Evidence of the effectiveness and adverse effects of other treatments for hyperemesis gravidarum
| Drug or therapy | Dose | Effectiveness | Safety in pregnancy | Other comments |
|---|---|---|---|---|
| Cannabis | Research has suggested that cannabis may provide an antinausea effect in adults with cancer receiving chemotherapy. (54) | In pregnancy, prenatal cannabis is suggested to be associated with adverse neurocognitive outcomes in offspring. (55), (56) | The use of cannabis is not advised | |
| Ginger | May be helpful to patients with mild nausea and vomiting, but the evidence of effectiveness was limited and inconsistent for patients with hyperemesis gravidarum. (44), (57) | Ginger is not known to cause any problems related to pregnancy. (57) | Relevant adverse effects of ginger were reported in a large self-selected online survey of 512 patients hospitalized for hyperemesis gravidarum, namely unpleasant physical effects in around half of those who tried it and negative psychological effects in 82% of participants. (58) | |
| Acupressure and acupuncture | Acupressure may be helpful in some patients and was associated with less need for additional antiemetics and a larger reduction in PUQE score than placebo. (43), (44) | A systematic review showed adverse events were all mild–moderate in severity, with needling pain being the most frequent. (59) | ||
| Psychotherapeutic treatment | Few studies have evaluated psychotherapeutic treatment for hyperemesis gravidarum; most have been evaluated as being of poor methodological quality. Several report a positive effect of psychotherapeutic treatment on symptoms of hyperemesis gravidarum. (60) | |||
| Eradication of Helicobacter pylori | Triple drug therapy, 3 times daily for 7–10 d | Whether eradication of H. pylori might improve or prevent symptoms of hyperemesis gravidarum remains unclear. (15) Eradication of H. pylori requires high doses, making this approach poorly feasible among patients with hyperemesis gravidarum. | If H. pylori is present, treatment is typically deferred until after delivery. However, with the exception of bismuth, fluoroquinolones, and tetracycline, the other medications used for H. pylori eradication are low risk in pregnancy, especially after 14 weeks. | H. pylori eradication before conception may be an attractive method of ameliorating risk of recurrent hyperemesis gravidarum in subsequent pregnancies, but its possible effectiveness in achieving this goal remains unproven. |
| Laxatives | Laxatives do not affect nausea or vomiting, but are prescribed for constipation, which can be an adverse effect of antiemetics or dehydration | Laxatives are considered safe in pregnancy for treatment of constipation. | ||
| Proton pump inhibitors | Acid-reducing drugs resulted in significant decreases in PUQE and well-being scores. After intervention with acid-reducing pharmacotherapy, a reduction in acid symptoms correlated with significant reductions in nausea and vomiting of pregnancy. (21) | Proton pump inhibitors are considered safe in pregnancy, especially omeprazole and lansoprazole. Studies have not shown an elevated risk of birth defects or other adverse effects in pregnancy. (61) | ||
| Antidepressants | Recent case reports suggest that mirtazapine could be considered in refractory hyperemesis gravidarum. The results of a recent double-blind placebo-controlled RCT investigating mirtazapine as a treatment for hyperemesis gravidarum have yet to be published. (62) | SSRIs are generally considered an option during pregnancy. Potential complications include maternal weight changes and preterm birth. Most studies show that SSRIs are not associated with birth defects. (63) | Antidepressants can be prescribed as an adjunct when nausea causes sleep disorders, or when sleep disorder worsens nausea. |
Note: PUQE = Pregnancy-Unique Quantification of Emesis and Nausea, RCT = randomized controlled trial, SSRI = selective serotonin reuptake inhibitor.