What is the treatment for hyperemesis gravidarum (vomiting) during pregnancy?

From the Guidelines

For hyperemesis gravidarum, the most effective treatment approach starts with lifestyle modifications, including eating small, frequent meals, avoiding triggers, and staying hydrated, followed by the use of vitamin B6 (pyridoxine) 10-25mg three times daily, which can be combined with doxylamine (an antihistamine) 12.5mg at night, as recommended by the American College of Obstetricians and Gynecologists (ACOG) 1.

Initial Management

The initial steps in managing hyperemesis gravidarum involve diet and lifestyle modifications. Reducing spicy, fatty, acidic, and fried foods can help reduce heartburn, while eating small, frequent, and bland meals, such as the BRAT (bananas, rice, applesauce, and toast) diet, and high-protein and low-fat meals can be helpful in managing nausea and vomiting 1. Identifying and avoiding specific triggers, such as certain foods with strong odors or activities, is also crucial.

Pharmacological Interventions

If symptoms persist or are severe, therapeutic options include ginger (a 250-mg capsule 4 times daily) and vitamin B6 (pyridoxine, 10–25 mg every 8 hours), as recommended by ACOG 1. H1-receptor antagonists, such as doxylamine, promethazine, and dimenhydrinate, are considered safe first-line pharmacologic antiemetic therapies if needed. Doxylamine is US Food and Drug Administration–approved and recommended by ACOG for persistent NVP refractory to non-pharmacologic therapy 1.

Severe Cases

For more severe cases of hyperemesis gravidarum, prescription medications such as metoclopramide 5-10mg three times daily, ondansetron 4-8mg every 8 hours, or promethazine 12.5-25mg every 4-6 hours as needed may be required 1. Severe dehydration may necessitate IV fluids and hospitalization. These treatments are aimed at managing symptoms, preventing progression to more severe forms of hyperemesis gravidarum, and ensuring the health and well-being of both the mother and the fetus.

Key Considerations

It is essential to note that hyperemesis gravidarum can lead to significant morbidity if not managed properly. Early intervention and treatment are crucial to prevent complications such as dehydration, electrolyte imbalances, and weight loss 1. Healthcare providers should closely monitor patients with hyperemesis gravidarum and adjust treatment plans as necessary to ensure optimal outcomes.

From the Research

Treatment for Hyperemesis Gravidarum

The treatment for hyperemesis gravidarum, a condition characterized by severe vomiting during pregnancy, typically involves a combination of conservative measures and pharmacologic therapies.

• Initial treatment should be conservative and may include:
  • Dietary changes
  • Emotional support
  • Alternative therapy such as ginger or acupressure 2, 3
• For women with more complicated nausea and vomiting of pregnancy, pharmacologic therapy may be necessary, including:
  • Pyridoxine
  • Doxylamine
  • Metoclopramide
  • Prochlorperazine
  • Promethazine
  • Ondansetron 2, 4, 3, 5
• In severe cases, hospitalization may be required, along with:
  • Intravenous rehydration therapy
  • Total parenteral nutrition
  • Corticosteroid therapy 2, 4, 6
• It is essential to exclude other causes of nausea and vomiting, such as urinary tract infection and thyrotoxicosis, before initiating treatment for hyperemesis gravidarum 3, 6

Management of Hyperemesis Gravidarum

Management of hyperemesis gravidarum should include:

• Hospitalization for severe cases
• Intravenous fluid and electrolyte replacement
• Thiamine (vitamin B1) supplementation
• Use of conventional antiemetics
• Psychological support 6
• Assessment of severity by checking for ketones is crucial, as it determines the management approach 3