Study on the efficacy of oral prednisolone therapy among hospitalized women with hyperemesis gravidarum in Ahvaz Jundishapur university's hospitals

Hyperemesis gravidarum (HEG) is a debilitating illness affecting 0.3- 2% of pregnant women. It is characterized by continuous vomiting, dehydration, ketosis and muscle weakness. Conservative measures are not effective in severe cases. In these conditions, prednisolone therapy has been used, but yet there is no consensus on the therapy. The aim of this study was to assess the effect of prednisolone therapy in control of symptoms in women with HEG.Subjects and a randomized, placebo-controlled trial was conducted on women with HEG who were admitted at Ahvaz University`s hospitals from April 2006 to March 2008. Initially, they were divided in two (Prednisolone and placebo) groups. The prednisolone group was administered oral daily prednisolone (20 mg bid) until improved, and then tapered off over a few weeks, while the control group was given a placebo (multivitamin) with the same manner. All women also received promethazine, metoclopramide, intravenous fluids with electrolytes and vitamin supplements (B1, B6). finally, 54 women in two groups (steroid: 28, placebo: 26) were analyzed. The mean age in both groups at admission was about 22 years. The mean gestational age at randomization was 10.7 (± 2.3) weeks in the prednisolone group and 8.4 (± 1.7) weeks in the placebo group. Among prednisolone group only 10 (35.71%) women versus 15 (57.68%) women in the placebo group needed hospital cares for women more than one week (P= 0.18). Severe vomiting was seen only in 4 (14%) patients in the prednisolone group compared with 12 (46%) in the placebo group (P=0.01). Nineteen women (73%) in the placebo, compared with 12(50%) in the prednisolone group, were readmitted for hyperemesis (P=0.03). After one week, ptyalism was seen in 6 (6/12) in the prednisolone group versus in one (1/4) in placebo group (P=0.59). Prednisolone therapy is useful in resolution of symptoms in women with hyperemesis gravidarum. Further study with a larger size is recommended.