A GUIDE TO HEALTHY PREGNANCY MANAGING AILMENTS AND FINDING SOLUTIONS

A_Guide_to_Healthy_Pregnancy

HOW TO DEAL WITH NAUSEA ANDVOMITINGDURINGPREGNANCY

İsmail Yılmaz

İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Gynecology and Obstetrics, İstanbul, Türkiye

Yılmaz İ. How to Deal with Nausea and Vomiting During Pregnancy. Çetin A, ed. A Guide To Healthy Pregnancy: Managing Ailments and Finding Solutions. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.15-21.

ABSTRACT

Nausea and vomiting is a common condition that affects an average of 90% of pregnant women in the first three months of pregnancy. In mild cases of severe nausea and vomiting, the symptoms usually resolve spontaneously, but in 0.3-2% of cases it can develop into a severe condition called hyperemesis gravidarum (HG). HG is characterized by extreme and prolonged nausea and vomiting, dehydration and electrolyte imbalances, weight loss of more than 5%, ketonuria. In the etiology, genetic factors, hormonal changes, Helicobacter pylori and gastrointestinal motility disorders have been reported. However, this factor cannot be fully explained. The presence of HG is established by excluding other possible causes. Motherisk- PUQE scoring is used to assess the severity of symptoms. Treatment is determined according to the severity of symptoms. For mild symptoms, lifestyle changes and diet can be effective. These changes may take the form of eating small amounts at frequent intervals, increasing fluid intake and avoiding environmental factors. As pharmacological treatment, in the first phase, a combination of doxylamine and pyridoxine (vitamin B6) is preferred. In the second stage, in advanced cases, antiemetic drugs and intravenous fluid support are used. If symptoms persist despite treatment, hospitalization protocol may be applied. This study comprehensively addressed the effects of nausea and vomiting in pregnancy on the mother and fetus, diagnosis and treatment approaches. In the ef- fective management of HG, i.e. accurate diagnosis and an appropriate treatment approach after the diagnosis, the quality of life of the pregnant woman can be improved and the pregnancy outcome is not affected. The study highlights the importance of future research to better understand this condition and develop treatment methods. Often, multidisciplinary approaches and early intervention are effective in protecting both maternal and fetal health.

Keywords: Pregnancy; Nause; Vomiting; Fetus; Hyperemesis gravidarum; Antiemetics

Referanslar

  1. Liu C, Zhao G, Qiao D, et al. Emerging Progress in Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum: Challenges and Opportunities. Front Med. 2022;8:809270. [Crossref]  [PubMed]  [PMC]
  2. Matthews A, Haas D, O'Mathúna D, Dowswell T. Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst Rev. 2015;2015(9):CD007575. [Crossref]  [PMC]
  3. Frias G. Gastrointestinal diseases during pregnancy: what does the gastroenterologist need to know? Ann Gastroenterol. Published online 2018. [Crossref]  [PubMed]  [PMC]
  4. Boelig RC, Barton SJ, Saccone G, Kelly AJ, Edwards SJ, Berghella V. Interventions for treating hyperemesis gravidarum - Boelig, RC - 2016 | Cochrane Library. Accessed December 9, 2024. [Crossref]  [PubMed]  [PMC]
  5. Hinkle SN, Mumford SL, Grantz KL, et al. Association of Nausea and Vomiting During Pregnancy With Pregnancy Loss: A Secondary Analysis of a Randomized Clinical Trial. JAMA Intern Med. 2016;176(11):1621-1627. [Crossref]  [PubMed]  [PMC]
  6. Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 189: Nausea And Vomiting Of Pregnancy. Obstet Gynecol. 2018;131(1):e15-e30. [Crossref]  [PubMed]
  7. Basso O, Olsen J. Sex Ratio and Twinning in Women With Hyperemesis or Pre-eclampsia. Epidemiology. 2001;12(6):747. [Crossref]  [PubMed]
  8. Brandes JM. First-trimester nausea and vomiting as related to outcome of pregnancy. Obstet Gynecol. 1967;30(3):427-431. [PubMed]
  9. The Effect of Heartburn and Acid Reflux on the Severity of Nausea and Vomiting of Pregnancy - Gill - 2009 - Canadian Journal of Gastroenterology and Hepatology - Wiley Online Library. Accessed December 9, 2024. [Link]
  10. Veenendaal M, van Abeelen A, Painter R, van der Post J, Roseboom T. Consequences of hyperemesis gravidarum for offspring: a systematic review and meta-analysis. BJOG Int J Obstet Gynaecol. 2011;118(11):1302-1313. [Crossref]  [PubMed]
  11. Weigel Mm, Weigel Rm. The Association Of Reproductive History, Demographic Factors, And Alcohol And Tobacco Consumption With The Risk Of Developing Nausea And Vomiting In Early Pregnancy. Am J Epidemiol. 1988;127(3):562-570. [Crossref]  [PubMed]
  12. Fejzo M, Rocha N, Cimino I, et al. GDF15 linked to maternal risk of nausea and vomiting during pregnancy. Nature. 2024;625(7996):760-767. [Crossref]  [PubMed]  [PMC]
  13. Kimura M, Amino N, Tamaki H, et al. Gestational thyrotoxicosis and hyperemesis gravidarum: possible role of hCG with higher stimulating activity. Clin Endocrinol (Oxf). 1993;38(4):345-350. [Crossref]  [PubMed]
  14. Goodwin TM, Montoro M, Mestman JH, Pekary AE, Hershman JM. The role of chorionic gonadotropin in transient hyperthyroidism of hyperemesis gravidarum. J Clin Endocrinol Metab. 1992;75(5):1333-1337. [Crossref]  [PubMed]
  15. Lee NM, Saha S. Nausea and Vomiting of Pregnancy. Gastroenterol Clin North Am. 2011;40(2):309-334. [Crossref]  [PubMed]  [PMC]
  16. Niemeijer MN, Grooten IJ, Vos N, et al. Diagnostic markers for hyperemesis gravidarum: a systematic review and metaanalysis. Am J Obstet Gynecol. 2014;211(2):150.e1-150. e15. [Crossref]  [PubMed]
  17. Goodwin TM. Hyperemesis Gravidarum. Obstet Gynecol Clin North Am. 2008;35(3):401-417. [Crossref]  [PubMed]
  18. Lacroix R, Eason E, Melzack R. Nausea and vomiting during pregnancy: A prospective study of its frequency, intensity, and patterns of change. Am J Obstet Gynecol. 2000;182(4):931-937. [Crossref]  [PubMed]
  19. Jansen L a. W, Koot MH, Hooft J van't, et al. The windsor definition for hyperemesis gravidarum: A multistakeholder international consensus definition. Eur J Obstet Gynecol Reprod Biol. 2021;266:15-22. [Crossref]  [PubMed]
  20. Koren G, Boskovic R, Hard M, Maltepe C, Navioz Y, Einarson A. Motherisk-PUQE (pregnancy-unique quantification of emesis and nausea) scoring system for nausea and vomiting of pregnancy. Am J Obstet Gynecol. 2002;186(5):S228-S231. [Crossref]  [PubMed]
  21. Rhodes VA, McDaniel RW. The Index of Nausea, Vomiting, and Retching: a new format of the lndex of Nausea and Vomiting. Oncol Nurs Forum. 1999;26(5):889-894. [Crossref]  [PubMed]
  22. Koot MH, Grooten IJ, Post JAM van der, et al. Determinants of disease course and severity in hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol. 2020;245:162-167. [Crossref]  [PubMed]
  23. Practice Bulletin No. 148: Thyroid Disease in Pregnancy. Obstet Gynecol. 2015;125(4):996. [Crossref]  [PubMed]
  24. Bischoff SC, Renzer C. Nausea and nutrition. Auton Neurosci Basic Clin. 2006;129(1):22-27. [Crossref]  [PubMed]
  25. Koretz RL, Rotblatt M. Complementary and alternative medicine in gastroenterology: The good, the bad, and the ugly. Clin Gastroenterol Hepatol. 2004;2(11):957-967. [Crossref]  [PubMed]
  26. A comparison between the effects of ginger, pyridoxine (vitamin B6) and placebo for the treatment of the first trimester nausea and vomiting of pregnancy (NVP): The Journal of Maternal-Fetal & Neonatal Medicine: Vol 31 , No19 - Get Access. Accessed December 9, 2024. [Link]
  27. McParlin C, O'Donnell A, Robson SC, et al. Treatments for Hyperemesis Gravidarum and Nausea and Vomiting in Pregnancy: A Systematic Review. JAMA. 2016;316(13):1392-1401. [Crossref]  [PubMed]
  28. Koren G, Hankins GDV, Clark S, et al. Effectiveness of doxylamine-pyridoxine for morning sickness. Am J Obstet Gynecol. 2016;214(5):664-666. [Crossref]  [PubMed]
  29. 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(2):121-132. [Crossref]  [PubMed]
  30. Magee LA, Mazzotta P, Koren G. Evidence-based view of safety and effectiveness of pharmacologic therapy for nausea and vomiting of pregnancy (NVP). Am J Obstet Gynecol. 2002;186(5):S256-S261. [Crossref]  [PubMed]
  31. 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(1):585269. [Crossref]  [PubMed]  [PMC]
  32. Badell ML, Ramin SM, Smith JA. Treatment Options for Nausea and Vomiting During Pregnancy. Pharmacother J Hum Pharmacol Drug Ther. 2006;26(9):1273-1287. [Crossref]  [PubMed]
  33. Tan P c., Jacob R, Quek K f., Omar S z. Indicators of prolonged hospital stay in hyperemesis gravidarum. Int J Gynecol Obstet. 2006;93(3):246-247. [Crossref]  [PubMed]
  34. Agmon N, Sade S, Pariente G, Rotem R, Weintraub AY. Hyperemesis gravidarum and adverse pregnancy outcomes. Arch Gynecol Obstet. 2019;300(2):347-353. [Crossref]  [PubMed]
  35. Emelianova S, Mazzotta P, Einarson A, Koren G. Prevalence and severity of nausea and vomiting of pregnancy and effect of vitamin supplementation. Clin Investig Med Med Clin Exp. 1999;22(3):106-110. [PubMed]
  36. Källén B, Lundberg G, Aberg A. Relationship between vitamin use, smoking, and nausea and vomiting of pregnancy. Acta Obstet Gynecol Scand. 2003;82(10):916-920. [Crossref]  [PubMed]