Medical assistance can help women suffering from severe nausea and vomiting during pregnancy, but insufficient recognition of Hyperemesis gravidarum (HG) means that many are not getting the help they need to overcome this severe and debilitating form of morning sickness.
Flinders University researchers have found many women say there is inadequate recognition and clinical management of HG, claiming too many people within the medical care system are not aware of guidelines or adequate pharmaceutical treatment – which is restricting access to equitable clinical care.
Much of the inadequate clinical care and poorer health outcomes for women affected by this debilitating condition relates to structural barriers – stigma, inadequate understanding and recognition of the illness, misinformation, access to treatments and clinical care.
“It’s a significant problem that affects almost 4% of pregnancies,” explains Associate Professor Luke Grzeskowiak, who is a clinical pharmacist and leads the Reproductive and Perinatal Pharmacoepidemiology Research Group at Flinders University.
“HG is a severe form of nausea and vomiting in pregnancy that can lead to significant pregnancy complications and negatively impact the health and wellbeing of mothers and their infants. However, women reporting these symptoms say they are often not taken seriously by clinicians. Furthermore, the impacts of HG can influence desires or actions to end pregnancy, or to avoid future pregnancies.”
A survey of 189 women identified several major issues: that many clinicians lack suitable training to diagnose patients, and are either not aware of, or not following clinical HG management guidelines; misperceptions about the safety and side-effect profiles of antiemetic medications are common and can impact treatment decisions; a woman’s educational and financial status may influence treatment outcomes; and systemic barriers to effective management exist in Australia’s healthcare system.
They are also concerned about scant awareness that the severe nature of HG can lead to impaired quality of life, resulting in psychological trauma that can extend beyond birth and affect future family planning.
The researchers say experiences and outcomes for women with HG can be improved through better education for health practitioners, changes to the Pharmaceutical Benefits Scheme, and expanded outpatient care modalities.
“Current treatment of HG is focused on providing supportive care and addressing underlying symptoms through medications including antiemetics,” says research lead author, Flinders University PhD Candidate Tim McNamara.
“However, women we surveyed say their symptoms were often not taken seriously, and clinicians across multiple professions commonly did not have the appropriate education and training to recognise and manage their condition.”
Women reported either not receiving a diagnosis of HG when they should have had one, or being diagnosed late. Others reported their health practitioners denied prescribing or dispensing medications for them.
Misinformation led to women’s misperceptions about safety, with some choosing not to take a medication they were prescribed after reading reported safety concerns that were not aligned to current research and management guidelines.
Some women reported that common medication side-effects were poorly managed by health professionals, with symptoms including constipation and mood disorders being exacerbated by a lack of appropriate side-effect management.
The overwhelming physical toll of HG and an enduring emotional load was problematic, with the impact of HG on the mental health of survey participants affected during and after illness. Women cited experiencing, anxiety and post-traumatic stress syndrome.
For some women, the impact of HG resulted in them needing to terminate their otherwise wanted pregnancy” explained Associate Professor Grzeskowiak. “Some women were haunted by decisions to terminate, even though it may have been a life-saving decision. Other women remained terrified of falling pregnant again due to the traumatic nature of a previous HG experience.”
The researchers say significant opportunities exist to improve experiences and outcomes for women with HG through raising public and health practitioner awareness about HG, and improving clinical practice guidelines.
They also say structural barriers should be changed to remove treatment inequality, such as investing in specialist HG clinics and care services, and developing strategies to improve medicines access and affordability.
The research – “Exploring women’s experiences and perceptions regarding the pharmacological management of Hyperemesis Gravidarum: a qualitative study,” by Timothy McNamara, Jacqueline Stephens, Stefan Kane, Emma Healy, Caitlin Kay-Smith and Luke Grzeskowiak – has been published in the Journal of Pharmacy Practice and Research. DOI: 10.1002/jppr.70096