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

Melanie Nana, Holly Morgan, Haroon Ahmed, Catherine Williamson

Hyperemesis gravidarum (HG), if untreated, can lead to malnutrition, dehydration and Wernicke's encephalopathy. Fetal 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. Identify factors that may influence prescribers' confidence and knowledge regarding pharmacological therapy for HG. Cross-sectional study of qualified GPs (General Practitioners) and GP trainees in Wales. Distribution of a 22-item online survey. Statistical analysis was carried out using SPSS. 241 responses were received with 216 included in the analysis (59% qualified GPs, 41% GP trainees). In total, 93% of respondents 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 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/education did not increase likelihood of this happening. 87% of participants would like additional education/access to evidence-based resources. This study demonstrates a demand for improved dissemination of evidence-based education to support those working in primary care. The extent to which HG is covered in pre-existing educational programmes should also be revisited.