TREATMENT OF NAUSEA AND VOMITING IN PREGNANCY

View printable version
(Date of issue: September 2019, Version: 2.0)

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 of pregnancy (NVP) is extremely common and is generally reported between weeks 6-16, though may persist for longer in a minority of women. Symptoms can range from mild, to those that severely impair quality of life.

Women with mild NVP should be advised of self-management strategies including eating smaller regular meals, avoiding fatty foods and food with strong odours, and drinking adequate fluids. Eating foods containing ginger and use of acupressure can also be tried for mild cases. Where treatment with anti-emetics is required, the Royal College of Obstetricians and Gynaecologists (RCOG) recommends the antihistamines cyclizine and promethazine, or the phenothiazines prochlorperazine or chlorpromazine as first-line options. A doxylamine/pyridoxine combination product (Xonvea®) was licensed for the treatment of NVP in the UK in 2018 and can also be offered as a first-line option. Metoclopramide, domperidone, and ondansetron can be considered as second-line treatments.

Hyperemesis gravidarum (HG) is thought to affect less than 1% of pregnant women and is defined as intractable vomiting resulting in 5% of pre-pregnancy weight loss, dehydration, and electrolyte disturbance. Ambulatory day care (where locally available) or hospital admission may be warranted for treatment with intravenous fluids, electrolytes, vitamins, and anti-coagulants, as well as anti-emetics. In severe cases of HG, where first- and second-line anti-emetic treatments have proved ineffective, treatment with corticosteroids may be considered and enteral or parenteral nutrition may be indicated.

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.