April 16, 2020

Background Information: Nausea and vomiting during pregnancy most commonly occurs during the first trimester. If left untreated, the development of hyperemesis gravidarum can lead to further complications characterized by dehydration and electrolyte abnormalities.1 Ondansetron, a 5-HT3 receptor antagonist has quickly become the most frequently prescribed drug in the United States for nausea and vomiting during pregnancy.2 With the creation of an oral dissolving tablet in 2006, Ondansetron’s popularity as an antiemetic continues to rise. In fact, a study from 2014 shows that nearly a quarter of all pregnant women in the United States are using it.3 There is uncertainty in the literature as to the association between Ondansetron and birth defects. While some studies report there is no increased risk in congenital abnormalities among women who took this antiemetic early in pregnancy, other evidence suggests it may be associated with cleft palate and cardiac malformations.2 The authors of this study sought to investigate the association between exposure to Ondansetron during the first trimester of pregnancy and risk of congenital malformations in newborns using a national cohort of publicly insured pregnant women.

July 23, 2018

Background: In 2011, the American College of Obstetricians and Gynecologists (ACOG) released a committee opinion warning against the use of nitrofurantoin (Macrobid) during the first trimester of pregnancy due to the perceived risk of an increased rate of congenital abnormalities with its use (Committee Opinion 2017). While the committee continued to recommend that nitrofurantoin be used as a first-line agent during the second and third trimesters, they stated that it should only be considered appropriate in the first trimester when no other suitable alternative antibiotics were available. While this recommendation seems to have been slow to permeate into the emergency medicine community, growing awareness has led to clinical trepidation in the provision of nitrofurantoin.