Steroid Therapy for HG
Newer research on hyperemesis defines parameters for the use of steroids for vomiting during pregnancy. Most protocols suggest using steroids after the 10th week of pregnancy and limiting their use to one month. The initial dose is typically high, then weaned down slowly after a few days. Some women report no beneficial effect, while others report dramatic cessation of vomiting immediately. Most women tolerate the oral form of the medication. Few require IV dosing. Steroid use is typically saved for women who do not respond to other medications by the end of the first trimester, and are losing weight rapidly due to more severe nausea and vomiting. Some research suggests the use of steroids once a woman loses 5% or more of her body weight due to HG.
According to current research studies on steroid use for asthma treatment during pregnancy, most of the steroid medication is inactivated by the placenta, so little of the active compound reaches the baby. This has been studied in late pregnancy using umbilical cord blood analysis and is assumed to also be true in early pregnancy. No studies are conclusive, but studies on asthmatics dependent on inhalants with occasional inpatient visits with high-dose steroids show no apparent fetal damage. The few studies finding potential adverse effects are those where the mother was dependent on very high-doses of oral steroids for many months, or the entire pregnancy.
There is some concern over use of steroid medications like Methylprednisolone or Prednisone during pregnancy due to their widespread effects on the body, and their unknown effects on the baby. A few small studies have been conducted on the use of steroids for HG, and none have found adverse effects on the baby since the treatment duration is typically a month or less. The risk decreases with the increase in gestational age. The risk increases with higher dosages, however, most doctors start women on a high dose initially and then wean fairly quickly. Most women complete their treatment after a month to six weeks, and women don't typically take steroids after delivery unless they had to take them late in pregnancy for an extended length of time.
Most women tell us that their use of steroids during pregnancy for HG resulted in a normal birth. It's best avoided if other drugs such as serotonin antagonists (e.g. Zofran) are effective, but better than termination or excessive suffering, both of which obviously affect the baby adversely. Some women do relapse when the steroid medication is discontinued, and may do so more than once. This may be avoided by use of serotonin antagonists during and after weaning.
As with all medications, the risk to the baby and mother must be weighed against the risks of adverse effects, or the lack of treatment. If a woman is losing weight quickly and chronically dehydrated and malnourished, she is at risk for potentially serious complications that may be avoided by medications such as steroids. Women considering steroids should review the information available and make an informed decision after discussing it with a health professional experienced in treating HG.
New Research Protocol
Al-Ozairi MBChB MRCP, E., Waugh MBBS MRCOG, J. J. S. , & Taylor MD FRCP, R. (2009). Termination is not the treatment of choice for severe hyperemesis gravidarum: Successful management using prednisolone. Obstetric Medicine. 2, 34-37.
Summary: Severe hyperemesis gravidarum causes profound maternal morbidity. Termination of pregnancy is still offered before the use of medical therapy. This report describes management of a woman who had undergone two previous terminations for hyperemesis, and additionally presents the dosage profile of prednisolone used to successfully manage a consecutive series of 33 women with severe hyperemesis gravidarum. The treatment protocol is described. The group had a median weight loss in pregnancy of 5.5 kg (range 2.0 – 12.5 kg), had been admitted on a median of 3.0 (range 0 – 9) occasions and had spent 7.5 (range 0 – 25) days on i.v. fluids. Continuing vomiting prevented oral steroid therapy in 14 women and i.v. hydrocortisone (50 mg t.i.d.; two women required 100 mg t.i.d.) was used initially for 24 – 48 h. Nineteen women commenced prednisolone 10 mg t.i.d. and this achieved suppression of vomiting within 48 h in all but two women who required 15 mg t.i.d. Two distinct subtypes of hyperemesis gravidarum were identified. Remitting hyperemesis spontaneously ceases between 14 and 22 weeks gestation and accounts for approximately 80% of cases. In contrast, full-term hyperemesis persists until minutes after delivery. These separate sub-types have not previously been described. Steroid treatment of hyperemesis should be considered in women who fulfil the criteria of severe disease.
Updated on: Apr. 18, 2013