Management of Nausea and Vomiting in Pregnancy

Nausea and vomiting affect up to 80% of pregnant women, presenting on a spectrum from mild discomfort to severe hyperemesis gravidarum. Management begins with reassurance and dietary modification, including small frequent meals, avoidance of triggering odours and flavours, and maintenance of hydration. Non-pharmacological approaches such as ginger supplementation and acupressure may provide additional relief. When symptoms persist, a stepwise pharmacological strategy is recommended, starting with vitamin B6 and antihistamines, progressing to dopamine antagonists or serotonin receptor antagonists when needed. Intravenous fluids, electrolyte correction and nutritional support, including enteral feeding in refractory cases, are central to preventing dehydration, weight loss and nutritional deficiencies. Close monitoring of maternal mental health, quality of life and pregnancy outcomes guides escalation of care. Multidisciplinary collaboration involving obstetricians, dietitians and mental health professionals is essential to optimise maternal and foetal well-being and to reduce hospital admissions and health-care costs.

Research from Nature Portfolio

Recent genetic studies have advanced understanding of severe nausea and vomiting by identifying two placental genes, GDF15 and IGFBP7, that confer increased susceptibility to hyperemesis gravidarum. A genome-wide association analysis revealed that variants at these loci influence appetite regulation and placental signalling pathways, offering potential biomarkers for early risk stratification. Insights into the molecular drivers of extreme cases may inform personalised interventions and stimulate development of targeted antiemetic therapies for women at greatest risk.

Management of Nausea and Vomiting in Pregnancy publication trend

The graph below shows the total number of articles in management of nausea and vomiting in pregnancy across all publications each year (not limited to Nature Index journals).

Technical terms

Hyperemesis gravidarum: Severe form of pregnancy-related nausea and vomiting leading to dehydration, weight loss and electrolyte imbalance.

Genome-wide association study (GWAS): A research approach that scans the genome for common genetic variants linked to a particular trait or disorder.

GDF15: Growth differentiation factor 15, a placental cytokine implicated in appetite regulation and cachexia.

IGFBP7: Insulin-like growth factor binding protein 7, involved in placental development and cellular signalling.

Antiemetic: A drug used to prevent or alleviate nausea and vomiting by acting on various neurotransmitter receptors.

PUQE score: Pregnancy-Unique Quantification of Emesis and Nausea, a validated tool for assessing severity of nausea and vomiting in pregnancy.

References

1. The Use of Ginger Bioactive Compounds in Pregnancy: An Evidence Scan and Umbrella Review of Existing Meta-Analyses. Advances in Nutrition (2024).
2. Placenta and appetite genes GDF15 and IGFBP7 are associated with hyperemesis gravidarum. Nature Communications (2018).
3. Norwegian PUQE (Pregnancy-Unique Quantification of Emesis and Nausea) Identifies Patients with Hyperemesis Gravidarum and Poor Nutritional Intake: A Prospective Cohort Validation Study. PLOS ONE (2015).
4. Interventions for treating hyperemesis gravidarum: a Cochrane systematic review and meta-analysis. The Journal of Maternal-Fetal & Neonatal Medicine (2017).