Clinical management of nausea and vomiting in pregnancy and hyperemesis gravidarum across primary and secondary care: a population based study

Fiaschi, L.; Nelson-Piercy, C.; Deb, S.; King, R.; Tata, L.J.

Abstract

Objectives: To assess how nausea and vomiting in pregnancy (NVP) and hyperemesis gravidarum (HG) are managed and treated across primary and secondary care.

Design: Population-based pregnancy cohort
Setting: Medical records (CPRD-GOLD) from England
Population: 417,028 pregnancies, during 1998-2014

Methods: Proportions of pregnancies with recorded NVP/HG diagnoses, primary care treatment and hospital admissions were calculated. Multinomial logistic regression was employed to estimate adjusted relative risk ratios (aRRRs) with 99% confidence intervals (CIs) for the association between NVP/HG management paths and maternal characteristics.

Main Outcome Measures: NVP/HG diagnoses, treatments and hospital admissions.

Results: Overall prevalence of clinically recorded NVP/HG was 9.1%: 2.1% had hospital admissions, 3.4% were treated with antiemetics in primary care only, and 3.6% had only recorded diagnoses. Hospital admissions and antiemetic prescribing increased continuously during 1998-2013 (trend p less than 0.001). Younger age, deprivation, Black/Asian/Mixed ethnicity, multiple-pregnancy were associated with NVP/HG generally across all levels, but associations were strongest for hospital admissions. Most comorbidities had patterns of association with NVP/HG levels. Among women with NVP/HG who had no hospital admissions, 49% were prescribed antiemetics, mainly from first line treatment (21% prochlorperazine, 15% promethazine, 13% cyclizine) and metoclopramide (10%). Of those admitted, 38% had prior antiemetic prescriptions (34% first-line, 9% second-line, 1% third-line treatment).

Conclusion: Previous focus on hospital admissions has greatly underestimated the NVP/HG burden. Although primary care prescribing has increased, most women admitted to hospital have no antiemetics prescribed before this. An urgent call is made to assess whether admissions could be prevented with better primary care recognition and timely treatment.

Citation

Fiaschi, L., Nelson-Piercy, C., Deb, S., King, R., & Tata, L. (2019). Clinical management of nausea and vomiting in pregnancy and hyperemesis gravidarum across primary and secondary care: a population based study. BJOG: An International Journal of Obstetrics and Gynaecology, 126(10), 1201-1211. https://doi.org/10.1111/1471-0528.15662

• Journal Article Type: Article
• Acceptance Date: Feb 4, 2019
• Online Publication Date: Feb 20, 2019
• Publication Date: Feb 20, 2019
• Deposit Date: Feb 5, 2019
• Publicly Available Date: Feb 21, 2020
• Journal: BJOG: An International Journal of Obstetrics & Gynaecology
• Print ISSN: 1470-0328
• Electronic ISSN: 1471-0528
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 126
• Issue: 10
• Pages: 1201-1211
• DOI: https://doi.org/10.1111/1471-0528.15662
• Keywords: Obstetrics and Gynaecology
• Public URL: https://nottingham-repository.worktribe.com/output/1520960
• Publisher URL: https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/1471-0528.15662?af=R
• Contract Date: Feb 5, 2019