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TOPLINE:

In an Australian survey of 289 women with severe nausea and vomiting in pregnancy (NVP) or hyperemesis gravidarum (HG), more than 50% reported major effects on daily activities, with ondansetron being the most commonly used antiemetic (91%). The study found that 62% of respondents experienced frequent depression or anxiety due to the symptoms, while 54% considered pregnancy termination.

METHODOLOGY:

• Researchers conducted a cross-sectional online survey between July and September 2020 of Australian women who were currently experiencing or had previously experienced severe NVP or HG.
• Analysis included 289 respondents with a mean age of 33 years, of whom 38% were pregnant at the time of survey completion.
• Survey data encompassed respondent demographics, hyperemesis medical history, effects on quality of life using Likert scale, and detailed experiences with treatments including timing, duration, side effects, and perceived effectiveness.
• The 24-hour Pregnancy-Unique Quantification of Emesis score was used to classify NVP/HG severity as moderate (41%) or severe (59%) on the basis of nausea duration, retching episodes, and vomiting frequency within 24 hours.

TAKEAWAY:

• Nearly all respondents (95%) who used ondansetron initiated it within the first trimester, with 55% reporting it as first-line therapy, and those experiencing subsequent HG-affected pregnancies were more likely to use it as first-line treatment than first-time cases (64% vs 27%; P = .015).
• Ondansetron, doxylamine, and corticosteroids showed the highest perceived effectiveness, with more than 50% of users rating them as effective or very effective, while less than 10% reported pyridoxine or ginger as effective.
• Side effects were most commonly reported with doxylamine (78%), ondansetron (73%), and promethazine (72%), with metoclopramide more frequently discontinued due to side effects (31%) compared to ondansetron (14%) and doxylamine (10%).
• The median onset of symptoms was 6 weeks of gestation, with 75% reporting weight loss (median, 7 kg; range, 1-40 kg), and 72% requiring hospital admission for intravenous fluids.

IN PRACTICE:

“With emerging evidence that ondansetron is superior to both doxylamine/pyri­doxine in reducing symptoms of nausea and vomiting, as well as superior to metoclopramide in reducing symptoms of vomiting, or is at least similarly effective with less side effects, it is perhaps unsurprising that it is increasingly being used as a first-line therapy in clinical practice,” the authors of the study wrote.

SOURCE:

This study was led by Loyola Wills, MD, College of Medicine and Public Health, Flinders University, Adelaide, Australia. It was published online on September 3 in PLoS One.

LIMITATIONS:

The researchers acknowledge several limitations including the use of nonprobabilistic and snowball sampling techniques, which makes it difficult to extrapolate findings to the broader Australian pregnant population. Additionally, the survey included both pregnant women and those reflecting on previous pregnancies that ended more than 2 years prior, introducing potential recall bias regarding exact timing and duration of medication use.

DISCLOSURES:

This study received support from a 2020 Engaging Opportunities research grant provided by the Robinson Research Institute, The University of Adelaide. Luke E. Grzeskowiak received salary support from the Channel 7 Children’s Research Foundation. The funding sources had no involvement in conducting the research or preparing the article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.