A systematic review and meta-analysis of the utility of corticosteroids in the treatment of hyperemesis gravidarum

BACKGROUND: Corticosteroids (CCS) are effective in reducing chemotherapy-induced nausea and vomiting, but it is unknown whether CCS are effective in treating hyperemesis gravidarum (HG). METHODS: We searched PubMed and ClinicalTrials.gov from inception to May 15, 2015, for randomized controlled trials examining the effects of CCS in HG. RESULTS: We identified five trials (n=310) examining the effects of CCS in women with HG. Meta-analysis was possible for one outcome (n=214) and showed no significant effect of CCS on readmission rates (odds ratio, 0.37; 95% confidence internal: 0.1-1.35). Two small studies (n=104) reported a reduction of vomiting episodes, and one (n=24) found improvement of well-being, but no effect on other outcomes. None of the studies that investigated perinatal outcome (n = 173) found an effect of CCS and were underpowered to investigate teratogenic effects. We found evidence of publication bias. CONCLUSION: Meta-analysis yielded no effect of CCS therapy on readmission rates. Single small studies indicated possible beneficial effects on other outcomes. Future high-quality trials are necessary and would benefit from consensus on HG definition and core outcomes of HG therapy.