Contents

Search

morning sickness (nausea & vomiting of pregnancy)

Epidemiology: - may affect over 1/2 of pregnancies Pathology: - fetal production of GDF15, & maternal sensitivity to GDF15, contribute to nausea & vomiting of pregnancy Clinical manifestations: - morning nausea, vomiting Complications: - morning sickness associated with reduced risk for miscarriage [6] Management: - frequent, small meals of bland food - vitamin B6 12.5 to 25 mg TID-QID - add doxylamine 12.5 mg with each B6 dose if B6 alone is not enough to relieve nausea [2] - combination doxylamine/pyridoxine (Diclegis) FDA-approved in 2013 [3] - may not be as effective as previously reported [7] - ginger, up to 1 g/day of ginger supplements without obvious problems - metoclopramide [4,5]

Related

hyperemesis gravidarum Monday morning sickness

General

pregnancy disorder; obstetric disorder; pregnancy complication vomiting

References

  1. Prescriber's Letter 16(11): 2009 COMMENTARY: Is Ginger Safe For Use During Pregnancy? GUIDELINES: AGA Position Statement on the Use of Gastrointestinal Medications in Pregnancy GUIDELINES: ACOG Practice Bulletin on Nausea and Vomiting of Pregnancy Detail-Document#: 251108 (subscription needed) http://www.prescribersletter.com
  2. Koren G et al. Effectiveness of delayed-release doxylamine and pyridoxine for nausea and vomiting of pregnancy: A randomized placebo controlled trial. Am J Obstet Gynecol 2010 Dec; 203:571.e1. PMID: 20843504
  3. FDA News Release: April 8, 2013 FDA approves Diclegis for pregnant women experiencing nausea and vomiting. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm347087.htm
  4. Matok I et al, The Safety of Metoclopramide Use in the First Trimester of Pregnancy PMID: 19516033 N Engl J Med 2009 (June 11) 360:2528-2535
  5. Pasternak B et al Metoclopramide in Pregnancy and Risk of Major Congenital Malformations and Fetal Death. JAMA. 2013;310(15):1601-1611 PMID: 24129464 http://jama.jamanetwork.com/article.aspx?articleid=1752754
  6. Hinkle SN, Mumford SL, Grantz KL et al Association of Nausea and Vomiting During Pregnancy With Pregnancy Loss. A Secondary Analysis of a Randomized Clinical Trial. JAMA Intern Med. Published online September 26, 2016 PMID: 27669539 http://archinte.jamanetwork.com/article.aspx?articleid=2553283
  7. Persaud N, Meaney C, El-Emam K, Moineddin R, Thorpe K. Doxylamine-pyridoxine for nausea and vomiting of pregnancy randomized placebo controlled trial: Prespecified analyses and reanalysis. PLOS One. January 17, 2018 PMID: 29342163 Free full text http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0189978
  8. NEJM Knowledge+ - Niebyl JR Clinical practice. Nausea and vomiting in pregnancy. N Engl J Med. 2010 Oct 14;363(16):1544-50. doi: 10.1056/NEJMcp1003896. PMID: 20942670 Review. No abstract available. https://www.nejm.org/doi/pdf/10.1056/NEJMcp1003896 - Committee on Practice Bulletins-Obstetrics ACOG Practice Bulletin No. 189: Nausea And Vomiting Of Pregnancy. Obstet Gynecol. 2018 Jan;131(1):e15-e30. PMID: 29266076
  9. Fejo M, Rocha N, Cimino I et al GDF15 linked to maternal risk of nausea and vomiting during pregnancy. Nature. 2-23. Dec 13. PMID: 38092039 https://www.nature.com/articles/s41586-023-06921-9