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Treatment of vomiting/nausea in pregnancy may be costing NHS £60 million a year

Treatment varies widely among GP practices; guidelines not always followed, finds study

Caroline White

Wednesday, 02 January 2019

Nausea and vomiting in pregnancy (NVP) continues to be inconsistently managed in primary care, which may be costing the NHS an annual £60 million as a result, finds an observational study* published online in the British Journal of General Practice.

Treatment approaches vary widely among practices and Royal College of Obstetricians and Gynaecologists (RCOG) guidelines, issued in 2016, are not always followed, the findings indicate.

Up to 80 per cent of pregnant women experience nausea and vomiting, and around one in four of them seek medical advice for their symptoms, say the researchers.

Given how common the condition is, the lack of licensed drug options, non-specific guidance, and absence of data on current management and costs, researchers set out to understand how NVP is managed and to assess its impact on NHS services and associated costs.

They drew on data collected from GP practices, local hospitals, ambulance services (2013–16), and Hospital Episode Statistics (2006–16) in Newcastle, Gateshead.

Eight GP practices took part. In all, just over 15 per cent of pregnant women sought help for NVP symptoms, over half of whom consulted their GP (55 per cent); 14 per cent consulted their midwife. Nearly a third (30 per cent) had a consultation with another health professional, but with a GP present.

Treatment varied significantly among the practices, and one in three women went back to their GP. There was an annual increase in the proportion of women admitted to hospital for NVP symptoms, with increasing length of stay for each admission.

Almost half (44.6 per cent) of calls made to 999/111 from women with NVP symptoms resulted in an ambulance dispatch, yet only a fraction of pregnancies (0.3–3.6 per cent) are affected by the most severe form of NVP, known as hyperemesis gravidarum, which can cause metabolic disturbances, including dehydration and ketosis, say the researchers.

The annual cost of NVP to the CCG was estimated to be £199, 804, which crudely works out at £25,758 731 at UK level. But due to underestimations of costs, the impact to the UK NHS could be up to £62,373 961, calculate the researchers from the University of Warwick.

The RCOG published its first guidelines for management of NVP in 2016, although many current treatments are off label, with only one recently licensed treatment for NVP in the UK, they point out.

The RCOG recommends beginning with conservative management. If medication is warranted, antiemetics such as histamine H1 receptor antagonists and phenothiazines are recommended first-line treatments. These can be used in combination for women who do not respond to one or other drug type. The guidelines also suggest second-line treatments, with corticosteroids only to be used as third-line where standard therapies fail.

As well as calling for better implementation of general practice guidelines on the management of NVP, to ensure consistency in care, and stave off potentially avoidable substantial resource use, the researchers emphasise the need to continue the search for effective treatments.

“The costs of NVP for the NHS are considerable, and any effective improvements in treatment and management will benefit sufferers, and potentially reduce the economic burden of the condition,” they conclude.


*Gadsby G, et al. Nausea and vomiting of pregnancy and resource implications: the NVP Impact Study. British Journal of General Practice, 2018. DOI: 10.3399/bjgp18X700745

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