From the Guidelines
For hyperemesis gravidarum, intravenous glucocorticoids may be required in moderate to severe cases, as part of a stepwise treatment approach that includes symptom control with vitamin B6 and doxylamine, hydration, and adequate nutrition, as well as ondansetron, metoclopramide, and promethazine as needed 1.
Key Considerations
- The treatment of hyperemesis gravidarum should prioritize minimizing potential risks, including gestational diabetes, hypertension, and preterm birth.
- Early treatment of nausea and vomiting of pregnancy may reduce progression to hyperemesis gravidarum.
- The use of steroids, such as intravenous glucocorticoids, should be considered only after failure of standard antiemetics and other supportive measures.
Treatment Approach
- Stepwise treatment consists of symptom control with vitamin B6 and doxylamine, hydration, and adequate nutrition.
- Ondansetron, metoclopramide, promethazine, and intravenous glucocorticoids may be required in moderate to severe cases.
- Treatment duration should be minimized, and patients should be monitored for maternal and fetal complications during treatment.
Evidence Base
- The most recent and highest quality study, published in 2024, recommends a stepwise treatment approach for hyperemesis gravidarum, including the use of intravenous glucocorticoids in moderate to severe cases 1.
- Other studies, such as those published in 2021, also emphasize the importance of supportive care, including rehydration, correction of electrolyte abnormalities, and anti-emetic therapy, in the treatment of hyperemesis gravidarum 1.
From the Research
Steroid Dose for Hyperemesis Gravidarum
- The steroid dose for hyperemesis gravidarum varies across studies, with different dosing regimens and steroid types used 2, 3, 4, 5.
- One study used oral methylprednisolone at a dose of 48 mg per day for 3 days, followed by a tapering dose over 2 weeks 2.
- Another study used prednisolone at a dose of 10 mg t.i.d., with some patients requiring 15 mg t.i.d. to achieve suppression of vomiting 3.
- Intravenous hydrocortisone was used in some cases, with doses of 50 mg t.i.d. or 100 mg t.i.d. used initially for 24-48 hours 3.
- A randomized, placebo-controlled trial used intravenous methylprednisolone (125 mg) followed by an oral prednisone taper (40 mg for 1 day, 20 mg for 3 days, 10 mg for 3 days, 5 mg for 7 days) 4.
- Another study used high-dose prednisolone therapy, with doses up to 45 mg/day, and found that prednisolone in doses of 15 mg/day or more was required for 10.6 +/- 4.7 weeks 5.