Nausea and Vomiting During Pregnancy

Nausea and vomiting are some of the most common symptoms during pregnancy. Severity should be assessed with a tool such as the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) score. In severe cases, additional medical history should be obtained to rule out possible secondary causes. Treatment depends on the severity of symptoms, beginning with behavioral modification such as trigger avoidance and dietary changes for mild cases. Modification includes meals that are small, frequent, bland, dry, and high in protein. First-line pharmacologic management for mild or moderate cases is vitamin B6 with or without doxylamine. When conservative measures are ineffective or not tolerated, additional pharmacologic options include other antihistamines or dopamine antagonists. Metoclopramide and ondansetron are considered second-line treatments for persistent symptoms. Dehydration and electrolyte abnormalities should be corrected and may necessitate hospitalization if oral intake is not possible. Treatment of refractory or severe symptoms include the consideration of corticosteroids and, in rare cases, supplemental enteral or parenteral nutrition.