Clinical Evidence Handbook

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Nausea and Vomiting in Early Pregnancy

 


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Am Fam Physician. 2015 Sep 15;92(6):516-517.

Author disclosure: Mario Festin declares that he has no competing interests.

More than one-half of pregnant women have nausea and vomiting, which typically begins by the fourth week and disappears by the 16th week of pregnancy.

  • The cause of nausea and vomiting in pregnancy is unknown, but it may be due to the rise in human chorionic gonadotropin concentration.

  • In one out of 200 women, the condition progresses to hyperemesis gravidarum, which is characterized by prolonged and severe nausea and vomiting, dehydration, and weight loss.

In general, the trials we found were small and of limited quality. There is a need for other large high-quality trials on this condition with consistent outcomes.

For nausea and vomiting in early pregnancy:

  • Ginger may reduce nausea and vomiting compared with placebo, although studies used different preparations of ginger and reported varying outcome measures.

  • Pyridoxine (vitamin B6) may be more effective than placebo at reducing nausea, but we do not know about vomiting, and evidence was weak.

  • Pyridoxine may be as effective as ginger at reducing nausea and vomiting, although evidence was limited.

  • Acupressure may be more effective than sham acupressure at reducing nausea and vomiting. However, evidence was weak, and interventions and outcomes varied between trials.

  • We do not know if acupressure is more effective than pyridoxine at reducing nausea or vomiting because we found insufficient evidence.

  • We do not know if acupuncture is more effective than sham acupuncture at reducing nausea and vomiting.

  • We do not know if prochlorperazine, promethazine, or metoclopramide reduces nausea or vomiting compared with placebo.

For hyperemesis gravidarum:

  • We do not know if acupressure, acupuncture, corticosteroids, ginger, metoclopramide, or ondansetron is effective at treating hyperemesis gravidarum.

  • Hydrocortisone may be more effective than metoclopramide at reducing vomiting episodes and reducing readmission to the intensive care unit in women with hyperemesis gravidarum.

View/Print Table

Clinical Questions

What are the effects of treatment for nausea and vomiting in early pregnancy?

Likely to be beneficial

Acupressure

Ginger

Pyridoxine (vitamin B6)

Unknown effectiveness

Acupuncture

Metoclopramide

Prochlorperazine

Promethazine

What are the effects of treatments for hyperemesis gravidarum?

Unknown effectiveness

Acupressure

Acupuncture

Corticosteroids

Ginger

Ondansetron

Unlikely to be beneficial

Metoclopramide (less effective than corticosteroids)

Clinical Questions

What are the effects of treatment for nausea and vomiting in early pregnancy?

Likely to be beneficial

Acupressure

Ginger

Pyridoxine (vitamin B6)

Unknown effectiveness

Acupuncture

Metoclopramide

Prochlorperazine

Promethazine

What are the effects of treatments for hyperemesis gravidarum?

Unknown effectiveness

Acupressure

Acupuncture

Corticosteroids

Ginger

Ondansetron

Unlikely to be beneficial

Metoclopramide

Author disclosure: Mario Festin declares that he has no competing interests.

This is one in a series of chapters excerpted from the Clinical Evidence Handbook, published by the BMJ Publishing Group, London, U.K. The medical information contained herein is the most accurate available at the date of publication. More updated and comprehensive information on this topic may be available in future print editions of the Clinical Evidence Handbook, as well as online at http://www.clinicalevidence.bmj.com (subscription required).

This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.

A collection of Clinical Evidence Handbook published in AFP is available at http://www.aafp.org/afp/bmj.



 

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