Abstract
Background Hyperemesis gravidarum (HG) is a severe complication
of pregnancy affecting around 1% of pregnancies globally.
Objective To investigate whether ondansetron use during
pregnancy is associated with increased rates of abnormal pregnancy
outcomes.
Search strategy PubMed, Embase, the Cochrane Library, CINAHL,
CNKI, CBM, WANFANG, and ClinicalTrials.gov were searched for citations
published in any language from inception to 15 December 2021.
Selection criteria Eligible studies included any observational
study.
Data collection and analysis We used odds ratios (ORs) and 95%
confidence intervals (CIs) as a measure of the association between
ondansetron and abnormal pregnancy outcomes.
Main results Of 1,558 citations screened, 19 articles were
included. No significant increased risk for overall congenital
malformations (OR=1.10,95% CI:0.94–1.29, Low certainty), cleft palate
(OR=0.78,95% CI:0.37–1.64, Very Low certainty), stillbirth
(OR=0.60,95% CI:0.40–0.91, Low certainty) or preterm birth
(OR=0.78,95% CI:0.37–1.64, Low certainty) were identified in our
primary analysis. However, the results of our primary analysis indicated
that ondansetron use during pregnancy was associated with significantly
increased rates of heart defects (OR=1.06,95% CI:1.02–1.11, Moderate
certainty) and other organ malformations (OR=1.09,95% CI:1.03–1.16,
Moderate certainty) when exposed infants were compared with healthy or
disease-matched controls.
Conclusion Ondansetron use during pregnancy was associated with
a significant increase in rate of some abnormal pregnancy outcomes in
our primary analysis. In conclusion, our review found that ondansetron
should not use as first-line treatment for NVP. But for sever and
incurable NVP, clinician can consider use moderate amount ondansetron to
treat NVP with close monitoring.