Balancing Maternal Need for Pain Control and Fetal Risk

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

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

The data are insufficient to support an assertion that metoclopramide useduring pregnancy carries no risk. However, if this patient needs the medicationto 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 vomitingof 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 metoclopramidefor 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 electiveobstetric anaesthesia. Anaesthesia. 1993;48:114-119.