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Prise en charge des nausées et vomissements de la grossesse

      Résumé

      Objectifs

      Passer en revue la prise en charge fondée sur des preuves scientifiques des nausées et des vomissements de la grossesse (NVG) et de l'hyperemesis gravidarum.

      Évidence

      Des recherches ont été effectuées dans les bases de données MEDLINE et Cochrane à partir des sujets médicaux (MeSH) suivants : traitement, nausée, vomissements, grossesse et hyperemesis gravidarum. La qualité des résultats présentés dans cette directive est évaluée au moyen des critères décrits dans le rapport du Groupe d'étude canadien sur les soins de santé préventifs.

      Avantages

      Les NVG ont des effets majeurs sur la santé et la qualité de vie d'une femme pendant sa grossesse, en plus d'avoir des répercussions financières sur le système de santé; c'est pourquoi la détection et la prise en charge précoces sont recommandées.

      Coûts

      Certains coûts, notamment associés aux hospitalisations, aux consultations en cabinet et à la productivité perdue, peuvent être réduits si les NVG sont traités rapidement.

      Recommandations

      • 1.
        Les femmes souffrant de NVG peuvent cesser leurs vitamines prénatales contenant du fer au premier trimestre et les remplacer par de l'acide folique ou des vitamines faibles en fer pour adultes ou pour enfants. (II-2A)
      • 2.
        Il faut encourager les femmes enceintes à modifier leurs habitudes de vie et à manger tout ce qui leur plaît et qui est sécuritaire pendant la grossesse. (III-C)
      • 3.
        Le gingembre peut réduire les NVG. (I-A)
      • 4.
        L'acupression peut atténuer les NVG chez certaines femmes. (I-B)
      • 5.
        La thérapie cognitive basée sur la pleine conscience peut être efficace comme complément à la pyridoxine. (I-B)
      • 6.
        Pour soulager les NVG, la pyridoxine en monothérapie ou la combinaison de doxylamine et de pyridoxine sont recommandées en première intention en raison de leur efficacité et de leur innocuité. (I-A)
      • 7.
        La prise de doxylamine et de pyridoxine à titre préventif en début de grossesse peut s'avérer efficace chez les femmes à risque élevé de NVG. (I-A)
      • 8.
        Un traitement aux antagonistes des récepteurs H1 peut être envisagé pour traiter des épisodes aigus ou chroniques. (I-A)
      • 9.
        La métoclopramide peut être utilisée de façon sécuritaire comme traitement d'appoint pour soulager les NVG. (II-2B)
      • 10.
        Les phénothiazines sont sécuritaires et efficaces comme traitement d'appoint pour soulager les NVG graves. (I-A)
      • 11.
        Malgré les problèmes d'innocuité potentiels associés à l'ondansétron pendant la grossesse, ce médicament peut être utilisé comme traitement d'appoint pour soulager les NVG graves lorsque les autres combinaisons d'antiémétiques ont échoué. (II-1C)
      • 12.
        Les corticostéroïdes devraient être évités durant le premier trimestre en raison du risque accru de fissure labio-palatine. Leur utilisation devrait se limiter aux cas réfractaires. (I-B)
      • 13.
        Lorsque les NVG résistent à une pharmacothérapie initiale, il faut se pencher sur les autres causes possibles. (III-A)

      Mots clés

      Abréviations:

      H. pylori (Helicobacter pylori), HG (Hyperemesis gravidarum), TCBPC (Thérapie cognitive basée sur la pleine conscience), NVG (Nausées et vomissements de la grossesse), ECR (Essai clinique randomisé)
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