Dr Sumithra Giritharan1, Dr Sing Ching Lee1, Mrs Pushpa Sivakumar2, Mrs Phoebe Fitzgerald2, Mrs Katie Lussenberg3, Dr Jennifer Pontre4, Dr Dorothy Graham1,5
1Department of Obstetric Medicine, Women and Newborn Health Service, King Edward Memorial Hospital, Perth, Australia, 2Department of Dietetics, Women and Newborn Health Service, King Edward Memorial Hospital, Perth, Australia, 3Adult Special Care Unit and Emergency Centre, Women and Newborn Health Service, King Edward Memorial Hospital, Perth, Australia, 4Department of Obstetrics and Gynaecology, Women and Newborn Health Service, King Edward Memorial Hospital, Perth, Australia, 5University of Western Australia, Perth, Australia
Biography:
'Biographies to come'
Abstract:
Despite several case reports identifying mirtazapine as a potential therapeutic option for the management of Hyperemesis Gravidarum (HG)(1) it is not currently recommended in national guidelines(2). To investigate the efficacy and safety of mirtazapine for refractory HG, we will present results from our single centre case series.
From July 2023 to December 2023 a total of 15 patients were prescribed mirtazapine for HG after failure to control symptoms with diet, pyridoxine, antiemetics, antihistamines and proton pump inhibitors. We will review complications of HG in our cohort including admission for intravenous hydration, weight loss, biochemical abnormalities and inability to function. We will present data on symptom severity (PUQE score), mirtazapine dosage, duration of use and need for further treatment escalation. We will also discuss patient reported side-effects, gestational weight gain, obstetric and neonatal outcomes.
Preliminary analysis shows that 73.3% of our cohort required hospitalisation for intravenous fluids on 1-16 occasions prior to commencement of mirtazapine. Prior to treatment, weight loss was documented in 46.7%, hypokalaemia in 33.3% and deranged liver function tests in 13.3% of our cohort.
Mirtazapine was a highly effective treatment for HG in our cohort, with 86.7% of patients reporting symptom improvement or resolution. Of the two patients who did not respond, one did not take the treatment consistently and the other had an underlying eating disorder. Patient reported side-effects were noted in 13.3%.
To our knowledge, this is the largest single centre series reporting on the use of mirtazapine for HG. Our results are consistent with prior publications describing mirtazapine as an effective therapeutic option for HG. Current guideline directed medications for HG unfortunately lack high quality evidence(3). Based on our results, we plan to conduct a randomised controlled trial comparing mirtazapine versus corticosteroids for the treatment of refractory HG and will present our planned protocol.
Keywords
"hyperemesis gravidarum", "mirtazapine", "PUQE score"
References
1. Galletta MAK, Tess VLC, Pasotti IM, Pelegrini LF, Ribeiro Rocha NK, Testa CB, et al. Use of Mirtazapine and Olanzapine in the Treatment of Refractory Hyperemesis Gravidarum: A Case Report and Systematic Review. Case Rep Obstet Gynecol. 2022;2022:7324627.
2. Lowe SA, Armstrong G, Beech A, Bowyer L, Grzeskowiak L, Marnoch CA, et al. SOMANZ position paper on the management of nausea and vomiting in pregnancy and hyperemesis gravidarum. Aust N Z J Obstet Gynaecol. 2020;60(1):34-43.
3. Boelig RC, Barton SJ, Saccone G, Kelly AJ, Edwards SJ, Berghella V. Interventions for treating hyperemesis gravidarum: a Cochrane systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2018;31(18):2492-505.