TREATMENT OF NAUSEA AND VOMITING IN PREGNANCY

Nausea and vomiting of pregnancy (NVP) is extremely common, affecting up to 90% of women. NVP generally starts between weeks four and seven and resolves by week 20 in 90% of cases. Symptoms can range from mild, to those that severely impair quality of life.

Women with mild NVP can be advised that self-management strategies may improve symptoms. These include regularly eating smaller amounts of food to avoid an empty stomach, avoiding food or smells that trigger symptoms, and drinking adequate fluids. Where treatment with antiemetics is required, the Royal College of Obstetricians and Gynaecologists (RCOG) recommends the antihistamines cyclizine and promethazine, or the phenothiazines prochlorperazine and chlorpromazine as first-line options. A doxylamine/pyridoxine combination product (Xonvea®) is licensed for the treatment of NVP and can also be offered as a first-line option. Second-line treatment options include ondansetron and metoclopramide.

Hyperemesis gravidarum (HG) is defined as nausea and/or vomiting that is severe enough to prevent normal eating and drinking, strongly limits activities of daily living, and is accompanied by signs of dehydration. HG affects up to 3.6% of pregnant women and starts in early pregnancy.

Ambulatory day care (where locally available) or hospital admission may be warranted for treatment with intravenous fluids, electrolytes, vitamins, and anti-coagulants, as well as proton pump inhibitors and antiemetics. In severe cases of HG, treatment with corticosteroids may be considered and enteral or parenteral nutrition may be indicated.