Hyperemesis gravidarum, nutritional treatment by nasogastric tube feeding: a 10-year retrospective cohort study

Acta Obstet Gynecol Scand. 2015 Apr;94(4):359-67. doi: 10.1111/aogs.12578. Epub 2015 Feb 17.


Objective: To investigate maternal and fetal outcome in hyperemesis gravidarum comparing enteral tube feeding of the mothers with other fluid/nutrition regimens.

Design: Retrospective hospital-based cohort.

Setting: University hospital, Norway.

Sample: All 558 women treated for hyperemesis gravidarum 2002-2011; 273 received water/electrolytes intravenously, 177 received nutritional supplements by peripheral line, 107 received enteral feeding by gastroscopically positioned nasojejunal tube and 10 received total parenteral nutrition.

Methods: Different fluid/nutritional groups were compared by chi-squared or non-parametric tests. The influence (odds ratio) of nutritional regimens on having small-for-gestational-age infants was evaluated by binary logistic regression.

Main outcome measures: Maternal weight gain during hospitalization and pregnancy, birthweight and gestational age at delivery.

Results: Women receiving enteral nutrition had significantly greater weight loss on admission (median 5.0 kg) and at start of nutrition (5.5 kg) than the other treatment groups (4.0 kg) (p < 0.001). Enteral nutrition was administered for up to 41 days (median 5 days) during hospitalization, leading to 0.8 kg weight gain (95% CI 0.5-1.0, p = 0.005). The tube-fed women achieved similar weight gain during pregnancy and experienced similar incidence of preterm birth or small-for-gestational age compared with the other treatment groups. Women with <7 kg total weight gain had increased risk of birthweight <2500 g and small-for-gestational-age infants (odds ratio 3.68, 95% CI 1.89-7.18, p < 0.001). The nutritional regimen used was not an independent risk factor.

Conclusion: Compared with other fluid/nutrition regimens, enteral tube feeding for women affected by severe hyperemesis gravidarum is associated with adequate maternal weight gain and favorable pregnancy outcomes.

Keywords: Hyperemesis gravidarum; naso-enteral tube; nutrition; outcome; pregnancy complications.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Adult
  • Birth Weight
  • Cohort Studies
  • Combined Modality Therapy
  • Enteral Nutrition / methods*
  • Female
  • Fetal Growth Retardation / etiology
  • Fetal Growth Retardation / prevention & control*
  • Fluid Therapy
  • Gestational Age
  • Humans
  • Hyperemesis Gravidarum / therapy*
  • Infant, Newborn
  • Infant, Small for Gestational Age
  • Intubation, Gastrointestinal*
  • Logistic Models
  • Odds Ratio
  • Parenteral Nutrition, Total
  • Pregnancy
  • Premature Birth / etiology
  • Premature Birth / prevention & control*
  • Retrospective Studies
  • Treatment Outcome
  • Weight Gain*