Nausea and Vomiting of Pregnancy

Publication Date: January 1, 2018
Last Updated: March 14, 2022

Recommendations

Treatment of nausea and vomiting of pregnancy with vitamin B6 (pyridoxine) alone or vitamin B6 (pyridoxine) plus doxylamine in combination is safe and effective and should be considered first-line pharmacotherapy. (A)
574
The standard recommendation to take prenatal vitamins for 1 month before fertilization may reduce the incidence and severity of nausea and vomiting of pregnancy. (A)
574
The appropriate management of abnormal maternal thyroid tests attributable to gestational transient thyrotoxicosis, or hyperemesis gravidarum, or both, includes supportive therapy, and antithyroid drugs are not recommended. (A)
574
Treatment of nausea and vomiting of pregnancy with ginger has shown some beneficial effects in reducing nausea symptoms and can be considered as a nonpharmacologic option. (B)
574
Treatment of severe nausea and vomiting of pregnancy or hyperemesis gravidarum with methylprednisolone may be efficacious in refractory cases; however, the risk profile of methylprednisolone suggests it should be a last-resort treatment. (B)
574
Early treatment of nausea and vomiting of pregnancy may be beneficial to prevent progression to hyperemesis gravidarum. (C)
574
Intravenous hydration should be used for the patient who cannot tolerate oral liquids for a prolonged period or if clinical signs of dehydration are present.
Correction of ketosis and vitamin deficiency should be strongly considered. Dextrose and vitamins should be included in the therapy when prolonged vomiting is present, and thiamine should be administered before dextrose infusion to prevent Wernicke encephalopathy. (C)
574
Enteral tube feeding (nasogastric or nasoduodenal) should be initiated as the first-line treatment to provide nutritional support to the woman with hyperemesis gravidarum who is not responsive to medical therapy and cannot maintain her weight. (C)
574
Peripherally inserted central catheters should not be used routinely in women with hyperemesis gravidarum given the significant complications associated with this intervention. Peripherally inserted central catheters should be utilized only as a last resort in the management of a woman with hyperemesis gravidarum because of the potential of severe maternal morbidity. (C)
574

Recommendation Grading

Overview

Title

Nausea and Vomiting of Pregnancy

Authoring Organization

Publication Month/Year

January 1, 2018

Last Updated Month/Year

January 9, 2023

Document Type

Consensus

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Adolescent, Adult

Health Care Settings

Ambulatory

Intended Users

Physician, nurse midwife, nurse, nurse practitioner, physician assistant

Scope

Diagnosis, Management

Diseases/Conditions (MeSH)

D011247 - Pregnancy, D011248 - Pregnancy Complications, D048968 - Morning Sickness, D009325 - Nausea, D014839 - Vomiting

Keywords

pregnancy, nausea, vomiting, morning sickness