New Clinical Practice Guidelines, February 2018

John Anello; Brian Feinberg; John Heinegg; Yonah Korngold; Richard Lindsey; Cristina Wojdylo; Olivia Wong, DO


February 07, 2018

In This Article

Nausea and Vomiting in Pregnancy

American College of Obstetricians and Gynecologists

Use vitamin B6 (pyridoxine) alone or in combination with doxylamine as first-line pharmacotherapy, as they are safe and effective.

Clinicians should encourage women to take prenatal vitamins for 1 month before fertilization, as it may decrease the incidence and severity of nausea and vomiting during pregnancy.

Supportive therapy is recommended for abnormal maternal thyroid tests caused by gestational transient thyrotoxicosis or hyperemesis gravidarum, or both, but ACOG recommends against antithyroid medications.

Ginger may be used as a nonpharmacologic option, as it has had some beneficial effects in the treatment of nausea and vomiting of pregnancy.

Methylprednisolone has been effective in some refractory cases of severe nausea and vomiting of pregnancy; however, it should be considered a last-resort treatment as a result of its risk profile.

Early treatment of nausea and vomiting of pregnancy may help prevent it from progressing to hyperemesis gravidarum.

Intravenous hydration should be administered to patients who are unable to tolerate oral fluids for a prolonged period and if clinical signs of dehydration develop.

Strongly consider correction of ketosis and vitamin deficiency. Include dextrose and vitamins in therapy in cases of prolonged vomiting; consider administering thiamine before dextrose infusion to prevent Wernicke encephalopathy.

Begin enteral tube feeding (nasogastric or nasoduodenal) as first-line treatment to support nutrition for women with hyperemesis gravidarum who do not respond to medical therapy and who are unable to maintain their weight.

Use peripherally inserted central catheters only as a last resort in women with hyperemesis gravidarum, as significant complications are associated with this intervention, and there is the potential for severe maternal morbidity.



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