Overview
Nausea and vomiting in pregnancy (NVP) range from mild morning sickness to severe hyperemesis gravidarum (HG), significantly impacting maternal well-being and healthcare costs 17.Diagnosis
Severity Classification: Use validated tools like PUQE and HELP to classify NVP and HG severity 1.
Avoid Misleading Indicators: Ketone levels are not indicative of dehydration and should not be used to assess severity 1.Management
First-Line Treatments:
- Antihistamines (e.g., doxylamine/pyridoxine [Xonvea®])
- Phenothiazines
- Vitamin B6 (pyridoxine) supplementation (10mg daily) 3
Second-Line Treatments:
- Ondansetron: Safe and effective; use if first-line treatments are ineffective, despite a small increased risk of orofacial clefting 1.
- Metoclopramide: Safe and effective, but use cautiously due to extrapyramidal effects 1.Special Populations
Pregnancy: Management should prioritize safety and efficacy, with evidence supporting the use of ondansetron and metoclopramide in severe cases 14.Key Recommendations
Utilize validated tools like PUQE and HELP for assessing NVP severity (Evidence: Strong 1).
Prescribe first-line antiemetics such as antihistamines, phenothiazines, and vitamin B6 supplementation initially (Evidence: Strong 13).
Consider ondansetron as a second-line option if first-line treatments fail, balancing risks with benefits (Evidence: Moderate 1).
Use metoclopramide cautiously as a second-line therapy due to potential extrapyramidal effects (Evidence: Moderate 1).
Early recognition and management of NVP can reduce healthcare costs and improve quality of life (Evidence: Moderate 7).
Avoid using ketonuria as a marker for assessing severity or dehydration status (Evidence: Strong 1).
Health plans should prioritize evidence-based pharmacologic interventions to manage NVP effectively and cost-efficiently (Evidence: Expert opinion 5).References
1 Nelson-Piercy C, Dean C, Shehmar M, Gadsby R, O'Hara M, Hodson K et al.. The Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum (Green-top Guideline No. 69). BJOG : an international journal of obstetrics and gynaecology 2024. link
2 Tan A, Foran T, Henry A. Managing nausea and vomiting in pregnancy in a primary care setting. Australian family physician 2016. link
3 Wibowo N, Purwosunu Y, Sekizawa A, Farina A, Tambunan V, Bardosono S. Vitamin B₆ supplementation in pregnant women with nausea and vomiting. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2012. link
4 Nulman I, Koren G. Diclectin for morning sickness: Long-term neurodevelopment. Canadian family physician Medecin de famille canadien 2011. link
5 Reichmann JP, Kirkbride MS. Nausea and vomiting of pregnancy: cost effective pharmacologic treatments. Managed care (Langhorne, Pa.) 2008. link
6 Woolhouse M. Complementary medicine for pregnancy complications. Australian family physician 2006. link
7 Arsenault MY, Lane CA, MacKinnon CJ, Bartellas E, Cargill YM, Klein MC et al.. The management of nausea and vomiting of pregnancy. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2002. link