CLINICAL PRACTICE OBSTETRICS COMMITTEE

Objectives: To review the evidence-based management of nausea and vomiting of pregnancy (NVP) and hyperemesis gravidarum. Evidence: MEDLINE and Cochrane database searches were performed using the medical subject headings (MeSH) of treatment, nausea, vomiting, pregnancy, and hyperemesis gravidarum. The quality of evidence reported in these guidelines has been described using the Evaluation of Evidence criteria outlined in the Report of the Canadian Task Force on the Periodic Health Exam. Benefits: NVP has a profound effect on women’s health and quality of life during pregnancy, as well as a financial impact on the health care system, and its early recognition and management are recommended. (III-B) Cost: Costs, including hospitalizations, additional office visits, and time lost from work, may be reduced if NVP is treated early. Recommendations: 1. Dietary and lifestyle changes should be liberally encouraged, and women should be counselled to eat whatever appeals to them. (III-C) 2. Alternative therapies, such as ginger supplementation, acupuncture, and acupressure, may be beneficial. (I-A) 3. A doxylamine/pyridoxine combination should be the standard of care, since it has the greatest evidence to support its efficacy and safety. (I-A) 4. H 1 receptor antagonists should be considered in the management of acute or breakthrough episodes of NVP. (I-A) 5. Pyridoxine monotherapy supplementation may be considered as an adjuvant measure. (I-A) 6. Phenothiazines are safe and effective for severe NVP. (I-A) 7. Metoclopramide is safe to be used for management of NVP, although evidence for efficacy is more limited. (II-2D) 8. Corticosteroids should be avoided during the first trimester because of possible increased risk of oral clefting and should be restricted to refractory cases. (I-B) 9. When NVP is refractory to initial pharmacotherapy, investigation of other potential causes should be undertaken. (III-A) Sponsor: The Society of Obstetricians and Gynaecologists of Canada.