The windsor definition for hyperemesis gravidarum: A multistakeholder international consensus definition

Abstract

Objective: To develop an international definition for hyperemesis gravidarum to assist in clinical diagnosis and harmonize hyperemesis gravidarum definition for study populations.Study design: A mixed-methods approach was used to identify potential hyperemesis gravidarum definition criteria (i.e. systematic review, semi-structured interviews and closed group sessions with patients and Project Steering Committee input). To reach consensus on the definition we used a webbased Delphi survey with two rounds, followed by a face-to-face consensus development meeting, held in Windsor UK, and a web-based consultation round, in which the provisional hyperemesis gravidarum definition was fed back to the stakeholders. Four stakeholder groups were identified 1) researchers; 2) women with lived experience of hyperemesis gravidarum and their families; 3) obstetric health professionals (obstetricians, gynecologists, midwives); and 4) other health professionals involved in care for women with hyperemesis gravidarum (general practitioners, dieticians, nurses). To reflect the opinions of the international community, stakeholders from countries in all global regions were invited to participate.Results: Twenty-one identified potential criteria entered the Delphi survey. Of the 277 stakeholders invited, 178 completed round one, and 125 (70%) also completed round two. Twenty stakeholders attended the consensus development meeting, representing all stakeholder groups. The consultation round was completed by 96 (54%) stakeholders, of which 92% agreed with the definition as presented. The consensus definition for hyperemesis gravidarum consisted of: start of symptoms in early pregnancy (before 16 weeks gestational age); nausea and vomiting, at least one of which severe; inability to eat and/ or drink normally; strongly limits daily living activities. Signs of dehydration were deemed contributory for the definition for hyperemesis gravidarum. Conclusions: The proposed definition for hyperemesis gravidarum will help clinical studies to achieve more uniformity, and ultimately increasing the value of evidence to inform patient care.

Emerging Progress in Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum: Challenges and Opportunities

“…Importantly, more studies regarding the safety and efficacy of the current treatment strategies for NVP and HG are urgently needed, especially regarding antiemetics exposure and their association with specific structural birth defects in offspring ( 197 ). Hence, an international consensus on therapy for NVP and HG is needed ( 21 ). It is worth noting that mother and child may have a higher risk from untreated HG compared with standard treatment with the antiemetic drugs.…”

“…A recent international consensus definition for HG consists of: symptoms start in early pregnancy (before 16 weeks gestational age); nausea and vomiting, at least one of which is severe; inability to eat and/or drink normally; strongly limits daily living activities. Signs of dehydration were deemed contributory for the definition for HG ( 21 ). Clinical practice regards HG as the most severe expression of NVP, with complications such as dehydration or metabolic disorders (weight loss, electrolyte deficiency, or malnutrition) ( 1 ).…”

Lack of catch-up in weight gain may intermediate between pregnancies with hyperemesis gravidarum and reduced fetal growth: the Japan Environment and Children’s Study

“…There are also studies that have focused on the adverse impact of insufficient gestational weight gain [ 15 – 17 ] and weight gain in early pregnancy [ 18 , 19 ] on fetal growth. The lack of definite diagnostic criteria for hyperemesis gravidarum may have confused the situation and made research synthesis challenging [ 6 , 7 ]. Nonetheless, few studies have investigated the mechanism underlying this paradoxical phenomenon.…”

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

“…However, 0.3-3.6% of pregnant patients experience the most severe form of NVP known as Hyperemesis Gravidarum (HG), with debilitating symptoms [1]. A recently developed consensus definition for hyperemesis gravidarum, also referred to as the Windsor Definition, includes start of symptoms in early pregnancy (before 16 weeks gestational age); nausea and vomiting, at least one of which severe; inability to eat and/or drink normally; strongly limits daily living activities [2]. HG is further characterized by intractable vomiting, especially during the first trimester that is difficult to treat and often leads to hypovolemia and weight loss.…”