In the absence of any good-quality clinical evidence in this area, this updated guidance from CKS provides pragmatic advice for the management of women with nausea and vomiting in pregnancy.
It takes into account a clinical management guideline from the American College of Obstetricians and Gynecologists, an evidence-based review of nausea and vomiting in pregnancy, and feedback from expert reviewers.
Symptoms (nausea, vomiting or both) normally manifest before nine weeks of gestation in almost all affected women and are usually mild and self-limiting. However, a minority of women, for whom symptoms are more severe, will require further assessment. This group includes women with hyperemesis gravidarum, which commonly presents with:
- Persistent vomiting not related to other causes (the guidance has advice on what other causes to consider)
- Weight loss (usually at least 5% of pre-pregnancy body weight)
- Signs of acute starvation (usually large ketonuria).
The guidance recommends reassurance and simple lifestyle measures (e.g. diet, rest) in the first instance. Women should be informed of the circumstances when they should seek further medical advice. Over the counter (OTC) remedies are not recommended, but prescribed drug treatment may be considered if initial simple measures have failed and the woman has persistent, severe symptoms that prevent daily activities, or increased urine ketone levels.
Where drugs are necessary, promethazine is the first-line antiemetic; second-line choices are prochlorperazine or metoclopramide. It is important that, where drug treatments are prescribed, patients are followed up after 24 hours. Suggested dosing regimens are provided in the CKS guidance. No drugs are licensed for use in pregnancy; they should be given for the shortest time necessary to manage symptoms.
Please refer to the full guidance for more details.