausea and vomiting scores from 8.7 +/- 2.2 to 5.4 +/- 2.0 and 8.3 +/- 2.5 to 5.7 +/- 2.3 respectively, (p < 0.05). The mean score change after treatment with ginger was greater than with vitamin B6 (3.3 +/- 1.5 versus 2.6 +/- 1.3), (p < 0.05). There were some minor side effects in both groups 25.4% and 23.8% (p = 0.795) respectively, such as sedation, heartburn, arrhythmia. CONCLUSION: Both ginger and vitamin B6 were effective for treatment of nausea and vomiting in pregnancy. Moreover, ginger was more effective than vitamin B6. Side effects from ginger were reported to be minor and did not need any treatment.

Publication Types:

• randomised controlled trial

Low vitamin B6 status associated with slow growth in healthy breast-fed infants

Pediatr Res. 1995 Nov;38(5):740-6

Heiskanen K, Siimes MA, Salmenperä L, Perheentupa J.

To evaluate the effect of vitamin B6 status on infant growth, we studied longitudinally anthropometry and the erythrocyte parameters that reflect long-term vitamin B6 status [erythrocyte pyridoxal 5'-phosphate concentration (EPLP), erythrocyte aspartate transaminase basal activity (EAST0), and its activation co-efficient (alpha EAST)] in 44 infants. The infants were exclusively breast-fed for 6 mo, given additional solids according a uniform schedule from 6-9 mo, and formula after 9 mo, if needed. In seven of these infants, a low vitamin B6 status (EPLP < 10th, and EAST0 > 10th or alpha EAST > 90th percentile for these values in reference infants) was observed between 4 and 6 mo of age. These seven infants showed slower length velocity (0.30 +/- 0.05 versus 0.40 +/- 0.02 mm/d, p < or = 0.02) and deeper fall in length-for-age (-0.69 +/- 0.20 versus -0.25 +/- 0.07 SD score, p < or = 0.03) from 6 to 9 mo of age than the similarly fed infants with higher vitamin B6 status. Preceding vitamin B6 status remained a significant explanatory factor for length velocity and change in length-for-age in addition to preceding and concomitant weight velocity, when sex, birth size, preceding length gain, and mid-parent height were taken into account. Change in weight-for-age alone explained 16% and 18% and, together with vitamin B6 status, 23 and 27% of the variation in length velocity and in change in length-for-age, respectively. Thus, in healthy breast-fed infants, according to our results, low vitamin B6 status is associated with reversibly reduced gain in length.

Publication Types:

• Review