The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Nausea and Vomiting in Pregnancy

임신 중 구역과 구토의 관리

  • Kim, Kyeong-Ok (Department of Internal Medicine, Yeungnam University College of Medicine)
  • 김경옥 (영남대학교 의과대학 내과학교실)
  • Published : 2012.05.01
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Abstract

Nausea and vomiting in pregnancy (NVP) is common medical condition during pregnancy and associated with hormonal change. Early recognition and active treatment is warranted because it can be associated with adverse healthy effect in both fetus and mother. First, the possibility of other gastrointestinal disorder should be considered and precipitating factor, renal and liver function should be evaluated. Primay recommended pharmacotherapy is the combination of oral pyridoxine hydrochloride and doxylamine succinate. Other options including dopamin (D2) receptor antagonist, antihistamine and serotonine 5 hydroxytryptamine 3-receptor (5-HT3) can be used. Fluid mixed with multivitamine including thiamine supplement should be considered in case of severe dehydration and hyperemesis gravidarum. Emotional support is also an important part in the management of NVP. The physician shoud apply individualized approach for the safest and most appripriate treatment.

Keywords

References

  1. Lacroix R, Eason E, Melzack R. Nausea and vomiting during pregnancy: a prospective study of its frequency, intensity, and patterns of change. Am J Obstet Gynecol 2000;182:931-937. https://doi.org/10.1016/S0002-9378(00)70349-8
  2. Berkovitch M, Mazzota P, Greenberg R, et al. Metoclopramide for nausea and vomiting of pregnancy: a prospective multicenter international study. Am J Perinatol 2002;19:311-316. https://doi.org/10.1055/s-2002-34469
  3. Piwko C, Ungar WJ, Einarson TR, Wolpin J, Koren G. The weekly cost of nausea and vomiting of pregnancy for women calling the Toronto Motherisk Program. Curr Med Res Opin 2007;23:833-840. https://doi.org/10.1185/030079907X178739
  4. Reichmann JP, Kirkbride MS. Nausea and vomiting of pregnancy: cost effective pharmacologic treatments. Manag Care 2008;17:41-45.
  5. American College of Obstetrics and Gynecology. ACOG (American College of Obstetrics and Gynecology) Practice Bulletin: nausea and vomiting of pregnancy. Obstet Gynecol 2004;103:803-814. https://doi.org/10.1097/00006250-200404000-00045
  6. Miller F. Nausea and vomiting in pregnancy: the problem of perception: is it really a disease? Am J Obstet Gynecol 2002;186(5 Suppl):S182-S183. https://doi.org/10.1067/mob.2002.122594
  7. Arsenault MY, Lane CA, MacKinnon CJ, et al. The management of nausea and vomiting of pregnancy. J Obstet Gynaecol Can 2002;24:817-831. https://doi.org/10.1016/S1701-2163(16)30475-3
  8. Vellacott ID, Cooke EJ, James CE. Nausea and vomiting in early pregnancy. Int J Gynaecol Obstet 1988;27:57-62. https://doi.org/10.1016/0020-7292(88)90088-4
  9. Gadsby R, Barnie-Adshead AM, Jagger C. A prospective study of nausea and vomiting during pregnancy. Br J Gen Pract 1993;43:245-248.
  10. Davis M. Nausea and vomiting of pregnancy: an evidencebased review. J Perinat Neonatal Nurs 2004;18:312-328. https://doi.org/10.1097/00005237-200410000-00002
  11. Koch KL. Gastrointestinal factors in nausea and vomiting of pregnancy. Am J Obstet Gynecol 2002;186(5 Suppl): S198-S203. https://doi.org/10.1067/mob.2002.122598
  12. Nguyen P, Einarson A. Managing nausea and vomiting of pregnancy with pharmacological and nonpharmacological treatments. Womens Health (Lond Engl) 2006;2:753-760. https://doi.org/10.2217/17455057.2.5.753
  13. Guven MA, Ertas IE, Coskun A, Ciragil P. Serologic and stool antigen assay of Helicobacter pylori infection in hyperemesis gravidarum: which test is useful during early pregnancy? Taiwan J Obstet Gynecol 2011;50:37-41. https://doi.org/10.1016/j.tjog.2009.11.003
  14. Fejzo MS, Ingles SA, Wilson M, et al. High prevalence of severe nausea and vomiting of pregnancy and hyperemesis gravidarum among relatives of affected individuals. Eur J Obstet Gynecol Reprod Biol 2008;141:13-17. https://doi.org/10.1016/j.ejogrb.2008.07.003
  15. Clark SM, Costantine MM, Hankins GD. Review of NVP and HG and Early Pharmacotherapeutic Intervention. Obstet Gynecol Int 2012;2012:252-676.
  16. Eliakim R, Abulafia O, Sherer DM. Hyperemesis gravidarum: a current review. Am J Perinatol 2000;17:207-218. https://doi.org/10.1055/s-2000-9424
  17. O'Brien B, Zhou Q. Variables related to nausea and vomiting during pregnancy. Birth 1995;22:93-100. https://doi.org/10.1111/j.1523-536X.1995.tb00566.x
  18. Lane CA. Nausea and vomiting of pregnancy: a tailored approach to treatment. Clin Obstet Gynecol 2007;50:100-111. https://doi.org/10.1097/GRF.0b013e31802f178f
  19. Sherman PW, Flaxman SM. Nausea and vomiting of pregnancy in an evolutionary perspective. Am J Obstet Gynecol 2002;186(5 Suppl):S190-S197. https://doi.org/10.1067/mob.2002.122593
  20. Firoz T, Maltepe C, Einarson A. Nausea and vomiting in pregnancy is not always nausea and vomiting of pregnancy. J Obstet Gynaecol Can 2010;32:970-972. https://doi.org/10.1016/S1701-2163(16)34685-0
  21. Koren G, Boskovic R, Hard M, Maltepe C, Navioz Y, Einarson A. Motherisk-PUQE (pregnancy-unique quantification of emesis and nausea) scoring system for nausea and vomiting of pregnancy. Am J Obstet Gynecol 2002; 186(5 Suppl):S228-S231. https://doi.org/10.1067/mob.2002.123054
  22. Goodwin TM, Montoro M, Mestman JH. Transient hyperthyroidism and hyperemesis gravidarum: clinical aspects. Am J Obstet Gynecol 1992;167:648-652. https://doi.org/10.1016/S0002-9378(11)91565-8
  23. Niebyl JR. Clinical practice. Nausea and vomiting in pregnancy. N Engl J Med 2010;363:1544-1550. https://doi.org/10.1056/NEJMcp1003896
  24. Koren G, Piwko C, Ahn E, et al. Validation studies of the Pregnancy Unique-Quantification of Emesis (PUQE) scores. J Obstet Gynaecol 2005;25:241-244. https://doi.org/10.1080/01443610500060651
  25. Newman V, Fullerton JT, Anderson PO. Clinical advances in the management of severe nausea and vomiting during pregnancy. J Obstet Gynecol Neonatal Nurs 1993;22:483-490. https://doi.org/10.1111/j.1552-6909.1993.tb01833.x
  26. Jednak MA, Shadigian EM, Kim MS, et al. Protein meals reduce nausea and gastric slow wave dysrhythmic activity in first trimester pregnancy. Am J Physiol 1999;277(4 Pt 1):G855-G861.
  27. Borrelli F, Capasso R, Aviello G, Pittler MH, Izzo AA. Effectiveness and safety of ginger in the treatment of pregnancy-induced nausea and vomiting. Obstet Gynecol 2005;105:849-856. https://doi.org/10.1097/01.AOG.0000154890.47642.23
  28. Roscoe JA, Matteson SE. Acupressure and acustimulation bands for control of nausea: a brief review. Am J Obstet Gynecol 2002;186(5 Suppl):S244-S247. https://doi.org/10.1067/mob.2002.122606
  29. Rosen T, de Veciana M, Miller HS, Stewart L, Rebarber A, Slotnick RN. A randomized controlled trial of nerve stimulation for relief of nausea and vomiting in pregnancy. Obstet Gynecol 2003;102:129-135. https://doi.org/10.1016/S0029-7844(03)00375-2
  30. Niebyl JR, Goodwin TM. Overview of nausea and vomiting of pregnancy with an emphasis on vitamins and ginger. Am J Obstet Gynecol 2002;186(5 Suppl):S253-S255. https://doi.org/10.1067/mob.2002.122595
  31. Ebrahimi N, Maltepe C, Einarson A. Optimal management of nausea and vomiting of pregnancy. Int J Womens Health 2010;2:241-248.
  32. Badell ML, Ramin SM, Smith JA. Treatment options for nausea and vomiting during pregnancy. Pharmacotherapy 2006;26:1273-1287. https://doi.org/10.1592/phco.26.9.1273
  33. Gill SK, Einarson A. The safety of drugs for the treatment of nausea and vomiting of pregnancy. Expert Opin Drug Saf 2007;6:685-694. https://doi.org/10.1517/14740338.6.6.685
  34. Mazzotta P, Magee LA. A risk-benefit assessment of pharmacological and nonpharmacological treatments for nausea and vomiting of pregnancy. Drugs 2000;59:781-800. https://doi.org/10.2165/00003495-200059040-00005
  35. Bottomley C, Bourne T. Management strategies for hyperemesis. Best Pract Res Clin Obstet Gynaecol 2009;23:549-564. https://doi.org/10.1016/j.bpobgyn.2008.12.012
  36. Asker C, Norstedt Wikner B, Källén B. Use of antiemetic drugs during pregnancy in Sweden. Eur J Clin Pharmacol 2005;61:899-906. https://doi.org/10.1007/s00228-005-0055-1
  37. Einarson A, Maltepe C, Navioz Y, Kennedy D, Tan MP, Koren G. The safety of ondansetron for nausea and vomiting of pregnancy: a prospective comparative study. BJOG 2004;111:940-943. https://doi.org/10.1111/j.1471-0528.2004.00236.x
  38. Deuchar N. Nausea and vomiting in pregnancy: a review of the problem with particular regard to psychological and social aspects. Br J Obstet Gynaecol 1995;102:6-8. https://doi.org/10.1111/j.1471-0528.1995.tb09017.x
  39. Hsu JJ, Clark-Glena R, Nelson DK, Kim CH. Nasogastric enteral feeding in the management of hyperemesis gravidarum. Obstet Gynecol 1996;88:343-346. https://doi.org/10.1016/0029-7844(96)00174-3
  40. Soltani H, Taylor GM. Changing attitudes and perceptions to hyperemesis gravidarum. RCM Midwives 2003;6:520-524.
  41. Tamay AG, Kuscu NK. Hyperemesis gravidarum: current aspect. J Obstet Gynaecol 2011;31:708-712. https://doi.org/10.3109/01443615.2011.611918

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