Plain English Summary
Background and study aims
Nausea and vomiting are common symptoms during early pregnancy, occurring in about 70–85% of pregnancies. Some pregnant women experience excessive nausea and vomiting, known as hyperemesis gravidarum, which leads to dehydration and significant weight loss. Hospitalisation is typically needed to rehydrate patients through a drip and to control nausea and vomiting with medication. In hyperemesis gravidarum, nausea may be triggered by just the thought of food, and vomiting often follows drinking or eating. In women recently hospitalised for hyperemesis it is not known whether there is benefit to a short (12 hour) delay in eating and drinking to allow rehydration and medication to take effect before eating and drinking is restarted. On the other hand, continuing to feed at the same time as rehydration and medication may permit the quickest recovery path. The aim of this study is to find out which is the better approach.
Who can participate?
Pregnant women aged 18 or over with hyperemesis gravidarum
What does the study involve?
Participants are randomly allocated to one of two groups. One group is encouraged eat and drink as soon as possible after hospitalisation. The other group is told to delay eating and drinking (fast) for the first 12 hours after hospitalisation, then resume eating and drinking at their own pace. Both groups receive intravenous rehydration (a drip), thiamine (vitamin) supplementation and anti-emetic (anti- vomiting) medication as standard inpatient treatment for hyperemesis gravidarum. Frequency of vomiting, nausea, patient satisfaction and duration of hospitalisation are measured.
What are the possible benefits and risks of participating?
We do not foresee any major benefits or significant risks. It is not clear which intervention will prove to be superior and there is a distinct likelihood the interventions may produce similar outcomes.
Where is the study run from?
University Malaya Medical Centre (Malaysia)
When is the study starting and how long is it expected to run for?
April 2016 to September 2017
Who is funding the study?
University of Malaya (Malaysia)
Who is the main contact?
Prof. Peng Chiong Tan
Prof Peng Chiong Tan
Department of Obstetrics and Gynaecology
Faculty of Medicine
University of Malaya
+60 (0)123 052 970
Delayed compared with early oral intake in the initial manangement of hyperemesis gravidarum: a randomised trial
An initial 12-hour period of fasting (delayed oral intake) at hospitalisation for hyperemesis gravidarum to allow for hydration and anti-emetic medication to become effective compared to early feeding will result in less nausea and vomiting and higher patient satisfaction at 24 hours.
University Malaya Medical Centre Medical Ethics Committee, 04/02/2016, approval no. 1206.12
Two-arm clinical trial
Primary study design
Secondary study design
Randomised controlled trial
Patient information sheet
Not available in web format, please use then contact details below to request a patient information sheet
Participants are randomized to:
1. Delayed oral intake (fasting) for the first 12 hours after hospitalisation for hyperemesis gravidarum followed by resumption of taking fluids and solids orally at the participants own pace
2. Encouraged to take fluids and solids orally as soon as, as much as and as often as tolerated after hospitalisation for hyperemesis gravidarum
Both arms are to receive intravenous rehydration, oral thiamine supplementation and intravenous anti-emetic as standard inpatient treatment for hyperemesis gravidarum
Primary outcome measure
1. Frequency of vomiting in the first 24 hours
2. Nausea score (using a Visual Numerical Rating Scale from 0 to 10) at enrollment, 8, 16 and 24 hours
3. Patient’s satisfaction score (using a Visual Numerical Rating Scale from 0 to 10) at 24 hours
Secondary outcome measures
1. Duration of hospitalisation
2. Ketonuria at 24 hours
3. An 8-item symptoms questionnaire at 24 hours
4. Participant preference on feeding regimen in a future hospitalisation for hyperemesis gravidarum at 24 hours
5. Participant recommendation of their feeding regimen to a friend in the same circumstances at 24 hours
Overall trial start date
Overall trial end date
Reason abandoned (if study stopped)
Participant inclusion criteria
1. Clinical diagnosis of hyperemesis gravidarum
2. First hospitalisation for hyperemesis gravidarum in current pregnancy
3. Presence of ketonuria by urine dipstick (of 2+ or greater) at hospitalisation
4. At least 18 years of age
5. Pregnancy gestation of 14 weeks or less
Target number of participants
Total final enrolment
Participant exclusion criteria
1. Multiple pregnancy
2. Molar pregnancy
3. Confirmed non-viable pregnancy
4. Any medical condition that contraindicates oral feeding or fasting
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
University Malaya Medical Centre
University of Malaya, UM
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
We plan to publish the trial results. We are not planning to release raw trial data.
Intention to publish date
Participant level data
Not expected to be available
Basic results (scientific)
2020 results in https://doi.org/10.1111/1471-0528.16290 (added 20/05/2020)