Reproduction Abstracts

Background: Prednisolone is a third-line oral antiemetic for hyperemesis gravidarum (HG) which can be considered if other treatments have failed. Current HG guidelines leave significant scope for interpretation with respect to prednisolone weaning advice. In NSW, Australia, a specialized medicines information telephone service received 1193 calls relating to NVP/HG, from consumers and healthcare professionals, between April-2023 and June-2024.

Objective: To increase awareness and understanding of how to dose and wean prednisolone slowly for HG, to achieve significant and sustained reduction in severe HG symptoms.

Method: Specialized staff were trained to assess symptoms and provide evidence-based advice regarding treatments. Patients were offered follow-up calls to assess progress. For prednisolone weaning advice, international NVP/HG guidelines were reviewed in detail. Throughout the literature, there were variations in weaning practices, and a gap in specific practice points to guide prednisolone weaning, particularly slower weaning. To address this, we developed a step-by-step, evidence-based guide for weaning prednisolone slowly.

Results: Success of prednisolone weaning was evaluated through follow up calls. While following the slower prednisolone weaning protocol, patients reported a significant and sustained reduction in the intensity of nausea and frequency of vomiting and retching. Most patients described this as "life-changing" for their severe HG symptoms and quality of life.

Conclusion: Effective prednisolone weaning can significantly improve severe HG symptoms and quality of life. In the future, it would be useful if international HG guidelines include slower prednisolone weaning advice, and detailed practice points, to further assist with prednisolone weaning in the management of HG.

Keywords: HG, hyperemesis, prednisolone, weaning, pregnancy