A patient-clinician James Lind Alliance partnership to identify research priorities for hyperemesis gravidarum.

OBJECTIVE: There are many uncertainties surrounding the aetiology, treatment and sequelae of hyperemesis gravidarum (HG). Prioritising research questions could reduce research waste, helping researchers and funders direct attention to those questions which most urgently need addressing. The HG priority setting partnership (PSP) was established to identify and rank the top 25 priority research questions important to both patients and clinicians. METHODS: Following the James Lind Alliance (JLA) methodology, an HG PSP steering group was established. Stakeholders representing patients, carers and multidisciplinary professionals completed an online survey to gather uncertainties. Eligible uncertainties related to HG. Uncertainties on nausea and vomiting of pregnancy and those on complementary treatments were not eligible. Questions were verified against the evidence. Two rounds of prioritisation included an online ranking survey and a 1-hour consensus workshop. RESULTS: 1009 participants (938 patients/carers, 118 professionals with overlap between categories) submitted 2899 questions. Questions originated from participants in 26 different countries, and people from 32 countries took part in the first prioritisation stage. 66 unique questions emerged, which were evidence checked according to the agreed protocol. 65 true uncertainties were narrowed via an online ranking survey to 26 unranked uncertainties. The consensus workshop was attended by 19 international patients and clinicians who reached consensus on the top 10 questions for international researchers to address. More patients than professionals took part in the surveys but were equally distributed during the consensus workshop. Participants from low-income and middle-income countries noted that the priorities may be different in their settings. CONCLUSIONS: By following the JLA method, a prioritised list of uncertainties relevant to both HG patients and their clinicians has been identified which can inform the international HG research agenda, funders and policy-makers. While it is possible to conduct an international PSP, results from developed countries may not be as relevant in low-income and middle-income countries.

[Hyperemesis gravidarum]. / Hyperemesis gravidarum.

Hyperemesis gravidarum Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting during pregnancy, accompanied by weight loss, dehydration and electrolyte imbalances. There is no international agreement on diagnostic criteria for HG. The diagnosis of HG is only made on the basis of the clinical picture. HG has a significant impact on quality of life and is related to negative birth outcomes. The principal elements of HG treatment consist of antiemetics and intravenous rehydration. The probability that there will be a reoccurrence of HG during a subsequent pregnancy is 15-80%. If a subsequent pregnancy is desired, a preconception consultation may have added value.