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In This Issue of JAMA
December 18, 2018


JAMA. 2018;320(23):2391-2393. doi:10.1001/jama.2017.12680

Early treatment of nausea and vomiting in pregnancy can provide symptom relief and prevent progression to hyperemesis gravidarum. In a retrospective cohort study of 1 816 414 pregnancies, Huybrechts and colleagues found that first-trimester exposure to the antiemetic ondansetron was not associated with cardiac malformations or congenital malformations overall, but was associated with a small increased risk of oral clefts. An Editorial by Haas discusses treatment options for women with nausea and vomiting during pregnancy.



The lifetime risk of developing a pelvic floor disorder is associated with childbirth and may vary by delivery mode. A cohort study by Blomquist and colleagues of 1528 women recruited from a community hospital 5 to 10 years after their first delivery and followed annually for up to 9 years found that in comparison with spontaneous vaginal delivery, operative vaginal delivery was associated with higher risks of anal incontinence and pelvic organ prolapse and cesarean delivery was associated with lower risks of stress urinary incontinence, overactive bladder, and pelvic organ prolapse.


Opioids are commonly prescribed for chronic noncancer pain, but the clinical benefits are uncertain. Busse and colleagues conducted a systematic review of 96 randomized trials and found that opioid therapy is associated with small improvements in pain and physical function. In an Editorial, Ashburn and Fleisher discuss the hazards of opioid therapy and recommend alternative treatments for chronic pain, such as physical therapy, cognitive-behavioral therapy, mindful meditation, yoga, and tai chi.



Clinical Review & Education

Lack of communication, complex regimens, high co-payments, and poor coordination of care are some of the reasons why patients fail to take medications as prescribed. Kini and Ho review the success and practicality of interventions to improve medication adherence.

In this JAMA Clinical Guidelines Synopsis of a 2017 guideline developed by the American Association for the Study of Liver Diseases, Paul and Davis discuss the diagnosis and treatment of patients with nonalcoholic fatty liver disease.

This JAMA Clinical Challenge by Youmans and colleagues presents a 36-year-old woman with symptoms and signs of spontaneous coronary artery dissection. What would you do next?