Secular Trends in the Treatment of Hyperemesis Gravidarum

ABSTRACT

The purpose of this study was to describe the treatment of women with hyperemesis gravidarum (HG). Women with HG pregnancies of at least 27 weeks duration occurring between 1985 and 2004 described their treatment on an HG website from 2003 to 2005. The usage and effectiveness of > 20 treatment options were reported by 765 women for 1193 pregnancies. The women who used intravenous (IV) hydration, serotonin inhibitors, and parenteral nutrition (PN) reported the highest rates of effectiveness, with 84%, 83%, and 79% reporting that these respective treatments may have contributed to decreased nausea/vomiting. The use of conventional treatments increased from 20 to 30% to > 60% between 1985 and 1989 and 2000 and 2004; serotonin inhibitor use increased to 55% after its introduction in the 1990s. Over the past 20 years, multiple treatments have been used for women with HG, with a trend toward treatment with reportedly more effective modalities, such as IV hydration and serotonin inhibitors.

KEYWORDS

Hyperemesis gravidarum - nausea - vomiting - pregnancy

REFERENCES

• 1 Gadsby R, Barnie-Adshead A M, Jagger C. A prospective study of nausea and vomiting during pregnancy.  Br J Gen Prac. 1993;  43(371) 245-248
• 2 Vellacott I D, Cooke E J, James C E. Nausea and vomiting in early pregnancy.  Int J Gynaecol Obstet. 1988;  27(1) 57-62
• 3 O'Brien B, Naber S. Nausea and vomiting during pregnancy: effects on the quality of women's lives.  Birth. 1992;  19(3) 138-143
• 4 Attard C L, Kohli M A, Coleman S, Bradley C, Hux M, Atanackovic G, Torrance G W. The burden of illness of nausea and vomiting of pregnancy in the United States.  Am J Obstet Gynecol. 2002;  186(5 Suppl Understanding) S220-227
• 5 Fairweather D VI. Nausea and vomiting in pregnancy.  Am J Obstet Gynecol. 1968;  102(1) 135-175
• 6 Goodwin T M, Montoro M, Mestman J H. Transient hyperthyroidism and hyperemesis gravidarum: clinical aspects.  Am J Obstet Gynecol. 1992;  167(3) 648-652
• 7 Adams R H, Gordon J, Combes B. Hyperemesis gravidarum. I. Evidence of hepatic dysfunction.  Obstet Gynecol. 1968;  31(5) 659-664
• 8 Selitsky T, Chandra P, Schiavello Henry J. Wernicke's encephalopathy with hyperemesis and ketoacidosis.  Obstet Gynecol. 2006;  107(2 pt 2) 486-490
• 9 Källén B. Hyperemesis during pregnancy and delivery outcome: a registry study.  Eur J Obstet Gynecol Reprod Biol. 1988;  26(4) 291-302
• 10 Bailit J L. Hyperemesis gravidarum: epidemiologic findings from a large cohort.  Am J Obstet Gynecol. 2005;  193(3 pt 1) 811-814
• 11 American College of Obstetricians and Gynecologists .Nausea and vomiting of pregnancy. Practice Bulletin number 52. Washington, DC; ACOG 2004
• 12 Vutyavanich T, Kraisarin T, Ruangsri R. Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial.  Obstet Gynecol. 2001;  97(4) 577-582
• 13 Roscoe J A, Matteson S E. Acupressure and acustimulation bands for control of nausea: a brief review.  Am J Obstet Gynecol. 2002;  186(5 Suppl Understanding) S244-247
• 14 Jewell D, Young G. Interventions for nausea and vomiting in early pregnancy.  Cochrane Database Syst Rev. 2003;  (4) CD000145
• 15 Magee L A, Mazzotta P, Koren G. Evidence-based view of safety and effectiveness of pharmacologic therapy for nausea and vomiting of pregnancy.  Am J Obstet Gynecol. 2002;  186(5 Suppl Understanding) S256-261
• 16 Koren G, Bologa M, Long D et al.. Perception of teratogenic risk by pregnant women exposed to drugs and chemicals during the first trimester.  Am J Obstet Gynecol. 1989;  160(5) 1190-1194
• 17 Sahakian V, Rouse D, Sipes S et al.. Vitamin B6 is effective therapy for nausea and vomiting of pregnancy: a randomized, double-blind placebo-controlled study.  Obstet Gynecol. 1991;  78(1) 33-36
• 18 Vutyavanich T, Wongtra-ngan S, Ruangsri R. Pyridoxine for nausea and vomiting of pregnancy: a randomized, double-blind, placebo-controlled trial.  Am J Obstet Gynecol. 1995;  173(3 pt 1) 881-884
• 19 Mazzotta P, Maltepe C, Navioz Y, Magee L A, Koren G. Attitudes, management and consequences of nausea and vomiting of pregnancy in the United States and Canada.  Int J Gynaecol Obstet. 2000;  70(3) 359-365
• 20 Nelson-Piercy , Fayers P, de Swiet M. Randomized, double-blind, placebo-controlled trial of corticosteroids for the treatment of hyperemesis gravidarum.  BJOG. 2001;  1080(1) 9-15
• 21 Fischer-Rasmussen W, Kjaer S K, Dahl C, Asping U. Ginger treatment of hyperemesis gravidarum.  Eur J Obstet Gynecol Reprod Biol. 1991;  42(2) 163-164
• 22 Smith C, Crowther C, Wilson K, Hotham N, McMillian V. A randomized controlled trial of ginger to treat nausea and vomiting in pregnancy.  Obstet Gynecol. 2004;  103(4) 639-645
• 23 Vutyavanich T, Kraisarin T, Ruangsri R. Ginger for nausea and vomiting in pregnancy: randomized, double-blind, placebo-controlled trial.  Obstet Gynecol. 2001;  97(4) 577-582
• 24 Willetts K E, Ekangaki A, Eden J A. Effect of ginger extract on pregnancy-induced nausea: a randomised controlled trial.  Aust N Z J Obstet Gynaecol. 2003;  43(2) 139-144
• 25 Bendectin Peer Group .Biol/basics International Peer Group report. Merrell Dow Pharmaceuticals Inc. 1975: 559-637
• 26 Lask S. Treatment of nausea and vomiting of pregnancy with antihistamines.  BMJ. 1953;  1(4811) 652-653
• 27 Newlinds J S. Nausea and vomiting in pregnancy: a trial of thiethylperazine.  Med J Aust. 1964;  14 234-236
• 28 Sullivan C A, Johnson C A, Roach H, Martin R W, Stewart D K, Morrison J C. A pilot study of intravenous ondansetron for hyperemesis gravidarum.  Am J Obstet Gynecol. 1996;  174(5) 1565-1568
• 29 Russo-Stieglitz K E, Levine A B, Wagner B A, Armenti V T. Pregnancy outcome in patients requiring parenteral nutrition.  J Matern Fetal Med. 1999;  8(4) 164-167
• 30 Ogura J M, Francois K E, Perlow J H, Elliot J P. Complications associated with peripherally inserted central catheter use during pregnancy.  Am J Obstet Gynecol. 2003;  188(5) 1223-1225
• 31 Hsu J J, Clark-Glena R, Nelson D K, Kim C H. Nasogastric enteral feeding in the management of hyperemesis gravidarum.  Obstet Gynecol. 1996;  88(3) 343-346

APPENDIX

Did the following treatments decrease or eliminate your nausea and vomiting? (Please answer: “Not offered” for all treatments that were not offered to you, “Effective” for all treatments that helped your symptoms, “Not effective” for treatments you tried that did not help, “Maybe” for all treatments you tried that might have helped, and “Not tried” for all treatments you did not try but were offered. Using the option of “Not tried” allows us to know if a treatment is being offered, but women are not trying it.)

List of Medications and Treatments: These are equivalent to the medications and treatments listed in Tables [1] and [2].

0 Some data in this paper were presented in preliminary form at the 55th Annual Clinical Meeting of American College of Obstetricians and Gynecologists, May 5-9, 2007, San Diego, CA (Obstet Gynecol 2007;109(4):1195S-1956S).