Hyperemesis gravidarum in the primary care setting: cross-sectional study of GPs

Abstract

BackgroundHyperemesis gravidarum (HG), if untreated, can lead to malnutrition, dehydration, and Wernicke’s encephalopathy. Foetal complications include low birth weight and neurodevelopmental delay. Recent evidence supports increased rates of termination of pregnancy and suicidal ideation. Drivers included difficulty in accessing medications, which thus contributed to poor perception of care.AimTo identify factors that may influence prescribers’ confidence and knowledge regarding pharmacological therapy for HG.Design & settingCross-sectional study of qualified GPs and GP trainees in Wales.MethodDistribution of a 22-item online survey. Statistical analysis was carried out using SPSS.ResultsIn total, 241 responses were received, with 216 included in the analysis (59% qualified GPs, 41% GP trainees). In total, 93% of responders correctly identified cyclizine as being safe in pregnancy, but no other drug recommended in the Royal College of Obstetrics and Gynaecology guidance was considered safe by more than 58%. Those reporting higher confidence levels in managing HG were more likely to correctly report guideline-recommended drugs as safe in pregnancy (P = 0.04). Additional qualifications related to obstetrics and gynaecology (O&G) and/or prior clinical experience increased confidence levels (P = 0.0001 and P = 0.0002, respectively). Only 19% of participants routinely screened for signs of mental health complications, and prior experience or education did not increase likelihood of this happening. The majority of participants (87%) would like additional education and/or access to evidence-based resources.ConclusionThis study demonstrates a demand for improved dissemination of evidence-based education on HG to support those working in primary care. The extent to which HG is covered in pre-existing educational programmes should also be revisited.