BJOG: An International Journal of Obstetrics & Gynaecology

Volume 126, Issue 10 p. 1201-1211

Epidemiology

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

L Fiaschi,

Corresponding Author

L Fiaschi

[email protected]

orcid.org/0000-0002-3780-5895

Division of Epidemiology & Public Health, University of Nottingham, Nottingham, UK

Correspondence: L Fiaschi, Division of Epidemiology & Public Health, University of Nottingham, Clinical Sciences Building Phase 2, City Hospital, NG5 1PB Nottingham, UK. Email: [email protected]Search for more papers by this author

C Nelson-Piercy,

C Nelson-Piercy

Women's Health Academic Centre, Guy's & St Thomas’ Foundation Trust, St Thomas’ Hospital, London, UK

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S Deb,

S Deb

Department of Obstetrics and Gynaecology, Nottingham University Hospital, Queen's Medical Centre, Nottingham, UK

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R King,

R King

Sherwood Health Centre, Nottingham, UK

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LJ Tata,

LJ Tata

Division of Epidemiology & Public Health, University of Nottingham, Nottingham, UK

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L Fiaschi,

Corresponding Author

L Fiaschi

[email protected]

orcid.org/0000-0002-3780-5895

Division of Epidemiology & Public Health, University of Nottingham, Nottingham, UK

C Nelson-Piercy,

C Nelson-Piercy

Women's Health Academic Centre, Guy's & St Thomas’ Foundation Trust, St Thomas’ Hospital, London, UK

Search for more papers by this author

S Deb,

S Deb

Department of Obstetrics and Gynaecology, Nottingham University Hospital, Queen's Medical Centre, Nottingham, UK

Search for more papers by this author

R King,

R King

Sherwood Health Centre, Nottingham, UK

Search for more papers by this author

LJ Tata,

LJ Tata

Division of Epidemiology & Public Health, University of Nottingham, Nottingham, UK

Search for more papers by this author

First published: 20 February 2019

https://doi.org/10.1111/1471-0528.15662

Citations: 36

Linked article This article is commented on by J Trovik and AV Vikanes, p. 1212 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.15824.

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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 < 0.001). Younger age, deprivation, Black/Asian/mixed ethnicity, and 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.

Tweetable abstract

The NVP/HG burden is increasing over time and management optimisation should be high priority to help reduce hospital admissions.

Supporting Information

Filename	Description
bjo15662-sup-0001-FigS1.pdfPDF document, 117.3 KB	Figure S1. Change in proportion of pregnancies with clinically recognised NVP/HG by level of burden, distinguishing NVP diagnosis from HG diagnosis
bjo15662-sup-0002-FigS2.pdfPDF document, 271.1 KB	Figure S2. Distribution of maternal characteristics across different HG and NVP level of burden groups
bjo15662-sup-0003-TableS1.pdfPDF document, 102.2 KB	Table S1. Read codes for NVP and HG diagnoses
bjo15662-sup-0004-TableS2.pdfPDF document, 86.1 KB	Table S2. ICD10 codes for NVP and HG diagnoses
bjo15662-sup-0005-TableS3.pdfPDF document, 104.1 KB	Table S3. Read codes for NVP differential diagnoses
bjo15662-sup-0006-TableS4.pdfPDF document, 99.4 KB	Table S4. ICD10 codes for NVP differential diagnoses.
bjo15662-sup-0007-TableS5.pdfPDF document, 191.5 KB	Table S5. Antiemetics codes used for extracting antiemetic prescriptions
bjo15662-sup-0008-TableS6.pdfPDF document, 179 KB	Table S6. Distribution of hyperemesis gravidarum level of burden according to maternal comorbidities for women with NVP diagnosis (with or without treatment) and HG diagnosis (with and without treatment)
bjo15662-sup-0009-ICMJES1.pdfPDF document, 1.2 MB
bjo15662-sup-0010-ICMJES2.pdfPDF document, 1.2 MB
bjo15662-sup-0011-ICMJES3.pdfPDF document, 1.2 MB
bjo15662-sup-0012-ICMJES4.pdfPDF document, 1.2 MB
bjo15662-sup-0013-ICMJES5.pdfPDF document, 1.2 MB

Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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Citing Literature

Volume126, Issue10

September 2019

Pages 1201-1211

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

Abstract

Objectives

Design

Setting

Population

Methods

Main outcome measures

Results

Conclusion

Tweetable abstract

Supporting Information

References

Citing Literature

References

Information

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

Abstract

Objectives

Design

Setting

Population

Methods

Main outcome measures

Results

Conclusion

Tweetable abstract

Supporting Information

References

Citing Literature

References

Related

Information