Comparative effectiveness of six intravenous treatment protocols for hyperemesis gravidarum: A retrospective cohort study

Aim: To evaluate the real-world comparative effectiveness of six inpatient intravenous (IV) treatment protocols for hyperemesis gravidarum (HG), stratified by antiemetic strategy and IV B-complex vitamin supplementation.

Materials and Methods: We conducted a retrospective cohort study of women hospitalized for HG. Patients were classified into six treatment protocols according to IV antiemetic regimen (metoclopramide, ondansetron or no IV antiemetic) and IV B-complex vitamin use (yes/no). The primary outcome was early clinical response within 24-48 hours. Secondary outcomes included length of hospital stay (LOS), 14-day rehospitalization and treatment-related complications. Outcomes were compared across treatment protocols and according to B-complex exposure.

Results: A total of 1.120 women were included in the analysis. Crude outcomes differed across treatment protocols, with B-complex-containing regimens demonstrating higher rates of early clinical response and shorter LOS. When pooled by exposure, early clinical response occurred in 83.5% of patients receiving B-complex vitamins compared with 68.8% of those without supplementation, while mean LOS was 1.47 ± 0.50 days versus 2.62 ± 0.65 days, respectively (all p < 0.001). Rates of 14-day rehospitalization and treatment-related complications were comparable between groups. However, baseline clinical characteristics were largely similar across groups, and B-complex supplementation was not independently associated with early clinical response after adjustment for baseline severity and treatment-related factors in multivariable analyses.

Conclusion: In this large real-world inpatient cohort of women with HG, IV treatment protocols including B-complex vitamins were associated with more favorable short-term outcomes in unadjusted analyses; however, these associations were not clearly independent after accounting for clinical and treatment confounders. Nevertheless, B-complex supplementation should be considered a routine part of HG management, regardless of the antiemetic used, primarily for its role in neurological prophylaxis. These findings support efforts toward protocol standardization and suggest a more targeted, evidence-based approach to HG management.