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    ACOG Guidelines at a Glance: Nausea and Vomiting of Pregnancy

     

    Medical management

    Prolonged and persistent nausea and vomiting can lead to dehydration, ketosis, and electrolyte imbalance. As such, judicious IV hydration, including electrolytes, dextrose and thiamine-containing vitamins, should be administered to women who cannot tolerate oral liquids or feeding.

    Enteral or parenteral nutrition is occasionally required for women with persistent hyperemesis who are not responsive to medical management and unable to stabilize their weight. If necessary, total parenteral nutrition through a peripherally inserted central catheter (PICC) can be used as a last resort.  However, PICC parenteral nutrition is not without the potential for maternal infectious morbidities.

    Summary

    Nausea and vomiting of pregnancy is common, impacts quality of life, and is costly. Hyperemesis is a serious form of the conditions and has the potential for serious morbidity if not managed appropriately.

    Prenatal vitamins in the preconception period may reduce the severity of nausea and vomiting in early pregnancy.  Early treatment with vitamin B6 and B6 plus doxylamine as a first-line therapy is safe and effective.

    Hyperemesis or refractory cases lead to dehydration, vitamin deficiency, and weight loss, therefore, attention to hydration, vitamin replacement, nutrition, and antiemetic therapy is critical to avoid maternal morbidity.

    ACOG Abstract References

    1. Attard CL, Kohli MA, Colemans S. Bradley C, Hux M, Atanackovic G, et al. The burden of illness of severe nausea and vomiting of pregnancy in the United States. Am J Obstet Gynecol 2002;186:S220-7.

    2. Piwko C, Koren G, Babshov V, Vicente C, Einarson TR. Economic burden of nausea and vomiting of pregnancy in the USA. J Popul Ther Clin Pharmacol 2013;20:e149-60.

    3. O’Brien B, Naber S. Nausea and vomiting during pregnancy: effects on the quality of women’s lives. Birth 1992;19:138-43.

    4. Brent R. Medical, social, and legal implications of treating nausea and vomiting of pregnancy. Am J Obstet Gynecol 2002;186:S262-6.

    Commentary References

    1. Trogstad LI, Stoltenberg C, Magnus P, Skjaerven R, Irtens LM. Recurrence risk in hyperemesis gravidarum. BJOG 2005;112:1641-5.

    2. Matthews A, Haas DM, O’Mathuna DP, Dowswell T, Doyle M. Interventions for nausea and vomiting in early pregnancy. Cochrane Database of systematic Reviews 2014, Issue 3. Art. No:  CD007575. DOI: 10.1002/14651858. CD007575.pub3.

    3. Nausea and Vomiting of Pregnancy. American College of Obstetricians and Gynecologists. Practice Bulletin Number 153, September 2014.

    4. Veenendaal MV, van Abeelen AF, Painter RC, van der Post JA, Roseboom TJ. Consequences of hyperemesis gravidarum for offspring: a systematic review and meta-analysis. BJOG 2011;118:1302-13.

    5. Vutyavanich T, Kraisarin T, Ruangsri R. ginger for nausea and vomiting in pregnancy: randomized, double masked, placebo-controlled trial. Obstet Gynecol 2001;97:577-82.

    6. 6. Slaughter SR, Hearns-Stokes R, van der Vlugt T, Joffe HV. FDA approval of doxylamine-pyridoxine therapy for use in pregnancy. N Engl J Med 2014;370:1081-3.

    7. Reichmann JP, Kirkbride MS. Reviewing the evidence for using continuous subcutaneous metoclopramide and ondansetron to treat nausea and vomiting during pregnancy. Manag Care 2012;21:4407.

    8. Einarson A, Maltepe C, Navioz Y, Kennedy D, Tan MP, Koren G. The safety of ondansetron for nausea and vomiting of pregnancy: a prospective comparative study. BJOG 2004;111:940-3.

    9. Safari HR, Fassett MJ, Souter IC, Alsulyman OM, Goodwin TM. The efficacy of methyprednisone in the treatment of hyperemesis gravidarum: A randomized double-blind, controlled study. Am J Obstet Gynecol 1998;179:921-4.

    Haywood L. Brown, MD
    Dr. Brown is the F. Bayard Carter Professor and Chair, Division of Maternal Fetal Medicine, Duke University Medical Center, Durham, ...

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