Hyperemesis gravidarum in the primary care setting: cross-sectional study of GPs

Melanie Nana; Holly Morgan; Haroon Ahmed; Catherine Williamson

doi:10.3399/BJGPO.2021.0119

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Figure 1. Heat map demonstrating geographical distribution of participants
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Figure 2. Breakdown of where participant would access further information on HG. ‘Other’ included the British Medical Journal resources, the British National Formulary, GP notebook, National Institute for Health and Care Excellence resources, patient information websites, and the website of a widely used GP educational resource (the ‘Red Whale’ website).
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Figure 3. Participants confidence levels with regards to managing women with HG

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Table 1. Relationship between additional qualifications or training and confidence levels and likelihood of screening for mental health consequences in HG.

	Confidence in managing HG (score/4)	Routinely screen for mental health problems
Additional qualifications or prior clinical experience related to O&G
Yes	3.0	19% (27/145)
No	2.6	19% (12/64)
P value	0.0001^a	1.0
Attendance or access to community/ GP teaching
Yes	2.9	18% (35/192)
No	3.1	24% (4/17)
P value	0.21	0.59
Routine attendance at regional or national conferences
Yes	3.0	22% (11/49)
No	2.9	18% (28/160)
P value	0.35	0.44
Previous teaching on HG
Yes	3.1	17% (13/78)
No	2.8	20% (26/131)
P value	0.0002^a	0.31

^aStatistically significant.

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Table 2. Participant knowledge and comfort in prescribing first line anti-emetics and all drugs recommended in guidelines

	Safety of medications in pregnancy	Comfort of physician in prescribing in primary care
Participants reporting first line anti-emetics being safe throughoutpregnancy, %	Participants reporting all guideline-recommended drugs being safe inpregnancy, %	Participants reporting first line anti-emetics not being safe in pregnancy, %	Participants reporting that guideline-recommended medications should not be prescribed in pregnancy, %
Confidence levels
Not at all/not so confident	27%	28%	7%	30%
Somewhat confident	52%	50%	5%	17%
Very confident	55%	57%	5%	17%
P value	0.09	0.04^a	0.49	0.04^a
Additional qualifications/additional clinical experience
Yes	52%	50%	5%	19%
No	37%	37%	7%	21%
P value	0.24	0.11	0.23	0.38
Previous teaching on hyperemesis gravidarum (HG)
HG teaching	52%	49%	5%	16%
No HG teaching	43%	43%	6%	21%
P value	0.34	0.29	0.27	0.18

^aStatistically significant. HG = hyperemesis gravidarum.

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Table 3. List of recommended resources for healthcare professionals.

Recommended resources
RCOG	The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum - Green-top Guideline
National Institute for Health and Care Excellence	Nausea/vomiting in pregnancy- Clinical Knowledge Summary
UK Teratology Information Service	Treatment of Nausea and Vomiting in Pregnancy
UpToDate	Nausea and vomiting of pregnancy: Treatment and outcomes
Red Whale	https://www.gp-update.co.uk/Latest-Updates/Nausea-and-vomiting-in-pregnancy
Pregnancy Sickness Support charity	Section for Healthcare Professionals
HER Foundation	Section for Healthcare Providers

Supplementary Data

BJGPO.2021.0119_Supp.pdf -
Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.