Assessment of discharge treatment prescribed to women admitted to hospital for hyperemesis gravidarum

Fiaschi, L.; Housley, G.; Nelson-Piercy, C.; Gibson, J.; Raji, Ayokunnu; Deb, S.; Tata, L.J.

Abstract

Aims: Prescribing drug treatment for the management of hyperemesis gravidarum (HG), the most severe form of nausea and vomiting in pregnancy, remains controversial. Since most manufacturers do not recommend prescribing antiemetics during pregnancy, little is known regarding which treatments are most prevalent among pregnant patients. Here we report for the first time, evidence of actual treatments prescribed in English hospitals.
Methods: A retrospective pregnancy cohort was constructed using anonymised electronic records in the Nottingham University Hospitals Trust system for all women who delivered between January 2010 and February 2015. For women admitted to hospital for HG, medications prescribed on discharge were described and variation by maternal characteristics was assessed. Compliance with local and national HG treatment guidelines was evaluated.
Results: Of 33,567 pregnancies (among 30,439 women), the prevalence of HG was 1.7%. Among 530 HG admissions with records of discharge drugs, Cyclizine was the most frequently prescribed (almost 73% of admissions). Prochlorperazine and metoclopramide were prescribed mainly in combination with other drugs, however, ondansetron was more common than metoclopramide at discharge from first and subsequent admissions. Steroids were only prescribed following readmissions. Thiamine was most frequently prescribed following readmission while high dose of folic acid was prescribed equally after first or subsequent admissions. Prescribing showed little variation by maternal age, ethnicity, weight, socioeconomic deprivation, or comorbidities.
Conclusion: Evidence that management of HG in terms of discharge medications mainly followed local and national recommendations provides reassurance within the health professional community. Wider documentation of drugs prescribed to women with HG is required to enable full assessment of whether optimal drug management is being achieved.

Citation

Fiaschi, L., Housley, G., Nelson-Piercy, C., Gibson, J., Raji, A., Deb, S., & Tata, L. (2019). Assessment of discharge treatment prescribed to women admitted to hospital for hyperemesis gravidarum. International Journal of Clinical Practice, 73(1), Article e13261. https://doi.org/10.1111/ijcp.13261

• Journal Article Type: Article
• Acceptance Date: Aug 27, 2018
• Online Publication Date: Sep 21, 2018
• Publication Date: 2019-01
• Deposit Date: Sep 3, 2018
• Publicly Available Date: Sep 22, 2019
• Journal: International Journal of Clinical Practice
• Print ISSN: 1368-5031
• Electronic ISSN: 1742-1241
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 73
• Issue: 1
• Article Number: e13261
• DOI: https://doi.org/10.1111/ijcp.13261
• Public URL: https://nottingham-repository.worktribe.com/output/1056877
• Publisher URL: https://onlinelibrary.wiley.com/doi/abs/10.1111/ijcp.13261
• Additional Information: This is the peer reviewed version of the following article: Fiaschi L, Housley G, Nelson‐Piercy C, et al. Assessment of discharge treatment prescribed to women admitted to hospital for hyperemesis gravidarum. Int J Clin Pract. 2018;e13261, which has been published in final form at https://doi.org/10.1111/ijcp.13261. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
• Contract Date: Sep 3, 2018