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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.

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


Authors

LINDA FIASCHI LINDA.FIASCHI@NOTTINGHAM.AC.UK
Senior Research Fellow in E-Health

C. Nelson-Piercy

S. Deb

R. King



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

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