Which statement about hyperemesis gravidarum and nutrition support is true?

• A. A trial of enteral nutrition before parenteral nutrition is appropriate
• B. Enteral nutrition is never used in HEG
• C. PN is always preferred over EN in HEG
• D. EN increases risk of intrahepatic cholestasis

Answer: (A)

In hyperemesis gravidarum, nutrition support should prioritize using the gut whenever possible. A trial of enteral nutrition before parenteral nutrition is appropriate because EN helps preserve gut mucosal integrity, reduces the risk of infection and sepsis, is usually safer and less costly, and avoids some metabolic complications associated with PN. Start with small, tolerable feeds or tube feeding as tolerated once fluids and electrolytes are corrected and the patient can protect their airway. If EN is not tolerated or cannot meet nutritional needs, then parenteral nutrition can be considered to prevent maternal malnutrition and support fetal growth.

Enteral nutrition is not never used in hyperemesis gravidarum; in fact, it is often used when feasible. Parenteral nutrition is not always preferred over enteral nutrition; guidelines generally favor EN first when the GI tract is functional. Enteral nutrition does not increase the risk of intrahepatic cholestasis; PN is more commonly associated with cholestasis due to lack of enteral stimulation.