Main Article Content
Abstract
Purpose: This study examines the role of soy biscuits as supplementary food in reducing the frequency and severity of nausea and vomiting in pregnant women experiencing hyperemesis gravidarum (HG) in health crises. The research explores the nutritional effectiveness of soy biscuits, their acceptability among pregnant women, and their potential as a non-pharmacological intervention in community-based maternal healthcare settings, particularly at TPMB Hj Sitti Hasrah Ibrahim.
Research Design and Methodology: This study employs a systematic literature review (SLR) approach, analyzing relevant studies from peer-reviewed journals to assess the impact of protein-based nutritional interventions on HG symptoms. The research synthesizes evidence on dietary strategies, maternal nutrition, and the physiological mechanisms through which soy biscuits alleviate HG symptoms. The review also incorporates empirical data from similar interventions to evaluate their feasibility in low-resource and crisis-affected healthcare settings.
Findings and Discussion: The findings indicate that soy biscuits significantly stabilize blood sugar levels, reduce gastric motility disturbances, and improve maternal food tolerance. Compared to high-carbohydrate or high-fat diets, a protein-based nutrition approach is more effective in managing nausea and vomiting in patients with HG. Additionally, soy biscuits are well-tolerated and accepted by pregnant women, making them a practical intervention for managing HG in settings with limited access to pharmacological treatments.
Implications: This study offers practical insights for healthcare providers, policymakers, and food manufacturers advocating for nutritional interventions in maternal healthcare programs. Future research should investigate alternative formulations, large-scale implementation, and long-term health outcomes to establish a comprehensive dietary strategy for managing HG.
Keywords
Article Details

This work is licensed under a Creative Commons Attribution 4.0 International License.
References
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- Dahab, A., Qurban, S., Altowyrqi, G., Aljuhani, R., Haij, J., Alkhunaizi, N., Alshaikh, I., Shakally, S., Ali, S., & Alshalawi, B. (2023). Presentation, Treatment, and Complications of Acute Dehydration in Hyperemesis Gravidarum. https://doi.org/10.52533/JOHS.2023.30909
- Elkins, J. R., Oxentenko, A. S., & Nguyen, L. A. B. (2022). Hyperemesis gravidarum and nutritional support. Official Journal of the American College of Gastroenterology| ACG, 117(10S), 2–9. https://doi.org/10.14309/ajg.0000000000001957
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- Fierro, P. (2012). The Everything Twins, Triplets, and More Book: From pregnancy to delivery and beyond--all you need to enjoy your multiples. Simon and Schuster.
- Gadsby, R., Barnie-Adshead, A. M., & Jagger, C. (1993). A prospective study of nausea and vomiting during pregnancy. British Journal of General Practice, 43(371), 245–248. https://bjgp.org/content/43/371/245.short
- Galletta, M. A. K., Carrieri, A., Peres, S. V., Dias, M. C. G., & Francisco, R. P. V. (2022). Weight loss among pregnant women hospitalized because of hyperemesis gravidarum: Is there a lack of nutrition intervention? Nutrition in Clinical Practice, 37(4), 887–895. https://doi.org/10.1002/ncp.10798
- Jennings, L. K., & Mahdy, H. (2018). Hyperemesis gravidarum. https://europepmc.org/books/nbk532917.
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- Lammi-Keefe, C. J., Couch, S. C., & Philipson, E. H. (2008). Handbook of nutrition and pregnancy. Springer. https://doi.org/10.1007/978-3-319-90988-2
- Ledward, R. S., Hawkins, D. F., & Stern, L. (2013). Drug treatment in obstetrics: A handbook of prescribing. Springer. https://doi.org/10.1007/978-1-4899-3296-9
- Liu, C., Zhao, G., Qiao, D., Wang, L., He, Y., Zhao, M., Fan, Y., & Jiang, E. (2022). Emerging progress in nausea and vomiting of pregnancy and hyperemesis gravidarum: challenges and opportunities. Frontiers in Medicine, 8, 809270. https://doi.org/10.3389/fmed.2021.809270
- Maslin, K., & Dean, C. (2022). Nutritional consequences and management of hyperemesis gravidarum: a narrative review. Nutrition Research Reviews, 35(2), 308–318. https://doi.org/DOI: 10.1017/S0954422421000305
- Maslin, K., Dean, C., & Shawe, J. (2023). The Nutritional Online sUrvey for pRegnancy Induced Sickness & Hyperemesis (NOURISH) study: results from the first trimester. Journal of Human Nutrition and Dietetics, 36(5), 1821–1832. https://doi.org/10.1111/jhn.13224
- Morokuma, S., Shimokawa, M., Kato, K., Sanefuji, M., Shibata, E., Tsuji, M., Senju, A., Kawamoto, T., Kusuhara, K., Kawamoto, T., Saito, H., Kishi, R., Yaegashi, N., Hashimoto, K., Mori, C., Hirahara, F., Yamagata, Z., Inadera, H., Kamijima, M., … Group, J. E. & C. S. (2016). Relationship between hyperemesis gravidarum and small-for-gestational-age in the Japanese population: the Japan Environment and Children’s Study (JECS). BMC Pregnancy and Childbirth, 16(1), 247. https://doi.org/10.1186/s12884-016-1041-6
- Mullin, P., MacGibbon, K., Morgan, Z., & Fejzo, M. (2020). 82: Additional risk variant in GDF15 and a stronger maternal genetic influence linked to Hyperemesis Gravidarum. American Journal of Obstetrics & Gynecology, 222(1), S68. https://www.ajog.org/article/S0002-9378(19)31468-1/fulltext
- Nana, M., Tydeman, F., Bevan, G., Boulding, H., Kavanagh, K., Dean, C., & Williamson, C. (2021). Hyperemesis gravidarum is associated with increased rates of termination of pregnancy and suicidal ideation: results from a survey completed by> 5000 participants. American Journal of Obstetrics and Gynecology, 224(6), 629–631. https://doi.org/10.1016/j.ajog.2021.03.006
- Niebyl, J. R. (2010). Nausea and vomiting in pregnancy. New England Journal of Medicine, 363(16), 1544–1550. https://doi.org/10.1056/NEJMcp1003896
- Organization, W. H. (2013). Essential nutrition actions: improving maternal, newborn, infant and young child health and nutrition. World Health Organization.
- Oudman, E., Wijnia, J. W., Oey, M., van Dam, M., Painter, R. C., & Postma, A. (2019). Wernicke’s encephalopathy in hyperemesis gravidarum: A systematic review. European Journal of Obstetrics & Gynecology and Reproductive Biology, 236, 84–93. https://doi.org/https://doi.org/10.1016/j.ejogrb.2019.03.006
- Popa, S. L., Barsan, M., Caziuc, A., Pop, C., Muresan, L., Popa, L. C., & Perju-Dumbrava, L. (2021). Life-threatening complications of hyperemesis gravidarum. Experimental & Therapeutic Medicine, 21(6). https://doi.org/10.3892/etm.2021.10074
- Rondanelli, M., Perna, S., Cattaneo, C., Gasparri, C., Barrile, G. C., Moroni, A., Minonne, L., Lazzarotti, A., Mansueto, F., & Mazzola, G. (2025). A Food Pyramid and Nutritional Strategies for Managing Nausea and Vomiting During Pregnancy: A Systematic Review. Foods, 14(3), 373. https://doi.org/10.3390/foods14030373
- Ryan, J., Mansell, T., Fransquet, P., & Saffery, R. (2017). Does Maternal Mental Well-Being in Pregnancy Impact The Early Human Epigenome? Epigenomics, 9(3), 313–332. https://doi.org/10.2217/epi-2016-0118
- Sahakian, V., ROUSE, D., SIPES, S., ROSE, N., & NIEBYL, J. (1991). Vitamin B6 Is Effective Therapy for Nausea and Vomiting of Pregnancy: A Randomized, Double-Blind Placebo-Controlled Study. Obstetrics & Gynecology, 78(1). https://journals.lww.com/greenjournal/fulltext/1991/07000/vitamin_b6_is_effective_therapy_for_nausea_and.7.aspx
- Sutherland, H. W., Stowers, J. M., & Pearson, D. W. M. (2012). Carbohydrate Metabolism in Pregnancy and the Newborn· IV. Springer Science & Business Media. https://doi.org/10.1007/978-1-4471-1680-6
- Trüeb, R. M. (2020). Nutrition for healthy hair: guide to understanding and proper practice. Springer. https://doi.org/10.1007/978-3-030-59920-1
- Varshavsky, J., Smith, A., Wang, A., Hom, E., Izano, M., Huang, H., Padula, A., & Woodruff, T. J. (2020). Heightened susceptibility: A review of how pregnancy and chemical exposures influence maternal health. Reproductive Toxicology, 92, 14–56. https://doi.org/https://doi.org/10.1016/j.reprotox.2019.04.004
- Vinnars, M., Forslund, M., Claesson, I., Hedman, A., Peira, N., Olofsson, H., Wernersson, E., & Ulfsdottir, H. (2024). Treatments for hyperemesis gravidarum: A systematic review. Acta Obstetricia et Gynecologica Scandinavica, 103(1), 13–29. https://doi.org/10.1111/aogs.14706
- Zhi, S., Zhang, L., Cheng, W., Jin, Y., Long, Z., Gu, W., Ma, L., Zhang, S., & Lin, J. (2024). Association between Dietary Inflammatory Index and Hyperemesis Gravidarum. Nutrients, 16(16), 2618. https://doi.org/10.3390/nu16162618
- Zinga, J., McKay, F. H., Lindberg, R., & van der Pligt, P. (2022). Experiences of Food-Insecure Pregnant Women and Factors Influencing Their Food Choices. Maternal and Child Health Journal, 26(7), 1434–1441. https://doi.org/10.1007/s10995-022-03440-3
References
Ariyanti, R., Widyawati, M. N., Nurasmi, N., Mardhiana, M., & Yulianti, I. (2023). The effect of dayak ginger (Zingiber Officinale Roscoe) extraction in ginger cookies in reducing emesis gravidarum severity among pregnant women. Healthcare in Low-Resource Settings, 11(2). https://doi.org/10.4081/hls.2023.11753
Austin, K., Wilson, K., & Saha, S. (2019). Hyperemesis gravidarum. Nutrition in Clinical Practice, 34(2), 226–241. https://doi.org/10.1002/ncp.10205
Beirne, E. R., Andrews, L. B., Murtagh, L. P., Browne, S., Curran, S. B., & O’Brien, E. C. (2023). The far-reaching burden of Hyperemesis Gravidarum – an exploration of women’s experiences and perceptions of healthcare support. Women & Health, 63(7), 485–494. https://doi.org/10.1080/03630242.2023.2219749
Cheng, W., Li, L., Long, Z., Ma, X., Chen, F., Ma, L., Zhang, S., & Lin, J. (2023). Association between Dietary Patterns and the Risk of Hyperemesis Gravidarum. Nutrients, 15(15). https://doi.org/10.3390/nu15153300
Chortatos, A. (2017). Nausea and vomiting in pregnancy: effects on maternal diet, health, and birth outcomes. An investigation using the Norwegian Mother and Child Cohort Study. http://urn.nb.no/URN:NBN:no-56835
Dahab, A., Qurban, S., Altowyrqi, G., Aljuhani, R., Haij, J., Alkhunaizi, N., Alshaikh, I., Shakally, S., Ali, S., & Alshalawi, B. (2023). Presentation, Treatment, and Complications of Acute Dehydration in Hyperemesis Gravidarum. https://doi.org/10.52533/JOHS.2023.30909
Elkins, J. R., Oxentenko, A. S., & Nguyen, L. A. B. (2022). Hyperemesis gravidarum and nutritional support. Official Journal of the American College of Gastroenterology| ACG, 117(10S), 2–9. https://doi.org/10.14309/ajg.0000000000001957
Erdal, H., Holst, L., Heitmann, K., Volløyhaug, I., Torkildsen, E. A., Andreasen, S., Kjelstad, K. B., Bakkebø, J. B., & Trovik, J. (2024). Guidelines for Treatment of Hyperemesis Gravidarum and Implementation in Clinical Practice in Norway: A Descriptive Study. International Journal of Clinical Practice, 2024(1), 8830099. https://doi.org/10.1155/2024/8830099
Fejzo, M., Rocha, N., Cimino, I., Lockhart, S. M., Petry, C. J., Kay, R. G., Burling, K., Barker, P., George, A. L., Yasara, N., Premawardhena, A., Gong, S., Cook, E., Rimmington, D., Rainbow, K., Withers, D. J., Cortessis, V., Mullin, P. M., MacGibbon, K. W., … O’Rahilly, S. (2024). GDF15 linked to maternal risk of nausea and vomiting during pregnancy. Nature, 625(7996), 760–767. https://doi.org/10.1038/s41586-023-06921-9
Fejzo, M. S., Trovik, J., Grooten, I. J., Sridharan, K., Roseboom, T. J., Vikanes, Å., Painter, R. C., & Mullin, P. M. (2019). Nausea and vomiting of pregnancy and hyperemesis gravidarum. Nature Reviews. Disease Primers, 5(1), 62. https://doi.org/10.1038/s41572-019-0110-3
Fierro, P. (2012). The Everything Twins, Triplets, and More Book: From pregnancy to delivery and beyond--all you need to enjoy your multiples. Simon and Schuster.
Gadsby, R., Barnie-Adshead, A. M., & Jagger, C. (1993). A prospective study of nausea and vomiting during pregnancy. British Journal of General Practice, 43(371), 245–248. https://bjgp.org/content/43/371/245.short
Galletta, M. A. K., Carrieri, A., Peres, S. V., Dias, M. C. G., & Francisco, R. P. V. (2022). Weight loss among pregnant women hospitalized because of hyperemesis gravidarum: Is there a lack of nutrition intervention? Nutrition in Clinical Practice, 37(4), 887–895. https://doi.org/10.1002/ncp.10798
Jennings, L. K., & Mahdy, H. (2018). Hyperemesis gravidarum. https://europepmc.org/books/nbk532917.
Koot, M. H., Grooten, I. J., Post, J. A. M. vd, Bais, J. M. J., Ris-Stalpers, C., Naaktgeboren, C. A., Niemeijer, M. N., Bremer, H. A., van der Ham, D. P., Heidema, W. M., Huisjes, A., Kleiverda, G., Kuppens, S. M., van Laar, J. O. E. H., Langenveld, J., van der Made, F., Papatsonis, D., Pelinck, M. J., Pernet, P. J., … Painter, R. C. (2020). Ketonuria is not associated with hyperemesis gravidarum disease severity. European Journal of Obstetrics & Gynecology and Reproductive Biology, 254, 315–320. https://doi.org/https://doi.org/10.1016/j.ejogrb.2020.08.014
Lammi-Keefe, C. J., Couch, S. C., & Philipson, E. H. (2008). Handbook of nutrition and pregnancy. Springer. https://doi.org/10.1007/978-3-319-90988-2
Ledward, R. S., Hawkins, D. F., & Stern, L. (2013). Drug treatment in obstetrics: A handbook of prescribing. Springer. https://doi.org/10.1007/978-1-4899-3296-9
Liu, C., Zhao, G., Qiao, D., Wang, L., He, Y., Zhao, M., Fan, Y., & Jiang, E. (2022). Emerging progress in nausea and vomiting of pregnancy and hyperemesis gravidarum: challenges and opportunities. Frontiers in Medicine, 8, 809270. https://doi.org/10.3389/fmed.2021.809270
Maslin, K., & Dean, C. (2022). Nutritional consequences and management of hyperemesis gravidarum: a narrative review. Nutrition Research Reviews, 35(2), 308–318. https://doi.org/DOI: 10.1017/S0954422421000305
Maslin, K., Dean, C., & Shawe, J. (2023). The Nutritional Online sUrvey for pRegnancy Induced Sickness & Hyperemesis (NOURISH) study: results from the first trimester. Journal of Human Nutrition and Dietetics, 36(5), 1821–1832. https://doi.org/10.1111/jhn.13224
Morokuma, S., Shimokawa, M., Kato, K., Sanefuji, M., Shibata, E., Tsuji, M., Senju, A., Kawamoto, T., Kusuhara, K., Kawamoto, T., Saito, H., Kishi, R., Yaegashi, N., Hashimoto, K., Mori, C., Hirahara, F., Yamagata, Z., Inadera, H., Kamijima, M., … Group, J. E. & C. S. (2016). Relationship between hyperemesis gravidarum and small-for-gestational-age in the Japanese population: the Japan Environment and Children’s Study (JECS). BMC Pregnancy and Childbirth, 16(1), 247. https://doi.org/10.1186/s12884-016-1041-6
Mullin, P., MacGibbon, K., Morgan, Z., & Fejzo, M. (2020). 82: Additional risk variant in GDF15 and a stronger maternal genetic influence linked to Hyperemesis Gravidarum. American Journal of Obstetrics & Gynecology, 222(1), S68. https://www.ajog.org/article/S0002-9378(19)31468-1/fulltext
Nana, M., Tydeman, F., Bevan, G., Boulding, H., Kavanagh, K., Dean, C., & Williamson, C. (2021). Hyperemesis gravidarum is associated with increased rates of termination of pregnancy and suicidal ideation: results from a survey completed by> 5000 participants. American Journal of Obstetrics and Gynecology, 224(6), 629–631. https://doi.org/10.1016/j.ajog.2021.03.006
Niebyl, J. R. (2010). Nausea and vomiting in pregnancy. New England Journal of Medicine, 363(16), 1544–1550. https://doi.org/10.1056/NEJMcp1003896
Organization, W. H. (2013). Essential nutrition actions: improving maternal, newborn, infant and young child health and nutrition. World Health Organization.
Oudman, E., Wijnia, J. W., Oey, M., van Dam, M., Painter, R. C., & Postma, A. (2019). Wernicke’s encephalopathy in hyperemesis gravidarum: A systematic review. European Journal of Obstetrics & Gynecology and Reproductive Biology, 236, 84–93. https://doi.org/https://doi.org/10.1016/j.ejogrb.2019.03.006
Popa, S. L., Barsan, M., Caziuc, A., Pop, C., Muresan, L., Popa, L. C., & Perju-Dumbrava, L. (2021). Life-threatening complications of hyperemesis gravidarum. Experimental & Therapeutic Medicine, 21(6). https://doi.org/10.3892/etm.2021.10074
Rondanelli, M., Perna, S., Cattaneo, C., Gasparri, C., Barrile, G. C., Moroni, A., Minonne, L., Lazzarotti, A., Mansueto, F., & Mazzola, G. (2025). A Food Pyramid and Nutritional Strategies for Managing Nausea and Vomiting During Pregnancy: A Systematic Review. Foods, 14(3), 373. https://doi.org/10.3390/foods14030373
Ryan, J., Mansell, T., Fransquet, P., & Saffery, R. (2017). Does Maternal Mental Well-Being in Pregnancy Impact The Early Human Epigenome? Epigenomics, 9(3), 313–332. https://doi.org/10.2217/epi-2016-0118
Sahakian, V., ROUSE, D., SIPES, S., ROSE, N., & NIEBYL, J. (1991). Vitamin B6 Is Effective Therapy for Nausea and Vomiting of Pregnancy: A Randomized, Double-Blind Placebo-Controlled Study. Obstetrics & Gynecology, 78(1). https://journals.lww.com/greenjournal/fulltext/1991/07000/vitamin_b6_is_effective_therapy_for_nausea_and.7.aspx
Sutherland, H. W., Stowers, J. M., & Pearson, D. W. M. (2012). Carbohydrate Metabolism in Pregnancy and the Newborn· IV. Springer Science & Business Media. https://doi.org/10.1007/978-1-4471-1680-6
Trüeb, R. M. (2020). Nutrition for healthy hair: guide to understanding and proper practice. Springer. https://doi.org/10.1007/978-3-030-59920-1
Varshavsky, J., Smith, A., Wang, A., Hom, E., Izano, M., Huang, H., Padula, A., & Woodruff, T. J. (2020). Heightened susceptibility: A review of how pregnancy and chemical exposures influence maternal health. Reproductive Toxicology, 92, 14–56. https://doi.org/https://doi.org/10.1016/j.reprotox.2019.04.004
Vinnars, M., Forslund, M., Claesson, I., Hedman, A., Peira, N., Olofsson, H., Wernersson, E., & Ulfsdottir, H. (2024). Treatments for hyperemesis gravidarum: A systematic review. Acta Obstetricia et Gynecologica Scandinavica, 103(1), 13–29. https://doi.org/10.1111/aogs.14706
Zhi, S., Zhang, L., Cheng, W., Jin, Y., Long, Z., Gu, W., Ma, L., Zhang, S., & Lin, J. (2024). Association between Dietary Inflammatory Index and Hyperemesis Gravidarum. Nutrients, 16(16), 2618. https://doi.org/10.3390/nu16162618
Zinga, J., McKay, F. H., Lindberg, R., & van der Pligt, P. (2022). Experiences of Food-Insecure Pregnant Women and Factors Influencing Their Food Choices. Maternal and Child Health Journal, 26(7), 1434–1441. https://doi.org/10.1007/s10995-022-03440-3