Antiemetic Use in Pregnancy Not Linked to Neurodevelopmental Risks: Study
South Korea: Researchers have found in a new large-scale study that there was no overall association between antiemetic use during pregnancy and neurodevelopmental disorders or delays in children, offering reassurance for treating nausea and vomiting in pregnancy. Slightly increased risks in certain subgroups necessitate further study, but the findings can help inform clinical decision-making.
The population-based study, led by Yongtai Cho from the School of Pharmacy at Sungkyunkwan University in South Korea, analysed data from the nation’s National Health Insurance Service mother–child linked database from 2009 to 2023. The research, published in BMC Medicine, focused on metoclopramide as the primary antiemetic, with pyridoxine, doxylamine, dimenhydrinate, domperidone, and ondansetron included in secondary analyses. Children born to mothers not exposed to these drugs served as comparators.
A total of 630,904 children were included in the study, of whom 281,476 (44.6%) were exposed to metoclopramide during pregnancy. Smaller numbers were exposed to other antiemetics, including pyridoxine (20.9%), doxylamine (0.2%), dimenhydrinate (1.9%), domperidone (2.3%), and ondansetron (0.9%).
The research team examined seven neurodevelopmental disorders—autism spectrum disorder, cerebral palsy, communication disorder, intellectual disorder, movement disorder, attention-deficit hyperactivity disorder (ADHD), and epilepsy—alongside neurodevelopmental delays using the validated Korean Developmental Screening Test.
Key findings were as follows:
- No significant association was found between antiemetic exposure during pregnancy and neurodevelopmental disorders or delays in children.
- Results were consistent across multiple sensitivity and subgroup analyses.
- Slightly increased risk of ADHD was observed in children exposed to metoclopramide during the second half of pregnancy (hazard ratio 1.12).
- Prolonged metoclopramide exposure (≥7 days) was linked to mild neurodevelopmental delays.
The study addressed potential limitations, noting that prescriptions may not fully reflect actual drug use, though analyses requiring multiple prescriptions confirmed the results. Outcome misclassification was minimized using stricter definitions and validated developmental screening tools. Challenges such as estimating pregnancy start dates, underdiagnosed disorders like learning disabilities, and residual confounding by disease severity were also considered and mitigated using proxy measures.
Overall, the study provides reassuring evidence that commonly prescribed antiemetics during pregnancy, including metoclopramide, are not substantially linked to long-term neurodevelopmental harm in children. The authors emphasize, however, that caution may be warranted for extended use or administration in the latter half of pregnancy, and alternative treatments or closer developmental monitoring may be advisable in such cases.
"These findings offer valuable guidance for clinicians managing nausea and vomiting during pregnancy, highlighting both the safety of standard antiemetic therapy and the need for continued research on the timing and duration of exposure to optimize maternal and child health outcomes," the authors concluded.
Reference:
Cho, Y., Choi, EY., Han, J.Y. et al. Antiemetic use during pregnancy and child neurodevelopment: population-based birth cohort study. BMC Med 23, 667 (2025). https://doi.org/10.1186/s12916-025-04497-x
Next Story