Interventions for treating hyperemesis gravidarum

Boelig, Rupsa C.; Barton, Samantha J; Saccone, Gabriele; Kelly, Anthony; Edwards, Steve J; Berghella, Vincenzo

doi:10.1002/14651858.cd010607.pub2

Cited by 62 publications

(61 citation statements)

References 71 publications

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“…Notwithstanding, most studies agree that hyperemesis gravidarum is more common among young, primiparous mothers who are non-Caucasian and non-smokers [4,5]. Within the US population, there is lack of significant data on the difference in prevalence of hyperemesis gravidarum between different ethnic backgrounds.…”

Section: Epidemiologymentioning

confidence: 99%

“…The group reviewed 25 trials, involving approximately 2,052 women diagnosed with hyperemesis gravidarum, publishing their findings in 2016. It is important to note that by Cochran evidence standards, outcome data presented in most studies were graded as “low” or “very low” quality, mainly due to the “imprecision of effect estimates.” This finding highlights the need for further research in the field and the importance of developing standard criteria of a diagnosis of hyperemesis gravidarum [5]. …”

Section: Maternal Complicationsmentioning

confidence: 99%

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Hyperemesis Gravidarum: A Review of Recent Literature

et al. 2017

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Background: In the United States, hyperemesis gravidarum is the most common cause of hospitalization during the first half of pregnancy and is second only to preterm labor for hospitalizations in pregnancy overall. In approximately 0.3-3% of pregnancies, hyperemesis gravidarum is prevalent and this percentage varies on account of different diagnostic criteria and ethnic variation in study populations. Despite extensive research in this field, the mechanism of the disease is largely unknown. Although cases of mortality are rare, hyperemesis gravidarum has been associated with both maternal and fetal morbidity. The current mainstay of treatment relies heavily on supportive measures until improvement of symptoms as part of the natural course of hyperemesis gravidarum, which occurs with progression of gestational age. However, studies have reported that severe, refractory disease manifestations have led to serious adverse outcomes and to termination of pregnancies. Summary: Despite extensive research in the field, the pathogenesis of hyperemesis gravidarum remains unknown. Recent literature points to a genetic predisposition in addition to previously studied factors such as infectious, psychiatric, and hormonal contributions. Maternal morbidity is common and includes psychological effects, financial burden, clinical complications from nutritional deficiencies, gastrointestinal trauma, and in rare cases, neurological damage. The effect of hyperemesis gravidarum on neonatal health is still debated in literature with conflicting results regarding outcomes of birth weight and prematurity. Available therapy options remain largely unchanged in the past several decades and focus on parenteral antiemetic medications, electrolyte repletion, and nutritional support. Most studies of therapeutic options do not consist of randomized control studies and cross-study analysis is difficult due to considerable variation of diagnostic criteria. Key Messages: Hyperemesis gravidarum carries a significant burden on maternal health and US health care. Most published research on pathogenesis is observational and suggests multifactorial associations with hyperemesis gravidarum. Precise, strictly defined criteria for clinical diagnosis are likely to benefit meta-analyses of further research studies regarding pathogenesis as well as therapeutic options.

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Section: Epidemiologymentioning

confidence: 99%

Section: Maternal Complicationsmentioning

confidence: 99%

Hyperemesis Gravidarum: A Review of Recent Literature

et al. 2017

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“…Two Cochrane reviews were published recently. 62,63 Matthews et al 62 included only RCTs focusing on nausea and vomiting and excluded trials involving hyperemesis gravidarum; the review by Boelig et al 63 only included RCTs of hyperemesis gravidarum. Neither review categorized therapies depending on symptom severity.…”

Section: Comparison With Previous Literaturementioning

confidence: 99%

Treatments for Hyperemesis Gravidarum and Nausea and Vomiting in Pregnancy

McParlin

O’Donnell

Robson

et al. 2016

JAMA

141

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“…As two systematic reviews recently showed, the heterogeneity of definition for HG and poor quality of the studies hamper the little research there is 4546…”

Section: What Treatments Are Available?mentioning

confidence: 99%

“…The anti-emetic mechanism of steroids is not yet understood, but when used in combination may boost the effects of other anti-emetics 53. Evidence for the efficacy of steroids in HG is weak,454654 and there is some evidence of an increased relative risk of cleft palate in early first trimester exposure. The absolute risk remains small, however,55 and should be balanced with the risks associated with treatment resistant HG.…”

Section: What Treatments Are Available?mentioning

confidence: 99%