Contemporary approaches to hyperemesis during pregnancy

Current Opinion in Obstetrics and Gynecology

Volumn 23, Issue 2, 2011, Pages 87-93

  Tan, Peng C ^a   Omar, Siti Z ^a  

^a UNIVERSITY OF MALAYA   (Malaysia)

Author keywords

hyperemesis gravidarum; nausea; pregnancy; vomiting

Indexed keywords

ANTIEMETIC AGENT; BENDECTIN; CHORIONIC GONADOTROPIN; CHORIONIC GONADOTROPIN RECEPTOR; CORTICOSTEROID; DIMENHYDRINATE; DOXYLAMINE; DOXYLAMINE PLUS PYRIDOXINE; ESTRADIOL; ESTROGEN; GINGER EXTRACT; GLUCOSE; GROWTH HORMONE; HISTAMINE H2 RECEPTOR ANTAGONIST; HYDROCORTISONE; LEPTIN; METHYLPREDNISOLONE; METOCLOPRAMIDE; ONDANSETRON; PLACEBO; PREDNISOLONE; PROCHLOPERAZINE; PROGESTERONE; PROLACTIN; PROMETHAZINE; PROTON PUMP INHIBITOR; PYRIDOXINE; THIAMINE; THYROTROPIN; THYROTROPIN RECEPTOR; UNCLASSIFIED DRUG; UNINDEXED DRUG;

ACUPRESSURE; ACUPUNCTURE; ADVERSE OUTCOME; ANXIETY; AREA POSTREMA; ARTICLE; BEHAVIOR DISORDER; BIRTH DEFECT; CENTRAL PONTINE MYELINOLYSIS; CLINICAL TRIAL (TOPIC); DEPRESSION; DIAPHRAGM HERNIA; DIET THERAPY; DISEASE ASSOCIATION; DISEASE SEVERITY; DROWSINESS; DRUG EFFICACY; DRUG SAFETY; DRUG TOLERABILITY; DRUG TOLERANCE; DRUG TREATMENT FAILURE; DRUG WITHDRAWAL; DYSTONIA; ESOPHAGITIS; ESTRADIOL BLOOD LEVEL; ESTROGEN BLOOD LEVEL; FIRST TRIMESTER PREGNANCY; GASTRITIS; GASTROESOPHAGEAL REFLUX; GENETIC PREDISPOSITION; GENOTYPE; HEARTBURN; HELICOBACTER INFECTION; HORMONE BLOOD LEVEL; HOSPITAL READMISSION; HUMAN; HYPEREMESIS GRAVIDARUM; HYPERTHYROIDISM; HYPNOSIS; HYPONATREMIA; LIFESTYLE MODIFICATION; MONOTHERAPY; MOUTH MALFORMATION; NAUSEA; PARENTERAL NUTRITION; PATHOGENESIS; PERCUTANEOUS ENDOSCOPIC GASTROSTOMY; PREGNANCY; PREGNANCY OUTCOME; PREMATURE LABOR; PRIORITY JOURNAL; PSYCHOLOGICAL ASPECT; PSYCHOTHERAPY; REHYDRATION; SPONTANEOUS ABORTION; TARDIVE DYSKINESIA; THIAMINE DEFICIENCY; TOTAL PARENTERAL NUTRITION; TRANSPYLORIC FEEDING; TREATMENT OUTCOME; TUBE FEEDING; UNSPECIFIED SIDE EFFECT; VITAMIN SUPPLEMENTATION; VOMITING; WEIGHT REDUCTION; WERNICKE ENCEPHALOPATHY;

ADRENAL CORTEX HORMONES; ANTIEMETICS; DIET; DOXYLAMINE; FEMALE; GINGER; HUMANS; HYPEREMESIS GRAVIDARUM; OBSTETRICS; ONDANSETRON; PLANT EXTRACTS; PREGNANCY; PREGNANCY COMPLICATIONS; PREGNANCY OUTCOME; PYRIDOXINE;

EID: 79953164699     PISSN: 1040872X     EISSN: None     Source Type: Journal    
DOI: 10.1097/GCO.0b013e328342d208     Document Type: Article

References (54)

1. Lacasse A, Rey E, Ferreira E, et al. Epidemiology of nausea and vomiting of pregnancy: prevalence, severity, determinants, and the importance of race/ethnicity. BMC Pregnancy Childbirth 2009;9:26.
2. Chan RL, Olshan AF, Savitz DA, et al. Maternal influences on nausea and vomiting in early pregnancy. Matern Child Health J 2009. doi: 10.1007/s10995-009-0548-0
3. Verberg MF, Gillott DJ, Al-Fardan N, et al. Hyperemesis gravidarum, a literature review. Hum Reprod Update 2005;11:527-539. (Pubitemid 41418806)
4. Goodwin TM. Hyperemesisgravidarum. Obstet Gynecol Clin North Am 2008;35:401-417; viii.
5. Gazmararian JA, Petersen R, Jamieson DJ, et al. Hospitalizations during pregnancy among managed care enrollees. Obstet Gynecol 2002;100:94-100. (Pubitemid 34722848)
6. Fell DB, Dodds L, Joseph KS, et al. Risk factors for hyperemesis gravidarum requiring hospital admission during pregnancy. Obstet Gynecol 2006;107:277-284.
7. Tan PC, Vani S, Lim BK, et al. Anxiety and depression in hyperemesis gravidarum: prevalence, risk factors and correlation with clinical severity. Eur J Obstet Gynecol Reprod Biol 2010;149:153-158. This prospective study highlights the psychological burden in women hospitalized for hyperemesis gravidarum and provides support for the psychological distress being a consequence rather than a cause of hyperemesis gravidarum.
8. Tan PC, Yow CM, Omar SZ. A placebo-controlled trial of oral pyridoxine in hyperemesis gravidarum. Gynecol Obstet Invest 2009;67:151-157. This randomized trial shows that supplemental pyridoxine is not effective in women hospitalized for hyperemesis gravidarum contrary to evidence of pyridoxine effectiveness in outpatient treatment of NVP.
9. Chan RL, Olshan AF, Savitz DA, et al. Severity and duration of nausea and vomiting symptoms in pregnancy and spontaneous abortion. Hum Reprod 2010;25:2907-2912. This article provides contemporary data for the protective effect of NVP from spontaneous miscarriage and uniquely demonstrates an inverse correlation between symptom duration and miscarriage.
10. Nulman I, Rovet J, Barrera M, et al. Long-term neurodevelopment of children exposed to maternal nausea and vomiting of pregnancy and diclectin. J Pediatr 2009;155:45-50; 50e1-2. This interesting paper is the first that investigated the effect of NVP in childhood and demonstrates that children exposed to NVP may even have enhanced performance in some neurodevelopmental parameters. The neurodevelopmental data for children exposed in utero to pyridoxine-doxylamine for NVP are similarly reassuring.
11. van Oppenraaij RH, Jauniaux E, Christiansen OB, et al. Predicting adverse obstetric outcome after early pregnancy events and complications: a review. Hum Reprod Update 2009;15:409-421.
12. Dodds L, Fell DB, Joseph KS, et al. Outcomes of pregnancies complicated by hyperemesis gravidarum. Obstet Gynecol 2006;107:285-292.
13. Fejzo MS, Poursharif B, Korst LM, et al. Symptoms and pregnancy outcomes associated with extreme weight loss among women with hyperemesis gravidarum. J Womens Health (Larchmt) 2009;18:1981-1987.
14. Niebyl JR. Clinical practice. Nausea and vomiting in pregnancy. N Engl J Med 2010;363:1544-1550. This practice based review on hyperemesis of pregnancy provides a good overview of NVP and its management.
15. Tan PC, Tan NC, Omar SZ. Effect of high levels of human chorionic gonadotropin and estradiol on the severity of hyperemesis gravidarum. Clin Chem Lab Med 2009;47:165-171. This paper elaborated further on the central role of hCG in hyperemesis gravidarum, demonstrating a positive correlation between higher hCG levels and more severe hyperemesis gravidarum after adjustment for confounders. No correlation was demonstrated for higher estradiol levels.
16. Lei ZM, Rao CV, Kornyei JL, et al. Novel expression of human chorionic gonadotropin/luteinizing hormone receptor gene in brain. Endocrinology 1993;132:2262-2270. (Pubitemid 23133280)
17. Cole LA. Biological functions of hCG and hCG-related molecules. Reprod Biol Endocrinol 2010;8:102.
18. Lockwood CM, Grenache DG, Gronowski AM. Serum human chorionic gonadotropin concentrations greater than 400 000IU/L are invariably associated with suppressed serum thyrotropin concentrations. Thyroid 2009;19:863-868.
19. Sandven I, Abdelnoor M, Nesheim BI, et al. Helicobacter pylori infection and hyperemesis gravidarum: a systematic review and meta-analysis of casecontrol studies. Acta Obstet Gynecol Scand 2009;88:1190-1200. This meta-analysis confirms the association of H. pylori infection and hyperemesis gravidarum, but does not illuminate on causality.
20. Vikanes A, Skjaerven R, Grjibovski AM, et al. Recurrence of hyperemesis gravidarum across generations: population based cohort study. BMJ 2010;340: c2050. This large population and cross generational study from Norway provides solid demonstration for susceptibility to hyperemesis gravidarum arising from the maternal genotype and discounted a significant role for the Fetal genotype in generating hyperemesis gravidarum.
21. Fejzo MS, Ingles SA, Wilson M, et al. High prevalence of severe nausea and vomiting of pregnancy and hyperemesis gravidarum among relatives of affected individuals. Eur J Obstet Gynecol Reprod Biol 2008;141:13-17.
22. Grjibovski AM, Vikanes A, Stoltenberg C, et al. Consanguinity and the risk of hyperemesis gravidarum in Norway. Acta Obstet Gynecol Scand 2008;87:20-25.
23. Gill SK, Maltepe C, Koren G. The effect of heartburn and acid reflux on the severity of nausea and vomiting of pregnancy. Can J Gastroenterol 2009;23:270-272. This is an interesting early paper demonstrating the correlation between acid reflux and NVP; it opens up another possible mechanism in the pathogenesis of NVP.
24. Debby A, Golan A, Sadan O, et al. Clinical utility of esophagogastroduodenoscopy in the management of recurrent and intractable vomiting in pregnancy. J Reprod Med 2008;53:347-351. (Pubitemid 351846379)
25. Gill SK, Maltepe C, Mastali K, et al. The effect of acid-reducing pharmacotherapy on the severity of nausea and vomiting of pregnancy. Obstet Gynecol Int 2009;2009:585269. This descriptive paper on the effectiveness of acid-reducing medicines in reducing severity of NVP opens up another therapeutic option in selected hyperemesis gravidarum patients, but the data need to be confirmed by a randomized trial.
26. Gill SK, O'Brien L, Koren G. The safety of histamine 2 (H2) blockers in pregnancy: a meta-analysis. Dig Dis Sci 2009;54:1835-1838.
27. Gill SK, O'Brien L, Einarson TR, et al. The safety of proton pump inhibitors (PPIs) in pregnancy: a meta-analysis. Am J Gastroenterol 2009;104:1541-1545; quiz 1540, 1546.
28. Gill SK, Maltepe C, Koren G. The effectiveness of discontinuing iron-containing prenatal multivitamins on reducing the severity of nausea and vomiting of pregnancy. J Obstet Gynaecol 2009;29:13-16.
29. Munch S. Women's experiences with a pregnancy complication: causal explanations of hyperemesis gravidarum. Soc Work Healthcare 2002;36:59-76. (Pubitemid 36119005)
30. Power Z, Thomson AM, Waterman H. Understanding the stigma of hyperemesis gravidarum: qualitative findings from an action research study. Birth 2010;37:237-244. This qualitative study highlights the debilitating effects and burden of hyperemesis gravidarum on patients and the lack of appreciation and interest by care providers as perceived by patients.
31. Wills G, Forster D. Nausea and vomiting in pregnancy: what advice do midwives give? Midwifery 2008;24:390-398.
32. Latva-Pukkila U, Isolauri E, Laitinen K. Dietary and clinical impacts of nausea and vomiting during pregnancy. J Hum Nutr Diet 2010;23:69-77.
33. Matthews A, Dowswell T, Haas DM, et al. Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst Rev: CD007575. This updated comprehensive review and meta-analysis of trials is a useful first port of call in appreciating the quantitative data on effective therapy for NVP and hyperemesis gravidarum.
34. Ensiyeh J, Sakineh MA. Comparing ginger and vitamin B6 for the treatment of nausea and vomiting in pregnancy: a randomised controlled trial. Midwifery 2009;25:649-653.
35. Ozgoli G, Goli M, Simbar M. Effects of ginger capsules on pregnancy, nausea, and vomiting. J Altern Complement Med 2009;15:243-246.
36. American College of Obstetrics and Gynecology. ACOG (American College of Obstetrics and Gynecology) Practice Bulletin: nausea and vomiting of pregnancy. Obstet Gynecol 2004;103:803-814.
37. Koren G, Clark S, Hankins GD, et al. Effectiveness of delayed-release doxylamine and pyridoxine for nausea and vomiting of pregnancy: a randomized placebo controlled trial. Am J Obstet Gynecol. [Epub ahead of print] This trial report provides data on the effectiveness of a new vehicle for a widely used antiemetic preparation in NVP. The position of doxylamine-pyridoxine as a first-line drug combination for NVP is likely to be solidified by this report, at least in areas where it is available.
38. Lacasse A, Lagoutte A, Ferreira E, et al. Metoclopramide and diphenhydramine in the treatment of hyperemesis gravidarum: effectiveness and predictors of rehospitalisation. Eur J Obstet Gynecol Reprod Biol 2009;143:43-49.
39. Bsat FA, Hoffman DE, Seubert DE. Comparison of three outpatient regimens in the management of nausea and vomiting in pregnancy. J Perinatol 2003;23:531-535. (Pubitemid 37428160)
40. Tan PC, Khine PP, Vallikkannu N, et al. Promethazine compared with meto-clopramide for hyperemesis gravidarum: a randomized controlled trial. Obstet Gynecol 2010;115:975-981. This trial provides the data that intravenous metoclopramide should be preferred to intravenous promethazine in the immediate treatment of hospitalized women with hyperemesis gravidarum as metoclopramide is much better tolerated, but is not more effective.
41. Matok I, Gorodischer R, Koren G, et al. The safety of metoclopramide use in the first trimester of pregnancy. N Engl J Med 2009;360:2528-2535. This article provides convincing and reassuring data on a drug commonly prescribed for NVP and hyperemesis gravidarum. as drug safety in early pregnancy is a paramount concern for many women, this article should allow many more women to accept appropriate treatment for hyperemesis.
42. US Food and Drug Administration. Boxed warning and risk mitigation strategy for metoclopramide; 2009. http://www.fda.gov/NewsEvents/Newsroom/ PressAnnouncements/2009/ucm149533.htm. [Accessed 4 November 2010].
43. Safari HR, Fassett MJ, Souter IC, et al. The efficacy of methylprednisolone in the treatment of hyperemesis gravidarum: a randomized, double-blind, controlled study. Am J Obstet Gynecol 1998;179:921-924. (Pubitemid 28489281)
44. Sullivan CA, Johnson CA, Roach H, et al. A pilot study of intravenous ondansetron for hyperemesis gravidarum. Am J Obstet Gynecol 1996;174:1565-1568. (Pubitemid 26165279)
45. Yost NP, McIntire DD, Wians FH Jr, et al. A randomized, placebo-controlled trial of corticosteroids for hyperemesis due to pregnancy. Obstet Gynecol 2003;102:1250-1254. (Pubitemid 37518403)
46. Nelson-Piercy C, Fayers P, de Swiet M. Randomised, double-blind, placebocontrolled trial of corticosteroids for the treatment of hyperemesis gravidarum. BJOG 2001;108:9-15. (Pubitemid 32102598)
47. Ziaei S, Hosseiney FS, Faghihzadeh S. The efficacy low dose of prednisolone in the treatment of hyperemesis gravidarum. Acta Obstet Gynecol Scand 2004;83:272-275. (Pubitemid 38338868)
48. Bondok RS, El Sharnouby NM, Eid HE, et al. Pulsed steroid therapy is an effective treatment for intractable hyperemesis gravidarum. Crit Care Med 2006;34:2781-2783. (Pubitemid 44610943)
49. Puangsricharern A, Mahasukhon S. Effectiveness of auricular acupressure in the treatment of nausea and vomiting in early pregnancy. J Med Assoc Thai 2008;91:1633-1638.
50. Kim DR, Connolly KR, Cristancho P, et al. Psychiatric consultation of patients with hyperemesis gravidarum. Arch Womens Ment Health 2009;12:61-67. This review puts into stark perspective the paucity of evidence of effective psychological intervention in hyperemesis gravidarum.
51. McCormack D. Hypnosis for hyperemesis gravidarum. J Obstet Gynaecol 2010;30:647-653.
52. Nuthalapaty FS, Beck MM, Mabie WC. Complications of central venous catheters during pregnancy and postpartum: a case series. Am J Obstet Gynecol 2009;201:311e1-3115e. This descriptive article of complications of central venous catheters during pregnancy highlights the formidable challenge of prolonged total parenteral nutrition via a central line that may be required in the most recalcitrant of hyperemesis gravidarum cases.
53. Holmgren C, Aagaard-Tillery KM, Silver RM, et al. Hyperemesis in pregnancy: an evaluation of treatment strategies with maternal and neonatal outcomes. Am J Obstet Gynecol 2008;198:56e1-56e4.
54. Saha S, Loranger D, Pricolo V, et al. Feeding jejunostomy for the treatment of severe hyperemesis gravidarum: a case series. JPEN J Parenter Enteral Nutr 2009;33:529-534. This small series of five successfully managed cases of severe hyperemesis gravidarum using surgically created feeding jejunostomies illustrates an alternative to total parenteral nutrition for intractable hyperemesis gravidarum.