Antiemetic use during pregnancy and child neurodevelopment: population-based birth cohort study
Abstract
Antiemetics are commonly prescribed for nausea and vomiting during pregnancy (NVP), affecting up to 80% of pregnant women. However, data on their long-term neurodevelopmental effects are limited. We therefore aimed to assess the risk of neurodevelopmental disorders and delays in children exposed to antiemetics commonly prescribed during pregnancy. This nationwide cohort study, designed to emulate a pragmatic trial, used South Korea’s National Health Insurance Service mother–child linked database, 2009–2023. The primary exposure of interest was metoclopramide, while pyridoxine, doxylamine, dimenhydrinate, domperidone, and ondansetron were included in secondary analyses. Non-exposed pregnancies within the cohort served as comparators. The outcomes included seven neurodevelopmental disorders—autism spectrum disorder, cerebral palsy, communication disorder, intellectual disorder, movement disorder, attention deficit hyperactivity disorder (ADHD), and epilepsy—as well as neurodevelopmental delays assessed using the validated Korean Developmental Screening Test. Overlap weights based on potential confounders were applied to a Cox proportional hazard model to estimate hazard ratios (HR) with 95% confidence intervals (CI). Among 630,904 children included, 281,476 (44.6%) were exposed to metoclopramide during pregnancy, while 131,837 (20.9%), 1383 (0.2%), 12,013 (1.9%), 14,531 (2.3%), and 5673 (0.9%) were respectively exposed to pyridoxine, doxylamine, dimenhydrinate, domperidone,…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 630,904 participants or records.
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