Nausea and Vomiting: treatment during pregnancy

Paula Russell, Principal Pharmacist, Regional Drug and Therapeutics Centre (Newcastle Upon Tyne)Published Last updated See all updates

Signposting evidence-based information on the treatment of nausea and vomiting in pregnancy

Condition Management

It is important to complete an individual risk assessment for your patient and to apply the principles of prescribing during pregnancy when looking at the available information and making treatment decisions. Check to see if a risk assessment has already been completed.

Nausea and vomiting is very common in pregnancy and is generally reported between weeks 6-16, but it may persist for longer in a small number of women.

Hyperemesis gravidarum (HG) is defined as intractable vomiting resulting in 5% of pre-pregnancy weight loss, dehydration, and electrolyte disturbance. It is thought to affect less than 1% of pregnant women.

Untreated or inadequately treated severe or chronic nausea and vomiting, can have adverse effects on the mother and therefore on the foetus.

Guidelines

NICE CKS Nausea/vomiting in pregnancy includes treatment recommendations.

NICE Antenatal Care (NG 201) provides a table summarising the advantages and disadvantages of different pharmacological treatments for nausea and vomiting in pregnancy.

UK Teratology Information Service (UKTIS) has information on the management of nausea and vomiting.

The Royal College of Obstetricians and Gynaecologists (RCOG) Green-top Guideline No. 69 has information on the management of nausea and vomiting and hyperemesis gravidarum.

You should check if there is local guidance for you to use in your area.

Stepwise recommendations

The guidelines recommend a stepwise approach starting with non-pharmacological measures if appropriate or possible, through the range of pharmacological options:

Non-pharmacological management

  • Small, high carbohydrate, low fat, frequent meals
  • Ginger and/or acupressure may help if symptoms are mild.

Pharmacological management

First line
  • Cyclizine, Promethazine, Prochlorperazine or UK licensed Doxylamine/Pyridoxine combination product (Xonvea®)
Second line
  • Oral metoclopramide or ondansetron (max 5 days) or oral domperidone (max 7 days)
Other options
  • Corticosteroids can be used after failure of conventional anti-emetic treatment and intravenous fluid replacement.

Assessing severity of symptoms

Consider using a validated questionnaire to assess the severity of nausea and vomiting in pregnancy (for example the Pregnancy-Unique Quantification of Emesis [PUQE] score).

The PUQE scoring system is described in more detail in Appendix II of the RCOG guideline (no. 69): The management of nausea and vomiting of pregnancy and hyperemesis gravidarum for which there is also a patient information leaflet

Pregnancy outcome information

UKTIS provides an overview of the treatment of nausea and vomiting and information on specific treatments including gingerpromethazineXonvea® and ondansetron.

Patient information

Each of the UKTIS summaries has corresponding BUMPS patient information.

RCOG has a patient information leaflet on pregnancy sickness including hyperemesis gravidarum).

NHS Medicines A-Z provides a summary statement on the use in pregnancy of specific antiemetics, cyclizine, prochlorperazine, metoclopramide .

NHS also provides an overview of vomiting and morning sickness and severe vomiting in pregnancy

More from safety in pregnancy

All our training and guidance to help decision making about the use of medicines in pregnancy

Change history

  1. Added link to NICE Antenatal Care (NG 201) and to table of advantages and disadvantages of N&V treatment options.
  1. Published