Managing nausea and vomiting of pregnancy: a survey of obstetrician-gynecologists.

OBJECTIVE: To assess obstetrician-gynecologists' treatment of nausea and vomiting of pregnancy and to compare it with recommendations in an American College of Obstetricians and Gynecologists (ACOG) evidence-based practice bulletin on the topic. STUDY DESIGN: A survey questionnaire was mailed to the 1,075 ACOG fellows who constitute the Collaborative Ambulatory Research Network (CARN). RESULTS: The most frequently recommended treatments for a patient with moderate to severe nausea with occasional vomiting were: eat frequent, small meals (93%); snack on soda crackers (68.5%); and take vitamin B 6 plus doxylamine (67.1%). Two of 3 (66.7%) respondents had read the ACOG practice bulletin; most of those who had read it found it helpful (67.0%) or very helpful (29.5%). Respondents who read the practice bulletin were generally more willing to treat nausea and vomiting of pregnancy aggressively. They were more likely to be aware that early treatment is recommended to prevent progression to hyperemesis gravidarum and more likely to recommend the use of ginger (59.7% vs. 47.9%, p=0.014), and to prescribe vitamin B 6 (84.1% vs. 73.8%, p= 0.005) and vitamin B 6 plus doxylamine (70.9% vs. 59.3%, p = 0.009). CONCLUSION: Obstetrician-gynecologists' treatment and prescribing practices generally follow ACOG recommendations; the ACOG practice bulletin appears to have affected practice and knowledge.