Nausea and vomiting during pregnancy (NVP) is a common complaint during the first three months (first trimester) of pregnancy and may persist throughout pregnancy in some cases. Although NVP is also known as morning sickness, most women have symptoms throughout the day.1 Symptoms of NVP can range from mild to unbearable bouts of nausea and vomiting. For most women, NVP is a self-limited condition with no long-term negative outcome on their health or the health of their fetuses. Its severe form, hyperemesis gravidarum (HG), may result in dehydration, electrolyte imbalance and the need for hospitalization.2 The psychosocial consequences include decreased quality of life, time off work and secondary depression.3
The exact etiology and pathogenesis of NVP are poorly understood and are most likely multifactorial. Most evidence points to rapid fluctuations in hormone levels, which may cause changes in the gastrointestinal muscle contraction and relaxation patterns, thus leading to NVP. Other theories for the etiology of NVP include psychological predisposition, evolutionary adaptation and Helicobacter pylori infection.
The first choice in NVP treatment generally involves changes in diet or lifestyle. It had been proposed that early treatment of NVP might decrease the risk of HG. Pyridoxine and metoclopramide (category A) are first-line in treatment of HG followed by prochlorperazine (category C), prednisolone (category A), promethazine (category C) and ondansetron (category B1).3 When the nausea and vomiting is very severe and the patient is unable to tolerate oral fluids, she has to be admitted to the hospital and intravenous fluids and medications should be started.
The following approaches may be helpful in managing mild-to-moderate form of NVP:
1.Jewell D, Young G. Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst Rev. 2003; (4): CD000145.
2.Fell DB, Dodds L, Joseph KS, Allen VM, Butler B. Risk factors for hyperemesis gravidarum requiring hospital admission during pregnancy. Obstet Gynecol. 2006; 107(2 Pt 1): 277–284.
3.Sheehan P. Hyperemesis gravidarum--Assessment and management. Aust Fam Physician. 2007; 36(9): 698–701.
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