The management of nausea and vomiting during pregnancy

- References

1-     Gadsby R, Rawson V, Dziadulewicz E, Rousseau B, Collings H. Nausea and vomiting of pregnancy and resource implications: the NVP Impact Study. Br J Gen Pract. Mar 2019;69(680):e217-23. https:// doi. org/ 10. 3399/ bjgp1 8X700745

2-     Catherine Nelson-Piercy, Caitlin Dean, Manjeet Shehmar, Roger Gadsby, Margaret O'Hara, Kenneth Hodson | Melanie Nana | on behalf of the Royal College of Obstetricians and Gynaecologists. The Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum (Green-top Guideline No. 69), Royal College of Obstetricians and Gynaecologists, 10–18 Union Street, London SE1 1SZ. Email: clinicaleffectiveness@rcog.org.uk. Published online: 4 February 2024.

3-     Gadsby R, Ivanova D, Trevelyan E, Hutton JL, Johnson S. Nausea and vomiting in pregnancy is not just 'morning sickness': data from a prospective cohort study in the UK. Br J Gen Pract. 08 2020;70 (697) :e534-9.

4-     Nijsten K, Dean C, van der Minnen LM, et al. Recurrence, postponing pregnancy, and termination rates after hyperemesis gravidarum: Follow up of the MOTHER study. Acta Obstet Gynecol Scand. Sep 2021;100(9):1636-43.

5-     Fiaschi LN-PC, Deb S, King R, Tata LJ. Clinical management of nausea and vomiting in pregnancy and hyperemesis gravidarum across primary and secondary care: a population-based study. BJOG: an international journal of obstetrics and gynaecology. 2019;126(10):1201–11. [Comment in: BJOG. 2019 Sep;126(10):1212].

6-     Fejzo M, Rocha N, Cimino I, et al. Fetally-encoded GDF15 and maternal GDF15 sensitivity are major determinants of nausea and vomiting in human pregnancy. bioRxiv. [Preprint]. 2023 Jun 4:2023.06.02.542661. doi: 10.1101/2023.06.02.542661. PMID: 37398065; PMCID: PMC10312505.

7-     Mahmoud GA. Prevalence and risk factors of hyperemesis gravidarum among Egyptian pregnant women at the Woman Health Center. Med. J. Cairo Univ. 2012;80(2): 161-168.

8-     The Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum (Green-top Guideline No. 69). BJOG. 2024;131:e1–e30.

9-     Lowe SA, Bowyer L, Beech A, Tanner H, Armstrong G, Marnoch C, Grzeskowiak L. Position Statement on the Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum. The Society of Obstetric Medicine of Australia and New Zealand (SOMANZ), Updated October 2023.

10-  Nausea and Vomiting of Pregnancy. ACOG Practice Bulletin, Clinical Management Guidelines for Obstetrician–Gynecologists, Number 189, January 2018.

11-  Martinez de Tejada B, Vonzun L, Von Mandach DU, Burch A, Yaron M, Hodel M, Surbek D, Hoesli I. Nausea and vomiting of pregnancy, hyperemesis gravidarum. European Journal of Obstetrics and Gynecology 304 (2025) 115–120.

12-  Smith JA, Fox KA, Clark SM. Nausea and vomiting of pregnancy: Clinical findings and evaluation. Up To Date, Sep, 2025.

13-  Smith JA, Fox KA, Clark SM. Nausea and vomiting of pregnancy: Treatment and outcome. Up To Date, Aug, 2025.

14-  Niemeijer MN, Grooten IJ, Vos N, et al. Diagnostic markers for hyperemesis gravidarum: a systematic review and meta-analysis. Am J Obstet Gynecol 2014; 211:150.e1.

15-  Abell TL, Riely CA. Hyperemesis gravidarum. Gastroenterol Clin North Am 1992; 21:835.

16-  Goodwin TM. Hyperemesis gravidarum. Obstet Gynecol Clin North Am 2008; 35:401.

17-  Kinomoto-Kondo S, Umehara N, Sato S, et al. The effects of gestational transient thyrotoxicosis on the perinatal outcomes: a case-control study. Arch Gynecol Obstet 2017; 295:87.

18-  Kimura M, Amino N, Tamaki H, Ito E, Mitsuda N, Miyai K, Tanizawa O. Gestational thyrotoxicosis and hyperemesis gravidarum: possible role of hCG with higher stimulating activity. Clin Endocrinol (Oxf). 1993 Apr;38(4):345-50.

19-  Goldman AM, Mestman JH. Transient non-autoimmune hyperthyroidism of early pregnancy. J Thyroid Res 2011; 2011:142413.

20-  Hershman JM. Physiological and pathological aspects of the effect of human chorionic gonadotropin on the thyroid. Best Pract Res Clin Endocrinol Metab 2004;18:249.

21-  Thyroid Disease in Pregnancy: ACOG Practice Bulletin, Number 223. Obstet Gynecol 2020; 135:e261. Reaffirmed 2023.

22-  American College of Obstetricians and Gynecologists. Practice Bulletin No. 148: Thyroid disease in pregnancy. Obstet Gynecol 2015; 125:996. Reaffirmed 2019.

23-  Matthews A, Haas DM, O'Mathúna DP, Dowswell T. Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst Rev 2015; CD007575.

24-  Koren G, Clark S, Hankins GD, et al. Maternal safety of the delayed-release doxylamine and pyridoxine combination for nausea and vomiting of pregnancy; a randomized placebo-controlled trial. BMC Pregnancy Childbirth 2015; 15:59.

25-  Etwel F, Faught LH, Rieder MJ, Koren G. The Risk of Adverse Pregnancy Outcome After First Trimester Exposure to H1 Antihistamines: A Systematic Review and Meta-Analysis. Drug Saf 2017; 40:121.

26-  Tan PC, Khine PP, Vallikkannu N, Omar SZ. Promethazine compared with metoclopramide for hyperemesis gravidarum: a randomized controlled trial. Obstet Gynecol 2010; 115:975.

27-  Milkovich L, van den Berg BJ. An evaluation of the teratogenicity of certain antinauseant drugs. Am J Obstet Gynecol 1976; 125:244.

28-  Gilboa SM, Strickland MJ, Olshan AF, et al. Use of antihistamine medications during early pregnancy and isolated major malformations. Birth Defects Res A Clin Mol Teratol 2009; 85:137.

29-  Campbell K, Rowe H, Azzam H, Lane CA. The Management of Nausea and Vomiting of Pregnancy. J Obstet Gynaecol Can 2016; 38:1127.

30-  Bsat FA, Hoffman DE, Seubert DE. Comparison of three outpatient regimens in the management of nausea and vomiting in pregnancy. J Perinatol 2003; 23:531.

31-  Einarson A, Koren G, Bergman U. Nausea and vomiting in pregnancy: a comparative European study. Eur J Obstet Gynecol Reprod Biol 1998; 76:1.

32-  Fiaschi L, Housley G, Nelson-Piercy C, et al. Assessment of discharge treatment prescribed to women admitted to hospital for hyperemesis gravidarum. Int J Clin Pract. Jan 2019;73(1):e13261.

33-  Lavecchia M, Chari R, Campbell S, Ross S. Ondansetron in Pregnancy and the Risk of Congenital Malformations: A Systematic Review. J Obstet Gynaecol Can. 07 2018;40(7):910-8.

34-  Smith JA, Julius JM, Gaikwad A, et al. Evaluating the potential effect on fetal tissue after exposure to granisetron during pregnancy. Reprod Toxicol 2015; 53:92.

35-  Jarvis S, Nelson-Piercy C. Management of nausea and vomiting in pregnancy. BMJ. Jun 2011;342:d3606.

36-  Gill SK, Maltepe C, Mastali K, Koren G. The effect of Acid-reducing pharmacotherapy on the severity of nausea and vomiting of pregnancy. Obstet Gynecol Int 2009; 2009:585269.

37-  Clark SM, Zhang X, Goncharov DA. Inpatient Management of Hyperemesis Gravidarum. Obstet Gynecol 2024; 143:745.

38-  Mitchell-Jones N, Farren JA, Tobias A, et al. Ambulatory versus inpatient management of severe nausea and vomiting of pregnancy: a randomised control trial with patient preference arm. BMJ Open 2017; 7:e017566.

39-  Mitchell SJ, Cox P. ECG changes in hyperemesis gravidarum. BMJ Case Rep. 2017 Jan 4;2017:bcr2016217158. doi: 10.1136/bcr-2016-217158. PMID: 28052945; PMCID: PMC5256582.

40-  Tan PC, Norazilah MJ, Omar SZ. Dextrose saline compared with normal saline rehydration of hyperemesis gravidarum: a randomized controlled trial. Obstet Gynecol 2013; 121:291.

41-  Semler MW, Self WH, Wanderer JP, et al. Balanced Crystalloids versus Saline in Critically Ill Adults. N Engl J Med 2018; 378:829.

42-  Dingwall KM, Delima JF, Binks P, et al. What is the optimum thiamine dose to treat or prevent Wernicke's encephalopathy or Wernicke-Korsakoff syndrome? Results of a randomized controlled trial. Alcohol Clin Exp Res 2022; 46:1133.

43-  Flannery AH, Adkins DA, Cook AM. Unpeeling the Evidence for the Banana Bag: Evidence-Based Recommendations for the Management of Alcohol-Associated Vitamin and Electrolyte Deficiencies in the ICU. Crit Care Med 2016; 44:1545.

44-  Giugale LE, Young OM, Streitman DC. Iatrogenic Wernicke encephalopathy in a patient with severe hyperemesis gravidarum. Obstet Gynecol 2015; 125:1150.

45-  Mansour GM, Nashaat EH. Role of Helicobacter pylori in the pathogenesis of hyperemesis gravidarum. Arch Gynecol Obstet 2011; 284:843.

46-  Mitchell-Jones N, Gallos I, Farren J, Tobias A, Bottomley C, Bourne T. Psychological morbidity associated with hyperemesis gravidarum: a systematic review and meta-analysis. BJOG. Jan 2017;124(1):20-30.