Reproduction Abstracts

Hyperemesis Gravidarum (HG) is a severe form of pregnancy-induced nausea and vomiting, posing significant risks to maternal and fetal health. Limited data exist on the comparative efficacy and safety of promethazine versus ondansetron in managing HG, especially in resource-constrained settings. The objective of this study was to compare the effectiveness, safety, and cost-effectiveness of promethazine versus ondansetron in managing HG among primigravid women in Northern Uganda. A randomized controlled trial was conducted with 150 primigravid women diagnosed with HG. Participants were randomly assigned to receive promethazine (25 mg orally every 6 hours) or ondansetron (4 mg orally every 8 hours). The primary outcome was the reduction in nausea and vomiting severity, measured using the Pregnancy-Unique Quantification of Emesis (PUQE) score. Secondary outcomes included maternal weight gain, gestational age at delivery, neonatal outcomes, and cost-effectiveness. The results showed the ondansetron group had a mean PUQE score reduction of 13.2 points (95% CI: 11.5–14.8), compared to 9.1 points (95% CI: 7.6–10.6) in the promethazine group (P 0.01). Women treated with ondansetron gained 4.8 kg (95% CI: 4.3–5.3) on average, compared to 3.2 kg (95% CI: 2.8–3.6) in the promethazine group (P = 0.04). The ondansetron group had a mean gestational age of 39.1 weeks (95% CI: 38.7–39.5) compared to 37.4 weeks (95% CI: 37.0–37.8) for the promethazine group (P = 0.02). Neonates in the ondansetron group had a higher mean birth weight (3.3 kg, 95% CI: 3.1–3.5) compared to those in the promethazine group (2.9 kg, 95% CI: 2.7–3.1) (P = 0.01). Adverse effects were lower in the ondansetron group (5% vs. 15%, P = 0.01). Ondansetron reduced overall healthcare costs by minimizing hospital admissions and complications, making it more cost-effective despite higher medication costs. In conclusion, Ondansetron demonstrated superior efficacy, safety, and cost-effectiveness compared to promethazine, making it the preferred treatment option for managing HG in low-resource settings. These findings support the need for updated treatment protocols to improve maternal and neonatal outcomes in similar contexts.

Keywords: Hyperemesis Gravidarum, Ondansetron, Promethazine, PUQE Score, Maternal Health, Neonatal Outcomes, Cost-Effectiveness, Low-Resource Settings

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