TY - JOUR
T1 - Early enteral tube feeding in optimizing treatment of hyperemesis gravidarum
T2 - The Maternal and Offspring outcomes after Treatment of HyperEmesis by Refeeding (MOTHER) randomized controlled trial
AU - Grooten, Iris J.
AU - Koot, Marjette H.
AU - Van Der Post, Joris A.M.
AU - Bais, Joke M.J.
AU - Ris-Stalpers, Carrie
AU - Naaktgeboren, Christiana
AU - Bremer, Henk A.
AU - Van Der Ham, David P.
AU - Heidema, Wieteke M.
AU - Huisjes, Anjoke
AU - Kleiverda, Gunilla
AU - Kuppens, Simone
AU - van Laar, Judith O.E.H.
AU - Langenveld, Josje
AU - Van Der Made, Flip
AU - Van Pampus, Mariëlle G.
AU - Papatsonis, Dimitri
AU - Pelinck, Marie José
AU - Pernet, Paula J.
AU - Van Rheenen, Leonie
AU - Rijnders, Robbert J.
AU - Scheepers, Hubertina C.J.
AU - Vogelvang, Tatjana E.
AU - Mol, Ben W.
AU - Roseboom, Tessa J.
AU - Painter, Rebecca C.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - Background: Hyperemesis gravidarum (HG) leads to dehydration, poor nutritional intake, and weight loss. HG has been associated with adverse pregnancy outcomes such as low birth weight. Information about the potential effectiveness of treatments for HG is limited. Objective: We hypothesized that in women with HG, early enteral tube feeding in addition to standard care improves birth weight. Design: We performed a multicenter, open-label randomized controlled trial [Maternal and Offspring outcomes after Treatment of HyperEmesis by Refeeding (MOTHER)] in 19 hospitals in the Netherlands. A total of 116 women hospitalized for HG between 5 and 20 wk of gestation were randomly allocated to enteral tube feeding for ≥7 d in addition to standard care with intravenous rehydration and antiemetic treatment or to standard care alone. Women were encouraged to continue tube feeding at home. On the basis of our power calculation, a sample size of 120 women was anticipated. Analyses were performed according to the intention-to-treat principle. Results: Between October 2014 and March 2016 we randomly allocated 59 women to enteral tube feeding and 57 women to standard care. The mean ± SD birth weight was 3160 ± 770 g in the enteral tube feeding group compared with 3200 ± 680 g in the standard care group (mean difference: -40 g, 95% CI: -230, 310 g). Secondary outcomes, including maternal weight gain, duration of hospital stay, readmission rate, nausea and vomiting symptoms, decrease in quality of life, psychological distress, prematurity, and small-for-gestationalage, also were comparable. Of the women allocated to enteral tube feeding, 28 (47%) were treated according to protocol. Enteral tube feeding was discontinued within 7 d of placement in the remaining women, primarily because of its adverse effects (34%). Conclusions: In women with HG, early enteral tube feeding does not improve birth weight or secondary outcomes. Many women discontinued tube feeding because of discomfort, suggesting that it is poorly tolerated as an early routine treatment of HG.
AB - Background: Hyperemesis gravidarum (HG) leads to dehydration, poor nutritional intake, and weight loss. HG has been associated with adverse pregnancy outcomes such as low birth weight. Information about the potential effectiveness of treatments for HG is limited. Objective: We hypothesized that in women with HG, early enteral tube feeding in addition to standard care improves birth weight. Design: We performed a multicenter, open-label randomized controlled trial [Maternal and Offspring outcomes after Treatment of HyperEmesis by Refeeding (MOTHER)] in 19 hospitals in the Netherlands. A total of 116 women hospitalized for HG between 5 and 20 wk of gestation were randomly allocated to enteral tube feeding for ≥7 d in addition to standard care with intravenous rehydration and antiemetic treatment or to standard care alone. Women were encouraged to continue tube feeding at home. On the basis of our power calculation, a sample size of 120 women was anticipated. Analyses were performed according to the intention-to-treat principle. Results: Between October 2014 and March 2016 we randomly allocated 59 women to enteral tube feeding and 57 women to standard care. The mean ± SD birth weight was 3160 ± 770 g in the enteral tube feeding group compared with 3200 ± 680 g in the standard care group (mean difference: -40 g, 95% CI: -230, 310 g). Secondary outcomes, including maternal weight gain, duration of hospital stay, readmission rate, nausea and vomiting symptoms, decrease in quality of life, psychological distress, prematurity, and small-for-gestationalage, also were comparable. Of the women allocated to enteral tube feeding, 28 (47%) were treated according to protocol. Enteral tube feeding was discontinued within 7 d of placement in the remaining women, primarily because of its adverse effects (34%). Conclusions: In women with HG, early enteral tube feeding does not improve birth weight or secondary outcomes. Many women discontinued tube feeding because of discomfort, suggesting that it is poorly tolerated as an early routine treatment of HG.
KW - Enteral nutrition
KW - Intravenous rehydration
KW - Morning sickness
KW - Nausea and vomiting in pregnancy
KW - Weight loss pregnancy outcome
KW - Fluid Therapy
KW - Dehydration/etiology
KW - Humans
KW - Young Adult
KW - Adult
KW - Female
KW - Weight Gain
KW - Hyperemesis Gravidarum/therapy
KW - Infant, Newborn
KW - Antiemetics/therapeutic use
KW - Infant, Low Birth Weight
KW - Standard of Care
KW - Treatment Outcome
KW - Hospitalization
KW - Energy Intake
KW - Pregnancy
KW - Birth Weight
KW - Weight Loss
KW - Enteral Nutrition/adverse effects
KW - Pregnancy Outcome
UR - http://www.scopus.com/inward/record.url?scp=85028709464&partnerID=8YFLogxK
U2 - 10.3945/ajcn.117.158931
DO - 10.3945/ajcn.117.158931
M3 - Article
C2 - 28793989
AN - SCOPUS:85028709464
SN - 0002-9165
VL - 106
SP - 812
EP - 820
JO - American Journal of Clinical Nutrition
JF - American Journal of Clinical Nutrition
IS - 3
ER -