Nausea and Vomiting in Pregnancy: Prevalence, Clinical Characteristics, and Management Findings from a Prospective...

Nausea and vomiting in pregnancy (NVP) have a negative impact on quality of life and nutritional status and may progress to hyperemesis gravidarum (HG). We explored the incidence, severity, clinical evolution, and management of NVP.

In accordance with the Italian Society of Gynecology and Obstetrics (SIGO), we conducted a multicentric prospective cohort study at eighteen Italian hospitals, from October 2022 to November 2024. We enrolled pregnant women before 13 weeks of gestation. The severity of NVP and its management were assessed during pregnancy.

A total 890 pregnant participants completed the follow-up. NVP prevalence was 70.0% and was classified as 54.4% mild, 42.3% moderate, and 3.2% severe according to the PUQE score; 2.4% required hospitalization. Severe NVP was more frequent in multiparous women (90.0%; p < 0.001); NVP history was independently associated with NVP recurrence, OR 3.20 (2.12-4.83; p < 0.001). NVP cases showed a low rate of smoking (3.9% vs. 7.1%; p = 0.04). After the first consultation, pharmacological treatment, primarily doxylamine-pyridoxine, was prescribed to 50.7% of mild, 67.0% of moderate, and 50.0% of severe PUQE scores. Dosages of ≥3 capsules/day were common in moderate (51.0%) and severe (70.0%) NVP cases (p < 0.001). By the second visit, continuation of therapy did not differ among PUQE classes, although reasons for discontinuation varied (p < 0.001). By the third visit, therapy continuation dropped to 32.1% in moderate cases (p = 0.03).

NVP is a common disorder in pregnancy, with a predominance of mild and moderate symptoms. Prior NVP increases the recurrence risk threefold. Despite the high prevalence of NVP, the therapy remains inconsistent and delayed.