18 An ecologic proof of the fetal safety of the pyridoxine-doxylamine combination was published, showing that the withdrawal of the drug from the US market was not associated with decreased rates of major congenital malformations in general, or of any specific malformation.19 In addition, the pyridoxine-doxylamine combination is one of very few drugs that have safety information on selleck inhibitor the neurodevelopment of children exposed in utero. A prospective controlled cohort study of mother-child pairs was conducted to determine the

effects of NVP and its treatment with the pyridoxine-doxylamine combination on child neurodevelopment. Three groups of children were studied at 3-7 years of age: 45 born to mothers who had NVP and were exposed to the pyridoxine-doxylamine combination, 47 with find more mothers who had NVP but no pyridoxine- doxylamine was used, and 29 born to mothers not experiencing NVP, and mothers were assessed for IQ and socioeconomic status. The results showed

that the pyridoxine-doxylamine combination does not appear to adversely affect fetal brain development and can safely be used to treat NVP.20 In 1989, a report on the safety of the pyridoxine/doxylamine combination for use in the management of NVP was prepared by a panel of Canadian and American experts for the Special Advisory Committee on Reproductive Physiology to the Health Protection Branch of Health Canada (currently called the Health Products and Food Branch). They concluded that “numerous studies in animals and in humans that have been reported in the scientific and medical literature demonstrate that Bendectin is not a teratogen…The safety of the pyridoxine-doxylamine combination in the management of nausea and vomiting of pregnancy has been established by its use in many thousands of pregnant women.”21 These conclusions are similar to those leading the FDA to approve this combination in 2013.2

Similarly, reputable teratogen reference guides concluded that the pyridoxine-doxylamine combination is not associated with an increased risk for adverse pregnancy outcomes.22 and 23 Because of the extensive fetal safety data that exist, the pyridoxine-doxylamine combination received a FDA Pregnancy Category A classification, indicating that adequate and well-controlled Resminostat studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy and there is no evidence of risk in later trimesters.2 The clinical effectiveness of the delayed-release combination of doxylamine and pyridoxine has been documented over a span of 50 years by several randomized, controlled trials as well as in open postmarketing studies. In addition, several placebo-controlled clinical trials have been published, the results of which have confirmed the effectiveness of this combined agent (Table).