Hyperemesis gravidarum in the primary care setting: cross-sectional study of GPs

Abstract

BackgroundHyperemesis gravidarum (HG), if untreated, can lead to malnutrition, dehydration and Wernicke’s encephalopathy. Fetal complications include low birth weight and neurodevelopmental delay. Recent evidence supports increased rates of termination of pregnancy and suicidal ideation. Drivers included difficulty in accessing medications which thus contributed to poor perception of care.AimIdentify factors that may influence prescribers’ confidence and knowledge regarding pharmacological therapy for HG.Design & settingCross-sectional study of qualified GPs (General Practitioners) and GP trainees in Wales.MethodDistribution of a 22-item online survey. Statistical analysis was carried out using SPSS.Results241 responses were received with 216 included in the analysis (59% qualified GPs, 41% GP trainees). In total, 93% of respondents correctly identified cyclizine as being safe in pregnancy, but no other drug recommended in the Royal College of Obstetrics and Gynaecology guidance was considered safe by more than 58%. Those reporting higher confidence levels in managing HG were more likely to correctly report guideline recommended drugs as safe in pregnancy (P=0.04). Additional qualifications related to obstetrics and gynaecology and/or prior clinical experience increased confidence levels (P=0.0001 and P=0.0002 respectively). Only 19% of participants routinely screened for signs of mental health complications and prior experience/education did not increase likelihood of this happening. 87% of participants would like additional education/access to evidence-based resources.ConclusionThis study demonstrates a demand for improved dissemination of evidence-based education to support those working in primary care. The extent to which HG is covered in pre-existing educational programmes should also be revisited.

Antiemetic treatment of hyperemesis gravidarum in 1,064 Norwegian women and the impact of European warning on metoclopramide: a retrospective cohort study 2002–2019

“…Surprisingly, we found no compensatory increase in the use of other antiemetics when pre-hospital use of metoclopramide dropped, indicating that general practicioners (GPs) lacked treatment options to replace metoclopramide. This interpretation is supported by a study showing that GPs in the UK often lack confidence in prescribing recommended antiemetics in pregnancy [ 25 ], and Norwegian GPs have reported being wary of prescribing medicines for NVP due to the teratogenic potential, referring to the thalidomide tragedy [ 26 ]. The recovery in use of metoclopramide to the pre-intervention level, may suggest that GPs, in lack of alternatives, assess the benefit of metoclopramide to outweigh the potential risk of adverse effects in severe NVP/HG.…”

Reorganising and improving quality of care for hyperemesis gravidarum in a Danish hospital: a quality improvement project

“…Lack of access to treatment at GPs could be a reflection of inconsistency in GPs' knowledge and confidence regarding HG as is reported in other countries. 27 This may be due to overestimation of the risk associated with antiemetics in pregnancy. 28 To improve treatment for HG and NVP in the primary sector, we made standard discharge papers containing information on antiemetics and a synopsis in the regional news bulletin for GPs on the updated recommendations.…”

“…Lack of access to treatment at GPs could be a reflection of inconsistency in GPs’ knowledge and confidence regarding HG as is reported in other countries. 27 This may be due to overestimation of the risk associated with antiemetics in pregnancy. 28 …”

Clinical practice guidelines for the management of hyperemesis gravidarum: A systematic review and quality appraisal with AGREE II

“…Nana et al has highlighted the importance of evidencebased medicine in the management of HG in primary care. 9…”