Management of hyperemesis gravidarum: the importance of weight loss as a criterion for steroid therapy.

BACKGROUND Although the effectiveness of prednisolone therapy for severe hyperemesis gravidarum has been demonstrated, there is no consensus on how to assess severity to justify such treatment, nor any information on whether such therapy affects birth weight. AIM To document the effect of prednisolone therapy in women with defined severity of hyperemesis gravidarum. DESIGN Single centre, observational study of 30 consecutive pregnancies complicated by hyperemesis and weight loss of >5% of pre-pregnant weight between April 1995 and July 2000. Comparison of birth weight with a contemporaneous control series of women admitted with hyperemesis that was judged insufficiently severe to require steroids. RESULTS Treatment with prednisolone 10 mg tid rapid resolved nausea and vomiting, allowing discharge in 3 (range 1-6.5) days. Steroid therapy, which was reduced in a stepwise manner, was discontinued at a median gestation of 20 weeks. Maternal weight gain in pregnancy was restored to normal. Median birth weight in the severe, steroid-treated group was 3.33 (range 2.80-3.27) kg vs. 3.27 (range 3.04-3.53) kg in the less severe group. CONCLUSION Weight loss >5% served as a criterion to define a subset of women with severe hyperemesis gravidarum. In these women, steroid therapy was uniformly successful resulting in the prompt resolution of symptoms. Steroid therapy did not affect birth weight.