From the Guidelines
Corticosteroids, specifically intravenous glucocorticoids, may be required in moderate to severe cases of hyperemesis gravidarum, as stated in the 2024 clinical practice update on pregnancy-related gastrointestinal and liver disease 1.
Recommended Approach
When managing hyperemesis gravidarum, the following steps should be considered:
- Early treatment of nausea and vomiting of pregnancy to reduce progression to hyperemesis gravidarum
- Standard diet and lifestyle measures
- Symptom control with vitamin B6 and doxylamine
- Hydration and adequate nutrition
- Use of ondansetron, metoclopramide, promethazine, and intravenous glucocorticoids in moderate to severe cases
Important Considerations
- Use corticosteroids judiciously and only when the potential benefits outweigh the risks, as they may have side effects like elevated blood glucose 1.
- Limit use to short courses to minimize fetal exposure.
- Monitor both mother and fetus closely during treatment.
- Consider the potential risks and benefits of corticosteroid use, particularly the increased risk of oral clefts when used before 10 weeks of gestation 1.
Corticosteroid Use in Pregnancy
Corticosteroids, such as methylprednisolone, prednisolone, or hydrocortisone, which are metabolized in the placenta, are preferred over betamethasone or dexamethasone, which have an almost 100% placental passage to the fetus 1. The use of corticosteroids in pregnancy should be guided by the most recent and highest quality evidence, with consideration of the potential risks and benefits, as outlined in the 2024 clinical practice update 1.
From the Research
Role of Corticosteroids in Managing Hyperemesis Gravidarum
- Corticosteroids have been studied as a potential treatment for hyperemesis gravidarum, a severe form of nausea and vomiting during pregnancy 2, 3.
- A randomized, double-blind, placebo-controlled trial found that the addition of parenteral and oral corticosteroids to the treatment of women with hyperemesis gravidarum did not reduce the need for rehospitalization later in pregnancy 3.
- However, some studies suggest that corticosteroids may be beneficial in severe cases of hyperemesis gravidarum that are refractory to conventional management 2.
- The use of corticosteroids, such as prednisolone, is mentioned as a potential treatment option for hyperemesis gravidarum, although it is not considered a first-line treatment 4.
Treatment of Hyperemesis Gravidarum
- The treatment of hyperemesis gravidarum typically involves a combination of non-pharmacological and pharmacological approaches, including intravenous fluids, anti-emetics, and acid suppression 5.
- Pyridoxine and metoclopramide are considered first-line treatments for hyperemesis gravidarum, followed by other medications such as prochlorperazine, prednisolone, and ondansetron 4.
- The use of ginger and acupressure may also be beneficial in some cases, although the evidence is mixed 4, 5.
Assessment and Management of Hyperemesis Gravidarum
- Assessment of hyperemesis gravidarum requires an objective evaluation using a validated scoring system, such as the PUQE-24 score, as well as calculation of hydration and nutritional status 5.
- Treatment should be individualized and may require a combination of therapies, including intravenous fluids, anti-emetics, and acid suppression 5.
- Outpatient management is optimal, but admission may be required for refractory symptoms, organ dysfunction, or concurrent significant co-morbidities 5.