Assessment of management approaches for hyperemesis gravidarum and nausea and vomiting of pregnancy: a retrospective questionnaire analysis

Abstract

Background Hyperemesis gravidarum is the most severe form of nausea and vomiting of pregnancy, or morning sickness. 2% of pregnancies in the United States are affected by hyperemesis gravidarum. The condition is characterized by severe vomiting in pregnant people, especially during the first trimester, often leading to hypovolemia and weight loss. The standard of care for hyperemesis and nausea and vomiting of pregnancy is commonly ineffective. We hypothesize that based on patient experience; the current treatment guidelines for hyperemesis are not clinically effective. Our objective was to identify the efficacy of the various management approaches that are currently in place for hyperemesis and nausea and vomiting of pregnancy. Methods A questionnaire was designed based on diagnostic criteria, standard demographic identifiers, and common medications for the treatment of hyperemesis gravidarum. This questionnaire was distributed online to through hyperemesis and nausea and vomiting of pregnancy support groups, personal social media, and institutional email. Results In our study, most participants diagnosed with hyperemesis gravidarum trialed at least three medications, most of which were ineffective and/or had severe side effects. The most used medication for treatment of hyperemesis gravidarum is ondansetron, a standard antiemetic, with fatigue and constipation being the most reported side effects. All data in the dataset was coded as categorical and analyzed using contingency tables using Mantel-Haenszel Chi square tests. Conclusions The data presented in this research provides insight into the suffering that patients with these diagnoses face day-to-day due to the lack of efficacious, well-tolerated treatment options. Establishing this gap in treatment can facilitate the development of effective treatments that will provide relief for thousands of patients.

Survivors' Experiences of Hyperemesis Gravidarum

“…A sample of 786 women in the United States who experienced treatment of HG participated in an online survey. 15 Sixty percent of the women were formally diagnosed with HG. Of these participants, 57% reported taking 3 or more medications to try to alleviate their symptoms.…”

“…The trials included antiemetic pharmacological interventions and nonpharmacological interventions, such as acupuncture. A sample of 786 women in the United States who experienced treatment of HG participated in an online survey 15. Sixty percent of the women were formally diagnosed with HG.…”

Hyperemesis gravidarum – eine interprofessionelle und interdisziplinäre Herausforderung

“…Ein einheitliches Vorgehen wurde bisher nicht definiert. Wie eine jüngste Untersuchung aus den USA (n = 1002) ergab, nahmen 22,4% der Schwangeren mit HG 3, 15,3% 4 und 19,4% ≥5 Antiemetika 71 . Statt dieser Polypragmasie in der Therapie der HG ist ein am Schweregrad der Symptome orientiertes Stufenkonzept erforderlich 11 13 61 beginnend mit der niedrigsten Stufe wie z.…”

“…Ondansetron: in den USA stieg zwischen 2001 und 2014 die Anwendungsrate von Ondansetron von 1% auf 13–25% (500000–1000000 Anwendungen auf 4 Millionen Schwangerschaften) deutlich an 107 . Nach einer Untersuchung von Mares et al 2022 71 ist in den USA Ondansetron das am häufigsten eingesetzte Antiemetikum bei HG. Nach einer randomisierten Doppelblindstudie soll Ondansetron zur Behandlung des persistierenden Erbrechens (nicht aber der Übelkeit) in der Schwangerschaft effektiver sein als Metoclopramid 108 .…”

Presentation, Treatment, and Complications of Acute Dehydration in Hyperemesis Gravidarum

“…Studies showed a possible connection between hormone levels during pregnancy, known as human chorionic gonadotropin (hCG). This hormone tends to peak around the 10th week of pregnancy (5). Other factors that could potentially play a role in HG include psychological aspects, digestive system issues, Helicobacter pylori infection, thyroid problems, and liver complications.…”