Just fell down a rabbit hole on hyperemesis gravidarum and now I can’t stop thinking about how treatment might change if we focus on the placenta-brain signaling piece (GDF15/GFRAL). Has anyone’s care team actually talked about this or tailored therapy around it?
Things I’m curious about that I haven’t seen discussed much here:
- NK1 receptor antagonists in real life: aprepitant or rolapitant for refractory HG. Did any OBs or MFM teams offer these? What dosing, how soon did they help, any side effects or insurance hurdles?
- Mirtazapine or low-dose olanzapine as antiemetics: I’m seeing case reports where they helped with nausea, sleep, anxiety, and weight loss. Anyone try them, and did the sedation trade-off feel worth it?
- Neuromodulation gadgets: beyond P6 acupressure bands, has anyone used electrical P6 devices or vagus nerve stimulation wearables for HG-level nausea? Did they meaningfully reduce ER visits or meds?
- At-home care innovation: subcutaneous ondansetron pumps vs intermittent IV infusions-what worked better? Any clinics pairing this with home QTc monitoring via phone-based ECG to dose safely?
- Early nutrition strategy: experiences with nasojejunal tube feeding to avoid PICC/TPN and line complications. What tipped the scale for your team to place an NJ vs going straight to parenteral?
- Thiamine-first protocols: were you given IV thiamine before any dextrose-containing fluids? If yes, how often and for how long? Anyone have a written protocol their hospital uses that actually gets followed?
- Helicobacter pylori screening: did anyone get tested during pregnancy and notice HG improvement after eradication (now or postpartum)? Which test was used, and how did your team weigh antibiotic choices?
- Metformin and GDF15: since metformin can raise GDF15, did anyone with preexisting diabetes/PCOS notice worse HG on metformin and improvement after switching strategies?
- Dysautonomia/POTS overlap: if you have baseline tachycardia or orthostatic issues, did scheduled saline infusions or compression gear noticeably change your nausea/vomiting trajectory?
- Biomarkers and trials: has anyone had GDF15 measured, or been offered a study targeting this pathway? I’m seeing cachexia drugs in development that block GDF15/GFRAL-any pregnancy-safe angles being explored?
- Non-oral routes that actually work: favorite combos of ODTs, dissolvables, rectal suppositories, transdermal patches, or compounded formulations that bypass the “I can’t keep anything down” stage?
I’m collecting real-world experiences and any protocol handouts that people were given so we can compile a practical “show-your-OB” one-pager. What genuinely moved the needle for you, and what turned out to be hype?