From the Guidelines
Hyperemesis gravidarum treatment should involve a stepwise approach, starting with lifestyle modifications and progressing to medications if needed, with the primary goal of preventing dehydration, correcting electrolyte abnormalities, and supporting adequate maternal and fetal nutrition. The treatment approach is guided by the severity of symptoms and may require a multidisciplinary team involving obstetricians, nutritionists, psychologists, and gastroenterologists 1. Initially, patients should try small, frequent meals, avoiding triggers, and consuming ginger supplements. Adequate hydration is essential, sometimes requiring IV fluids for severe dehydration.
- First-line medications include vitamin B6 (pyridoxine) and doxylamine, with metoclopramide being a suitable alternative, as it has been shown to have similar efficacy to promethazine with fewer adverse events 1.
- If symptoms persist, antiemetics such as ondansetron may be prescribed, although its use should be carefully considered due to potential risks, such as an increased rate of orofacial clefting 1.
- For refractory cases, corticosteroids like methylprednisolone might be considered, with careful monitoring of potential risks, such as an increased risk of cleft palate when given before 10 weeks of gestation 1.
- Thiamine supplementation is important to prevent Wernicke's encephalopathy in prolonged vomiting, with a recommended dosage of 100 mg daily for a minimum of 7 days, followed by a maintenance dosage of 50 mg daily until adequate oral intake is established 1.
- Hospitalization may be necessary for severe cases requiring continuous IV hydration, electrolyte replacement, and nutritional support, with the goal of controlling symptoms, preventing complications, and maintaining maternal nutrition while minimizing risks to the developing fetus.
From the Research
Treatment Options for Hyperemesis Gravidarum
The treatment for hyperemesis gravidarum involves various approaches, including medication and supportive care. Some studies have investigated the efficacy of different treatments:
- Corticosteroids, such as hydrocortisone and methylprednisolone, have been shown to be effective in reducing vomiting episodes and improving symptoms in patients with hyperemesis gravidarum 2, 3, 4.
- A study comparing pulsed hydrocortisone therapy with metoclopramide found that hydrocortisone was more effective in reducing vomiting episodes and preventing readmission for intractable vomiting 2.
- However, another study found that the addition of corticosteroids to the treatment of women with hyperemesis gravidarum did not reduce the need for rehospitalization later in pregnancy 5.
- Pyridoxine, also known as vitamin B6, has been investigated as a potential treatment for hyperemesis gravidarum, but a study found that it did not improve the rehospitalization rate, vomiting frequency, or nausea score in patients with hyperemesis gravidarum 6.
- Methylprednisolone has been shown to be more effective than promethazine in the treatment of hyperemesis gravidarum, with a lower readmission rate for hyperemesis within 2 weeks of discharge 4.
Medications Used in Treatment
Some medications that have been used to treat hyperemesis gravidarum include:
- Corticosteroids, such as hydrocortisone and methylprednisolone 2, 3, 4.
- Metoclopramide, an antiemetic medication 2, 5.
- Promethazine, an antiemetic medication 5, 4.
- Pyridoxine, also known as vitamin B6 6.
Supportive Care
Supportive care, such as intravenous hydration and nutritional support, is also an important part of the treatment for hyperemesis gravidarum.