Discussion
taste’ food item, obese, dehydration, overweight, weight loss
DEHYDRATION, OBESE, ELECTROLYTE IMBALANCE
Weight change metrics over the 2 weeks trial period following hospital discharge for HG were significantly better for the watermelon arm both at the end of the first week and through to the end of the second week as hypothesized. PUQE-24, SNAQ and wellbeing point estimates were also better at end of week 1 in the watermelon arm but these across arm differences only reached significance at the 5% level by the end of week 2. In addition, maternal satisfaction was higher and recommendation of intervention rate to friend or family of allocated intervention was also higher in the watermelon arm. The confluence of these findings points to a consistent positive impact of watermelon. However, on rehospitalization for HG, there was no difference.By the end of week 2, there was a 0.75 kg difference in weight change across trial arms, equivalent to body weight change of about 1.4%. HG has been defined as protracted NVP with the triad of more than 5% prepregnancy weight loss, dehydration and electrolyte imbalance [In overweight and obese adults, daily consumption of watermelon elicited more robust satiety responses, decreased body weight and body mass index [Rehospitalization for HG within the next two weeks of the trial period was 9.4%-9.5%; this compared with a 2009 trial report from our center that reports a rehospitalization of 21.1–37.5% in the two weeks after hospital discharge for HG; indicating that the dietary advice leaflet might have a positive effect when compared to historic data [A 2021 narrative review on nutritional management of HG finds limited evidence-based research on the effectiveness of dietary approaches [We designed our trial with an “interventional” control arm of a dietary advice leaflet. Effective treatment of HG requires a combination of medical interventions, lifestyle changes, dietary changes, supportive care, and patient education [The trial intervention of watermelon consumption and dietary advice leaflet compared to dietary advice leaflet alone resulted in significant clinical improvements: in reducing further weight loss (NNTAs to strengths, the trial is original in the evaluation of a simple diet-based approach to managing HG. The trial is powered to a realistic impact size estimation and the findings are in line with our hypothesis. There was minimal loss of data with only one participant (control arm) who withdrew due to bereavement. Self-reported compliance was good. The trial was designed to minimize confounding from control arm watermelon consumption and from suggestion and placebo effect impacts. The findings are believed to be generalizable to other HG populations as watermelon is a widely available fruit and not a particularly ‘acquired taste’ food item that could case issues with acceptability and compliance.As to limitations, the trial with a follow up of only 2 weeks, was not informative of a longer-term impact. Outcomes like inability to tolerate oral fluids or food, dehydration, daily functioning and considering terminating a wanted pregnancy as outcomes [