A scoping review of models of care and services for nausea and vomiting in pregnancy and hyperemesis gravidarum.

BACKGROUND

Nausea and vomiting in pregnancy and hyperemesis gravidarum have significant physical and psychological impacts on pregnant women. Women are often unable to participate in everyday care and work activities, potentially affecting individual wellbeing and ability to contribute to the economy. Research priorities for hyperemesis gravidarum have been established, however little is known about the current landscape of literature on the health and social care provided to affected women. To inform decision makers on effective models of care and identify remaining evidence gaps, this scoping review aimed to map existing literature that evaluated health and social care delivery arrangements for pregnant women with nausea and vomiting and hyperemesis gravidarum.

METHODS

Seven databases (Medline, EMBASE, CINAHL, PsycInfo, Maternity and Infant Care, Cochrane Library and Scopus) were searched in August 2023 and again in March 2024 to identify evaluations of health care delivery arrangements for nausea and vomiting in pregnancy and hyperemesis gravidarum. Database searches were supplemented by a Google search for additional peer-reviewed and grey literature. Data from included publications were extracted and synthesised to report on models of care identified, countries, study designs, outcome measures and key findings.

RESULTS

Seventy-two records describing 60 separate models of care were identified. Models of care were grouped into hospital settings (n = 34 records), digital health (n = 19 records), group-based care (n = 11 records), and primary care (n = 8 records). Literature in the hospital setting addressed outpatient management (n = 15 records), inpatient management (n = 5 records), comparisons of outpatient and inpatient management (n = 10 records), in-home care (n = 3 records) and emergency departments (n = 1 record). Digital health care evaluations included telephone and web-based support (n = 14 records) and mobile phone applications (n = 5 records).

CONCLUSIONS

This scoping review has identified the need for further research on approaches to care provision for nausea and vomiting in pregnancy and hyperemesis gravidarum. Whilst some positive findings on patient outcomes, patient experiences and reduced hospital stays resulting from outpatient hospital management pathways were reported, much of this research was observational and limited to UK settings. Other research gaps identified pertained to the effectiveness of primary care, social support and in-home care services, including economic evaluations.