Cochrane · systematic review · CD010607
Interventions for treating hyperemesis gravidarum
Boelig, RC, Barton, SJ, Saccone, G, et al. · Cochrane Database of Systematic Reviews · 2016 · Cochrane Library
Pregnancy and ChildbirthAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
51
current version
GRADE rated
42
No studies
8
Included studies
NR
No studies 8 · 15.7%Ungraded 1 · 2%Very low 16 · 31.4%Low 20 · 39.2%Moderate 6 · 11.8%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Acupuncture versus placebo
Population: pregnant women with hyperemesis gravidarum
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Quality of life: anxiodepressive symptomatology Acupuncture vs placebo | RR 1.01 [0.73, 1.4] | 1 study · 36 participants | Very low Downgraded: imprecision |
Spontaneous abortion Acupuncture vs placebo | RR 0.48 [0.05, 5.03] | 1 study · 57 participants | Low Downgraded: imprecision |
Preterm birth less than 37 weeks Acupuncture vs placebo | RR 0.12 [0.01, 2.26] | 1 study · 36 participants | Low Downgraded: imprecision |
Stillbirth and neonatal death Acupuncture vs placebo | RR 0.57 [0.04, 8.3] | 1 study · 36 participants | Low Downgraded: imprecision |
Severity, reduction or cessation in nausea/vomiting 2. Number of episodes of emesis 3. Days of hospital admission 4. Intervention side effects Acupuncture vs placebo | no estimate extracted | NR | No studies |
Acupuncture versus metoclopramide
Population: pregnant women with hyperemesis gravidarum
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction or cessation in nausea Acupuncture vs metoclopramide | RR 1.4 [0.79, 2.49] | 1 study · 81 participants | Very low Downgraded: imprecision |
Reduction or cessation in vomiting Acupuncture vs metoclopramide | RR 1.51 [0.92, 2.48] | 1 study · 81 participants | Very low Downgraded: imprecision |
Number of episodes of emesis 2. Days of hospital admission 3. Intervention side effects 4. Quality of life outcomes 5. Pregnancy complications 6. Adverse fetal/neonatal outcomes Acupuncture vs metoclopramide | no estimate extracted | NR | No studies |
Pyridoxine versus placebo
Population: pregnant women with hyperemesis gravidarum
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Number of episodes of emesis Pyridoxine vs placebo | no estimate extracted | 1 study · 66 participants | Low Downgraded: imprecision |
Days of hospital admission Pyridoxine vs placebo | no estimate extracted | 1 study · 92 participants | Moderate Downgraded: imprecision |
Interventions side effects: dizziness Pyridoxine vs placebo | RR 1.67 [0.85, 3.26] | 1 study · 66 participants | Low Downgraded: imprecision |
Interventions side effects: headaches Pyridoxine vs placebo | RR 1.33 [0.52, 3.42] | 1 study · 66 participants | Low Downgraded: imprecision |
Interventions side effects: diarrhoea Pyridoxine vs placebo | RR 3 [0.13, 71.07] | 1 study · 66 participants | Ungraded |
Interventions side effects: palpitations Pyridoxine vs placebo | RR 1 [0.22, 4.6] | 1 study · 66 participants | Low Downgraded: imprecision |
Interventions side effects: dry mouth Pyridoxine vs placebo | RR 0.82 [0.49, 1.38] | 1 study · 66 participants | Low Downgraded: imprecision |
Severity, reduction or cessation in nausea/vomiting 2. Quality of life outcomes 3. Pregnancy complications 4. Adverse fetal/neonatal outcomes Pyridoxine vs placebo | no estimate extracted | NR | No studies |
Metoclopramide versus ondansetron
Population: pregnant women with hyperemesis gravidarum
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Severity of nausea Metoclopramide vs ondansetron | no estimate extracted | 1 study · 83 participants | Very low Downgraded: imprecision |
Severity of vomiting Metoclopramide vs ondansetron | no estimate extracted | 1 study · 83 participants | Very low Downgraded: imprecision |
Quality of life Metoclopramide vs ondansetron | no estimate extracted | 1 study · 160 participants | Moderate Downgraded: imprecision |
Intervention side effects: felt drowsy Metoclopramide vs ondansetron | RR 2.4 [1.23, 4.69] | 1 study · 160 participants | Moderate Downgraded: imprecision |
Intervention side effects: unable to sleep Metoclopramide vs ondansetron | RR 1.29 [0.5, 3.28] | 1 study · 160 participants | Low Downgraded: imprecision |
Intervention side effects: dry mouth Metoclopramide vs ondansetron | RR 2.38 [1.1, 5.11] | 1 study · 160 participants | Moderate Downgraded: imprecision |
Intervention side effects: felt dizzy Metoclopramide vs ondansetron | RR 2.33 [0.94, 5.77] | 1 study · 160 participants | Low Downgraded: imprecision |
Severity, reduction or cessation in nausea/vomiting 2.Days of hospital admission 3. Pregnancy complications 4. Adverse fetal/neonatal outcomes Metoclopramide vs ondansetron | no estimate extracted | NR | No studies |
Metoclopramide versus promethazine
Population: Pregnant women with hyperemesis gravidarum
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Quality of life Metoclopramide vs promethazine | no estimate extracted | 1 study · 149 participants | Low Downgraded: imprecision |
Intervention side effects: drowsy Metoclopramide vs promethazine | RR 0.7 [0.56, 0.87] | 1 study · 143 participants | Moderate Downgraded: imprecision |
Intervention side effects: unable to sleep Metoclopramide vs promethazine | RR 0.78 [0.4, 1.53] | 1 study · 143 participants | Low Downgraded: imprecision |
Intervention side effects: dry mouth Metoclopramide vs promethazine | RR 0.91 [0.62, 1.34] | 1 study · 143 participants | Low Downgraded: imprecision |
Intervention side effects: felt dizzy Metoclopramide vs promethazine | RR 0.48 [0.34, 0.69] | 1 study · 143 participants | Moderate Downgraded: imprecision |
Intervention side effects: diarrhea Metoclopramide vs promethazine | RR 1.39 [0.32, 5.99] | 1 study · 143 participants | Low Downgraded: imprecision |
Intervention side effects: headache Metoclopramide vs promethazine | RR 0.81 [0.47, 1.38] | 1 study · 143 participants | Low Downgraded: imprecision |
Severity, reduction or cessation in nausea/vomiting 2. Number of episodes of emesis 3. Days of hospital admission 4. Pregnancy complications 5. Adverse fetal/neonatal outcomes Metoclopramide vs promethazine | no estimate extracted | NR | No studies |
Ondansetron versus promethazine
Population: Pregnant women with hyperemesis gravidarum
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Days of hospital admission Ondansetron vs promethazine | no estimate extracted | 1 study · 30 participants | Very low Downgraded: imprecision |
Intervention side effect: sedation Ondansetron vs promethazine | RR 0.06 [0, 0.94] | 1 study · 30 participants | Low Downgraded: imprecision |
Severity, reduction or cessation in nausea/vomiting 2. Number of episodes of emesis 3. Quality of life outcomes 4. Pregnancy complications 5. Adverse fetal/neonatal outcomes Ondansetron vs promethazine | no estimate extracted | NR | No studies |
Corticosteroids versus promethazine
Population: Pregnant women with hyperemesis gravidarum
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Severe nausea 48 hours Corticosteroids vs promethazine | RR 2 [1.08, 3.72] | 1 study · 80 participants | Low Downgraded: imprecision |
Severe nausea 17th day Corticosteroids vs promethazine | RR 0.81 [0.58, 1.15] | 1 study · 78 participants | Very low Downgraded: imprecision |
Episodes of vomiting 48 hours Corticosteroids vs promethazine | RR 3 [0.33, 27.63] | 1 study · 80 participants | Very low Downgraded: imprecision |
Episodes of vomiting 17th day Corticosteroids vs promethazine | RR 1 [0.21, 4.65] | 1 study · 78 participants | Very low Downgraded: imprecision |
Intervention side effects: drowsiness 48hrs and 3‐10 days Corticosteroids vs promethazine | RR 0.08 [0, 1.32] | 1 study · 80 participants | Low Downgraded: imprecision |
Stillbirth and neonatal death Corticosteroids vs promethazine | RR 3 [0.13, 69.52] | 1 study · 40 participants | Low Downgraded: imprecision |
Preterm birth Corticosteroids vs promethazine | RR 3 [0.13, 69.52] | 1 study · 40 participants | Low Downgraded: imprecision |
Days of hospital admission 2. Quality of life outcomes 3. Pregnancy complications Corticosteroids vs promethazine | no estimate extracted | NR | No studies |
Corticosteroids versus placebo
Population: Pregnant women with hyperemesis gravidarum
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Days of hospital admission Corticosteroids vs placebo | no estimate extracted | 1 study · 110 participants | Very low Downgraded: imprecision |
Pregnancy complications Corticosteroids vs placebo | RR 0.61 [0.26, 1.47] | 1 study · 110 participants | Very low Downgraded: imprecision |
Spontaneous abortion Corticosteroids vs placebo | RR 0.64 [0.11, 3.7] | 1 study · 110 participants | Very low Downgraded: imprecision |
Stillbirth and neonatal death Corticosteroids vs placebo | RR 0.7 [0.15, 3.34] | 2 studies · 134 participants | Very low Downgraded: imprecision |
Congenital abnormalities Corticosteroids vs placebo | RR 0.32 [0.01, 7.73] | 1 study · 110 participants | Very low Downgraded: imprecision |
Intervention side effects Corticosteroids vs placebo | RR 0.79 [0.06, 11.2] | 1 study · 25 participants | Very low Downgraded: imprecision |
Preterm birth Corticosteroids vs placebo | RR 1.01 [0.31, 3.28] | 2 studies · 134 participants | Very low Downgraded: imprecision, inconsistency |
Severity, reduction or cessation in nausea/vomiting 2. Number of episodes of emesis 3. Quality of life outcomes Corticosteroids vs placebo | no estimate extracted | NR | No studies |