Early enteral tube feeding in optimizing treatment of hyperemesis gravidarum: the Maternal and Offspring outcomes after Treatment of HyperEmesis by Refeeding (MOTHER) randomized controlled trial

• Published in: The American journal of clinical nutrition Vol. 106; no. 3; pp. 812 - 820
• Main Authors: Grooten, Iris J, Koot, Marjette H, van der Post, Joris AM, Bais, Joke MJ, Ris-Stalpers, Carrie, Naaktgeboren, Christiana, Bremer, Henk A, van der Ham, David P, Heidema, Wieteke M, Huisjes, Anjoke, Kleiverda, Gunilla, Kuppens, Simone, van Laar, Judith OEH, Langenveld, Josje, van der Made, Flip, van Pampus, Mariëlle G, Papatsonis, Dimitri, Pelinck, Marie-José, Pernet, Paula J, van Rheenen, Leonie, Rijnders, Robbert J, Scheepers, Hubertina CJ, Vogelvang, Tatjana E, Mol, Ben W, Roseboom, Tessa J, Painter, Rebecca C
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2017; American Society for Clinical Nutrition, Inc
• Subjects: Adult; Antiemetics - therapeutic use; Birth Weight; Childbirth & labor; Clinical trials; Dehydration; Dehydration - etiology; Design standards; Energy Intake; Enteral nutrition; Enteral Nutrition - adverse effects; Feeding; Female; Fluid Therapy; Gestation; Hospitalization; Humans; Hyperemesis Gravidarum - therapy; Infant, Low Birth Weight; Infant, Newborn; Intravenous administration; intravenous rehydration; Low birth weight; Maternal & child health; Medical treatment; morning sickness; Motivation; Nausea; nausea and vomiting in pregnancy; Offspring; Pregnancy; Pregnancy Outcome; Quality of life; Randomization; Rehydration; Small for gestational age; Standard of Care; Treatment Outcome; Vomiting; Weight Gain; Weight Loss; Young Adult; enteral nutrition; PUQE-24; MOTHER; weight loss; HADS; NVP; EQ-VAS; QOL; SF-36; nausea and vomiting in pregnancy; HIS; morning sickness; pregnancy outcome; NVPQOL; intravenous rehydration; HG
• ISSN: 0002-9165; 1938-3207
• DOI: 10.3945/ajcn.117.158931

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. We hypothesized that in women with HG, early enteral tube feeding in addition to standard care improves birth weight. 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. 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-gestational-age, 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%). 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. This trial was registered at www.trialregister.nl as NTR4197.