Rise in abortions among mothers denied morning sickness drugs

Health Editor,Jeremy Laurance
Monday 18 April 2011 00:00

Doctors are failing to treat morning sickness, which can be so severe it has driven some women to abort their babies, because of the legacy of the thalidomide disaster.

The denial of drug treatment to pregnant women because of fears about birth defects – as happened with thalidomide – has contributed to a three-fold rise in the number of women admitted to hospital with severe nausea and vomiting in the past 20 years, an expert on the condition said.

In 1989-90 there were 8,637 admissions for hyperemesis gravidarum rising to 25,420 in 2006-07.

In a review of research on the condition, Professor Roger Gadsby of the University of Warwick Medical School, says 30 per cent of pregnant women suffer severe nausea and vomiting during pregnancy. It can have a profound impact on a woman's life, making her less likely to go through another pregnancy or to consider a termination, and should be treated with "appropriate medication".

"Pregnancy sickness is an under-appreciated and under-researched condition. There is a great fear of prescribing anything in the first trimester [three months] of pregnancy because of the legacy of the thalidomide affair. We have a lot of women suffering severely, and their spouses and families are suffering, who are not getting appropriate recognition and support."

Evidence from North America shows that women who receive drug treatment in the early stages are less likely to progress to the point where they require hospital admission. Those worst affected, who vomit many times a day, become dehydrated and require treatment on a drip so that fluid can be infused directly into a vein.

In Canada and the US, the drug diclectin is recommended, a combination of an antihistamine and vitamin B6. But in the UK, the National Institute for Clinical Excellence (Nice) advises against the use of drugs and recommends non-pharmacological treatments including the use of ginger and acupressure.

"Nice based its recommendations on what research there was – but it was mostly conducted in the 1970s and 1980s. No one will do research now because of thalidomide. If you have 200 women in a trial and one has a baby with a birth defect she will blame it on the drug even though it could happen by chance. Nice said pyridoxine (vitamin B6) was not proved safe in high doses. But no one wants to use it in high doses. You can buy it in health food shops in 50mg and 100mg tablets and we are recommending 10mg three times a day. We are talking small doses, not large doses."

The review is published in The Obstetrician and Gynaecologist.

In some women hyperemesis gravidarum used to prove fatal. Charlotte Brontë died with pregnancy sickness, describing in her letters how she had "strained until my vomit was mixed with blood." In the 1960s, doctors suggested sufferers were subconsciously rejecting their babies. In the 1970s the drug Debendox was prescribed, until the manufacturer was sued in the US by a woman who had a baby with a birth defect. The manufacturer voluntarily withdrew the drug in 1983, but later won on appeal after the court accepted there had been no decline in congenital abnormalities parallelling the decline in the drugs' sales.

Worldwide the drug had been taken by 33 million pregnant women. Its ingredients – pyridoxine and an antihistamine – are the same as in diclectin.

Patrick O'Brien, a spokesman for the Royal College of Obstetricians and Gynaecologists, said: "Nausea during pregnancy can be difficult to treat as the symptoms and severity vary from person to person – some have no problems at all whilst others suffer terribly. The duration also varies but the vomiting usually resolves itself within 16-20 weeks of pregnancy. Because of the legacy of thalidomide, many women prefer to have a drug-free pregnancy, where possible. If a woman is finding it hard to cope with her sickness, she should speak to her doctor who will prescribe antihistamines."

The shadow of Thalidomide

Thalidomide was the focus of one of the biggest drug scandals in history when it was prescribed to pregnant women as a treatment for morning sickness in the late 1950s.

It turned out to cause defects in the developing foetus and around 10,000 babies were born around the world with stunted arms or legs or, in some cases, no limbs at all.

When it was launched in Britain in 1958 the drug had not been subjected to the rigorous standards of testing which are applied to medicines today. It was withdrawn from the world market in 1961 after its catastrophic teratogenic effects – disturbance to the growth of the embryo in the womb – became clear.

Case study

"Morning sickness" was a misnomer for the condition Cheryl Harrison, 35, suffered from – she was sick morning, noon and night during her first pregnancy, with Scarlett, now six.

When she became pregnant a second time, in 2008, the vomiting was unrelenting – up to 40 times a day – and she developed dangerously high blood pressure.

Eventually, at nine weeks, with the support of her husband, James, she had an abortion at a clinic near the couple's home in East Yorkshire.

"It was the most horrendous decision I have ever made," she said. "I know I can't have any more children, even if they develop a treatment for morning sickness.

"I had severe hypertension, I was putting my life in danger and I sacrificed my baby's life. I could never risk that again."

She thinks about her unborn child every day and called for more support for women in her position.

"I think there are other women who have terminated pregnancies for the same reason but it's a taboo, no one discusses it."

She was diagnosed with hyperemesis gravidarum, the severest form of morning sickness, which affects one in 100 women.

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