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Nausea and Vomiting of Pregnancy

  • Practice Bulletin PB
  • Number 189
  • January 2018

ABSTRACT: Nausea and vomiting of pregnancy is a common condition that affects the health of a pregnant woman and her fetus. It can diminish a woman’s quality of life and also significantly contributes to health care costs and time lost from work 1 2. Because morning sickness is common in early pregnancy, the presence of nausea and vomiting of pregnancy may be minimized by obstetricians, other obstetric care providers, and pregnant women and, thus, undertreated 1. Furthermore, some women do not seek treatment because of concerns about the safety of medications 3. Once nausea and vomiting of pregnancy progresses, it can become more difficult to control symptoms. Treatment in the early stages may prevent more serious complications, including hospitalization 4. Safe and effective treatments are available for more severe cases, and mild cases of nausea and vomiting of pregnancy may be resolved with lifestyle and dietary changes. The woman’s perception of the severity of her symptoms plays a critical role in the decision of whether, when, and how to treat nausea and vomiting of pregnancy. Nausea and vomiting of pregnancy should be distinguished from nausea and vomiting related to other causes. The purpose of this document is to review the best available evidence about the diagnosis and management of nausea and vomiting of pregnancy.

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Figures & Tables

Figure 1. Algorithm of therapeutic treatment of nausea and vomiting of pregnancy (if no improvement, proceed to next step in algorithm). This algorithm assumes other causes of nausea and vomiting have been ruled out. At any step, consider enteral nutrition if dehydration or persistent weight loss is noted. *Some antiemetic medications have only been approved by the U.S. Food and Drug Administration for use in nonpregnant patients; however, off-label use is common. Obstetricians and other obstetric care providers should counsel patients and document such discussions accordingly. Care should be exercised if multiple antiemetic medications are used simultaneously. Parallel use of some medications (see text) may result in an increased risk of adverse effects. † In the United States, doxylamine is available as the active ingredient in some over-the-counter sleep aids; one half of a scored 25-mg tablet can be used to provide a 12.5-mg dose of doxylamine. ‡ Thiamine, intravenously, 100 mg with the initial rehydration fluid and 100 mg daily for the next 2–3 days (followed by intravenous multivitamins), is recommended for women who require intravenous hydration and have vomited for more than 3 weeks to prevent a rare but serious maternal complication, Wernicke encephalopathy. (Modified from Levichek Z, Atanackovic G, Oepkes D, Maltepe C, Einarson A, Magee L, et al. Nausea and vomiting of pregnancy. Evidence-based treatment algorithm. Can Fam Physician 2002;48:267–8, 277.)

Figure 1. Algorithm of therapeutic treatment of nausea and vomiting of pregnancy (if no improvement, proceed to next step in algorithm). This algorithm assumes other causes of nausea and vomiting have been ruled out. At any step, consider enteral nutrition if dehydration or persistent weight loss is noted. *Some antiemetic medications have only been approved by the U.S. Food and Drug Administration for use in nonpregnant patients; however, off-label use is common. Obstetricians and other obstetric care providers should counsel patients and document such discussions accordingly. Care should be exercised if multiple antiemetic medications are used simultaneously. Parallel use of some medications (see text) may result in an increased risk of adverse effects. † In the United States, doxylamine is available as the active ingredient in some over-the-counter sleep aids; one half of a scored 25-mg tablet can be used to provide a 12.5-mg dose of doxylamine. ‡ Thiamine, intravenously, 100 mg with the initial rehydration fluid and 100 mg daily for the next 2–3 days (followed by intravenous multivitamins), is recommended for women who require intravenous hydration and have vomited for more than 3 weeks to prevent a rare but serious maternal complication, Wernicke encephalopathy. (Modified from Levichek Z, Atanackovic G, Oepkes D, Maltepe C, Einarson A, Magee L, et al. Nausea and vomiting of pregnancy. Evidence-based treatment algorithm. Can Fam Physician 2002;48:267–8, 277.)

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Table 1. Modified Pregnancy-Unique Quantification of Emesis and Nausea

Table 1. Modified Pregnancy-Unique Quantification of Emesis and Nausea

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