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.

Keywords: Hyperemesis Gravidarum; Morning sickness; Nausea; Nausea and vomiting of pregnancy; Pregnancy; Quality of life; Vomiting.

Fig. 1

Respondent demographics. A Ethnicity and race of respondents. B Participants residing in the USA vs. outside the USA. C Have you even been diagnosed by a healthcare provided with Hyperemesis Gravidarum

Fig. 2

Number of medications women took depending on their diagnosis status. The expectation under Ho is the response percentage under a perfect allocation by group that would assume no effect; these expected values are calculated from a contingency table of the data. The larger the observed bars deviate from the expectation, the larger the effect in that group

Fig. 3

Three key questions from the survey were evaluated using contingency tables where pairwise associations were determined using Mantel-Haenszel Chi-square tests

Fig. 4

Commonly used medications frequency among surveyed women users formally diagnosed with HG