Twelve‐hour fasting compared with expedited oral intake in the initial inpatient management of hyperemesis gravidarum: a randomised trial

Abstract

Objective To evaluate fasting for 12‐hours compared to expedited oral feeding in hospitalised hyperemesis gravidarum (HG) Design Randomised trial Setting University Hospital, Malaysia: April 2016‐April 2017 Population 160 women hospitalised for hyperemesis gravidarum (HG) Method Women were randomised upon admission to fasting for 12‐hours or expedited oral feeding. Standard HG care was instituted. Main outcome measure Primary outcome was satisfaction score with overall treatment at 24 hours (0‐10 Visual Numerical Rating Scale VNRS), vomiting episodes within 24 hours and nausea VNRS score at enrollment, 8, 16 and 24 hours. Results Satisfaction score, median [interquartile range] 8 [5‐9] vs. 8 [7‐9] P=0.08 and 24‐hour vomiting episodes were 1[0‐4] vs. 1[0‐5] P = 0.24 for 12‐hours fasting vs. expedited feeding respectively. Repeated measures analysis of variance of nausea scores over 24‐hours showed no difference (P=0.11) between trial arms. Participants randomised to 12‐hours fasting compared to expedited feeding were less likely to prefer their feeding regimen in future hospitalisation 41% vs 65% P=0.001, to recommend to a friend 65% vs 84% P=0.01 (RR 0.8 95% CI 0.6‐0.9) and to adhere to protocol 85% vs 95% P=0.04 (RR 0.9 95% CI 0.8‐1.0). Symptoms profile, ketonuria status at 24 hours and length of hospital stay were not different. Conclusion Advisory of 12‐hours fasting compared to immediate oral feeding resulted in a non‐significant difference in satisfaction score but adherence to protocol, fidelity to and recommendation of immediate oral feeding to a friend were lower. 24‐hour nausea scores and vomiting episodes were similar.