TREATMENT OF NAUSEA AND VOMITING IN PREGNANCY

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(Date of issue: May 2015, Version: 1.4)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

A corresponding patient information leaflet on treatment of nausea and vomiting in pregnancy is available at www.medicinesinpregnancy.org.

Summary

Nausea and vomiting are extremely common symptoms of pregnancy, generally reported between weeks 6-16.  In a minority of women symptoms persist for longer.

Hyperemesis gravidarum, defined as intractable vomiting resulting in dehydration, electrolyte disturbances and nutritional deficiencies, affects less than 1% of pregnant women.  In such cases, hospitalisation may be warranted for treatment with intravenous fluids, electrolytes and vitamins.

Treatment of nausea and vomiting in pregnancy may involve use of medicines with antiemetic properties, such as cyclizine, promethazine, prochlorperazine, metoclopramide, and ondansetron, as well as B-vitamins and corticosteroids.  Due to concerns regarding an increased risk of IUGR and certain congenital malformations, corticosteroid use in the treatment of hyperemesis gravidarum should be reserved for use in cases where potential benefit is thought to outweigh possible fetal risk. 

Antiemetics, for which human pregnancy data are very limited or not available, should not be used in preference to preparations for which epidemiological data  showing no evidence of adverse fetal effects are available, unless there is a clinically justifiable argument to do so, and the potential for fetal risk has been considered.

This document is regularly reviewed and updated. Only use full UKTIS monographs downloaded directly from TOXBASE.org to be sure you are using the most up-to-date version. The summaries of these monographs are openly available on UKTIS.org.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at www.toxbase.org.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.