TREATMENT OF NAUSEA AND VOMITING IN PREGNANCY

Nausea and vomiting of pregnancy (NVP) is extremely common and is generally reported between weeks 6-16, though may persist for longer in a minority of women. Symptoms can range from mild, to those that severely impair quality of life.

Women with mild NVP should be advised of self-management strategies including eating smaller regular meals, avoiding fatty foods and food with strong odours, and drinking adequate fluids. Eating foods containing ginger and use of acupressure can also be tried for mild cases. Where treatment with anti-emetics is required, the Royal College of Obstetricians and Gynaecologists (RCOG) recommends the antihistamines cyclizine and promethazine, or the phenothiazines prochlorperazine or chlorpromazine as first-line options. A doxylamine/pyridoxine combination product (Xonvea®) was licensed for the treatment of NVP in the UK in 2018 and can also be offered as a first-line option. Metoclopramide, domperidone, and ondansetron can be considered as second-line treatments.

Hyperemesis gravidarum (HG) is thought to affect less than 1% of pregnant women and is defined as intractable vomiting resulting in 5% of pre-pregnancy weight loss, dehydration, and electrolyte disturbance. 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 anti-emetics. In severe cases of HG, where first- and second-line anti-emetic treatments have proved ineffective, treatment with corticosteroids may be considered and enteral or parenteral nutrition may be indicated.