Nausea and Vomiting

Nausea and vomiting during pregnancy (NVP) continue to challenge women and their providers. This chapter discusses the pathophysiology, diagnosis, treatment, complications, and preventions of NVP. Risk factors for NVP include an increased placental mass as seen with molar gestation or multiple gestations, a family history or personal history of hyperemesis gravidarum (HG), and a history of motion sickness or migraines. NVP exists as a spectrum of symptoms ranging in severity from mild and self-limited to severe and debilitating. Treatment of NVP varies with the severity of the disease and begins with non-pharmacological choices including dietary/lifestyle modification and vitamin/herbal supplementation, followed by pharmacological antiemetic therapy. When non-pharmacological approaches fail, breakthrough therapy using pharmacological agents is needed. The most common categories for use are antihistamines, dopamine antagonists, phenothiazines, and serotonin antagonists. Studies suggest that multivitamin use at the time of conception may be associated with a reduction of pregnancy-related nausea and vomiting.