Clinical Review

Management of nausea and vomiting in pregnancy

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d3606 (Published 17 June 2011) Cite this as: BMJ 2011;342:d3606

This article has a correction. Please see:

  1. Sheba Jarvis, academic specialist registrar in endocrinology and diabetes1,
  2. Catherine Nelson-Piercy, professor of obstetric medicine 12
  1. 1Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0NN, UK
  2. 2Guys and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
  1. Correspondence to: C Nelson-Piercy catherine.nelson-piercy{at}gstt.nhs.uk

Summary points

  • Nausea and vomiting occur in most pregnancies but hyperemesis gravidarum occurs in less than 1%; it requires exclusion of other causes and more aggressive management, usually in hospital

  • Perform a full investigation including blood tests, urinalysis, and a pelvic ultrasound to assess severity and to rule out other causes and molar pregnancy

  • Rehydration is first line treatment, but in cases with ongoing nausea and vomiting, antiemetics should be prescribed

  • Phenothiazine, antihistamines, dopamine agonists, and selective 5-hydroxytryptamine receptor antagonists are all safe in pregnancy

  • In cases of intractable vomiting, combinations of several parenteral antiemetics may be needed

  • Consider corticosteroids in women with severe hyperemesis gravidarum who are resistant to conventional management

Nausea and vomiting are the most common symptoms of pregnancy. As a result many medical practitioners will encounter this problem and should be familiar with the appropriate investigations and current treatment options. Nausea and vomiting affect 50-90% of pregnant women, and in about 35% of these women symptoms are of clinical relevance, with both physical and psychosocial sequelae. Although colloquially referred to as “morning sickness,” for many women symptoms persist over the whole day, with a broad spectrum of severity ranging from occasional nausea to fulminant and intractable vomiting. Nausea and vomiting begin in the first trimester, at about six to eight weeks’ gestation, typically peaking at about nine weeks’ gestation and settling by about 12 weeks. Only a minority of women have symptoms after 20 weeks of gestation. Adequate oral hydration and avoidance of dietary triggers are often sufficient, but a proportion of women with severe and protracted nausea and vomiting will need antiemetic drugs.

Sources and selection criteria

We performed a PubMed search to identify peer reviewed original articles, meta-analyses, and reviews. Cochrane Collaboration and clinical evidence databases were reviewed as well. We considered only papers written in English and mainly included …

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