Assessing the burden of severe nausea and vomiting of pregnancy or hyperemesis gravidarum and the associated use and experiences of medication treatments: An Australian consumer survey

Background: There is little data on contemporary patterns of antiemetic use or women’s experiences when using such agents in the treatment of severe nausea and vomiting of pregnancy (NVP) or hyperemesis gravidarum (HG). 

Methods: Online, national survey of Australian women who were currently or had previously experienced severe NVP or HG, distributed through the HG consumer group, Hyperemesis Australia between July and September 2020. 

Results: There were a total of 289 respondents with a mean age of 33 years, of which 38% were currently pregnant. More than 50% of respondents reported “major impacts” of the condition on areas such as social life, ability to undertake daily chores, ability to eat or drink, effects on work, taking care of pre-existing children and sleep. This resulted in 62% of respondents reporting ‘often’ or ‘always’ experiencing feelings of depression or anxiety as a result of their HG symptoms, with 54% reporting considering terminating their pregnancy, and 90% having considered having no more children. The most commonly used anti-emetic was ondansetron (91%), followed by pyridoxine (62%), doxylamine (62%), and metoclopramide (61%). Nearly all (95%) women who reported using ondansetron commenced it within the first trimester, with 55% reporting use as a first-line therapy. Most women reported one or more side effects to anti-emetics such as headache, constipation, sedation or impaired cognition, with 31% stopping metoclopramide because of side effects, compared with 14% for ondansetron and 10% for doxylamine. Ondansetron, doxylamine and corticosteroids had the greatest perceived effectiveness, with more than 50% rating them as “effective” or “very effective”. Half (50%) reported use of acid suppressive therapy, with 51% reporting using complementary or alternative therapies in addition to conventional treatments. 

Conclusions: The study findings demonstrate large variability in antiemetic use and outcomes, highlighting the need for individualised care and treatment approaches during pregnancy.