HYPEREMESIS GRAVIDARUM

85% of pregnant women experience some nausea and vomiting; severe enough to cause dehydration, electrolyte abnormalities, and/or weight loss in 0.2-0.3 of pregnancies.

Treatment:

• Antihistamines
• Pyridoxine 10mg BID-TID
• Cyanocobalamin (B12)
• Acupuncture or accupressure at the "P6" point over the median nerve has been shown in some studies, but not in others, to reduce symptoms.
• One placebo-controlled study of electrical stimulation at the same point showed significant reduction in sx of hyperemesis (Obs. Gyn. 102:129, 2003--AFP)
• Ginger
  • In a randomized trial in 70 women at < 17wks gestation randomized to ginger (1 powdered dried root of Zingiber oficinale QD) vs. placebo x 4d was as'sd with sig. fewer episodes of vomiting and sig. less nausea (Obs. Gyn. 97:577, 2001--JW)
  • In a study of 291 pregnant women at 8-16wks and hyperemesis gravidarum randomized to ginger 350mg vs. vitamin B6 25mg TID x 3wks, there was no sig. diff. in reduction of vomiting at 7, 14, or 21d (Obs. Gyn. 103:639, 2004--AFP)
  • In a systematic review of 6 studies of ginger for nausea and vomiting in early pregnancy, ginger was found to be superior to placebo in 4 studies and equivalent to vitamin B6 in 2 studies (Obs. Gyn. 105:849, 2005--JW)
• For severe hyperemesis, e.g. hospitalized patient:
  • Dimenhydrinate (Dramamine) IV
  • Metoclopramide (Reglan)
  • Promethazine (Phenergan)
  • In a study in 149 women with singleton pregnancies at < 17wks gestation admitted to hospital for hyperemesis with dehydration and ketonuria randomized to metoclopramide 10mg vs. promethazine 25mg Q8h x 24h (with option to switch to other treatment as open-label at 24h), there was no sig. diff. in frequency of vomiting, nausea scores, or overall sense of well-being at 24h, but metoclopramide group had sig. lower incidence of adverse effects. (Obs. Gyn. 115:975, 2010-AFP)