Risk Factors for Infusions, Emergency Room Visits and Hospitalizations for Hyperemesis Gravidarum: New Data and Literature Review

Summer A de Vera,1 Aimee Brecht-Doscher,2 Marlena S Fejzo,3 Mary-Lynn Brecht,4 Irene M Kwon,1 Kimber W MacGibbon1 1Hyperemesis Education and Research Foundation, Clackamas, OR, USA; 2Ventura County Health Department, Ventura, CA, USA; 3Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; 4School of Nursing, University of Southern California, Los Angeles, CA, USACorrespondence: Kimber W MacGibbon, Hyperemesis Education and Research Foundation, 10117 SE Sunnyside Road, Suite F8, Clackamas, OR, 97015, USA, Email [email protected]: Few factors have been identified that increase the risk of visits (hospital emergency room or inpatient stays) due to hyperemesis gravidarum (HG). The purpose of this study is to understand trends in HG management and identify variables increasing visit frequency so that strategies may be developed to reduce hospital utilization.Study Design: An online survey was posted on the Hyperemesis Education and Research Foundation website and social media between June 2022 and May 2023. Participants had previous or current severe pregnancy nausea and vomiting. Respondents were asked about themselves and their HG experience, including weight loss, medications, infusion care, and visit frequency. Odds ratios, p-values, and 95% confidence intervals were calculated via MedCalc to analyze the significance of each factor, and Spearman rank correlations were analyzed via SPSS for associations of ondansetron usage with visits and weight loss. Microsoft Excel and SPSS were used to calculate treatment and visit frequencies.Results: Survey data from 1220 respondents who reported a current or prior pregnancy with HG were included in this study. Respondents were primarily White, from the US, and had at least one visit due to HG. Participants with a visit were significantly more likely to be a person of color (POC), unable to work, have no children, and lose over 15 pounds (6.8 kg). Those who took medications as prescribed had fewer visits. No medication combination or dose was found to be significantly more effective in preventing weight loss or repeat hospital visits.Conclusion: Risk factors predicting visits included POC, not having children, being too sick to work, and having extreme weight loss. Utilization of medication and nutritional therapies is inconsistent and inadequate in this population, which may increase visit frequency.Keywords: hyperemesis gravidarum, hospitalization, ondansetron, preterm birth