From the Guidelines
Corticosteroids, such as methylprednisolone or prednisolone, can be considered for treating severe hyperemesis gravidarum that is refractory to first-line treatments, as stated in the most recent guideline evidence 1.
Recommended Regimen
The recommended regimen for corticosteroids in treating hyperemesis gravidarum is not explicitly stated in the provided evidence, but based on general medical knowledge, a possible regimen could be:
- Methylprednisolone 16 mg IV every 8 hours for 48-72 hours
- Then transition to oral prednisone 40 mg daily, tapering by 5 mg every 3 days until discontinuation This should only be used after other treatments (e.g., antiemetics, IV fluids, vitamin supplementation) have failed. Start treatment in a hospital setting for close monitoring.
Important Considerations
When using corticosteroids to treat hyperemesis gravidarum, it is essential to:
- Use the lowest effective dose for the shortest duration possible
- Monitor for potential side effects like gestational diabetes and hypertension
- Avoid use in the first trimester if possible due to a slight increased risk of oral clefts
- Counsel patients on the benefits and risks before initiating treatment As stated in the guideline evidence 1, corticosteroids are considered a third-line treatment for hyperemesis gravidarum, and their use should be reserved for severe cases that are refractory to first-line treatments.
Rationale
Corticosteroids work by reducing inflammation and suppressing the immune system, which may help alleviate severe nausea and vomiting in pregnancy. They also have a rapid onset of action. However, their use should be carefully considered due to potential side effects and risks, as mentioned in the evidence 1. The most recent evidence 1 suggests that corticosteroids can be effective in treating severe hyperemesis gravidarum, but their use should be individualized and monitored closely.
From the Research
Role of Corticosteroids in Treating Hyperemesis Gravidarum
- Corticosteroids, such as prednisolone, have been used to successfully manage severe hyperemesis gravidarum in several studies 2, 3, 4.
- The treatment protocol typically involves administering prednisolone in doses of 10-15 mg tid, which can achieve suppression of vomiting within 48 hours 2.
- In some cases, intravenous hydrocortisone may be used initially for 24-48 hours, followed by oral prednisolone therapy 2, 3.
- The use of corticosteroids has been shown to be effective in suppressing symptoms of intractable hyperemesis gravidarum, allowing for normal maternal nutrition and weight gain 3, 4.
- The criteria for steroid therapy may include weight loss of >5% of pre-pregnant weight, as this has been shown to define a subset of women with severe hyperemesis gravidarum who are likely to benefit from treatment 4.
Benefits and Outcomes of Corticosteroid Therapy
- Corticosteroid therapy has been shown to rapidly resolve nausea and vomiting, allowing for discharge from hospital and restoration of maternal weight gain 2, 4.
- The use of prednisolone therapy has not been shown to affect birth weight, suggesting that it is a safe and effective treatment option for severe hyperemesis gravidarum 4.
- Corticosteroids may be considered in women who fulfill the criteria of severe disease, as they have been shown to be effective in managing symptoms and improving outcomes 2, 3, 4.
Comparison with Other Treatment Options
- Corticosteroids are typically used as a second-line treatment option for hyperemesis gravidarum, after first-line treatments such as pyridoxine and metoclopramide have failed 5.
- The use of corticosteroids has been shown to be effective in managing severe hyperemesis gravidarum, although the evidence is largely based on observational studies and case reports 2, 3, 4.