Our recommendations are based on the Society of Obstetric Medicine of Australia and New Zealand Guideline For Management Of Nausea And Vomiting Of Pregnancy And Hyperemesis Gravidarum.

Many people are hesitant, or even resistant, to taking medication while pregnant. While there are risks associated with many of the recommended medications, these need to be weighed against the risks of leaving symptoms untreated. 

Mild to moderate NVP can often be managed without the need for pharmacological intervention. In more severe cases, however, where symptoms are impacting a sufferers ability to eat and/or drink and weight loss is occurring the need for treatment increases. While concerns around medication use in pregnancy are valid, failing to treat NVP or HG can do more harm than any medication. 

The treatments listed below are recommended by the SOMANZ Guidelines for Management of Nausea and Vomiting in Pregnancy and Hyperemesis Gravidarum. Increasingly, evidence shows the potentially harmful effects of malnutrition and dehydration during pregnancy, including the first trimester. Malnutrition in early pregnancy has been found to have lifelong cardiometabolic consequences for the offspring. Not treating a woman effectively enough to ensure she is able to eat and drink is riskier than leaving her untreated. 

Additionally, the physical and psychological effects of profound and prolonged nausea and/or vomiting should not be underestimated and quality of life should be a factor in decision making about treatments. A recent systematic review of qualitative evidence found that even moderate NVP could have a seriously detrimental effect on sufferer’s lives and mental health.

Treatment Plans

According to the SOMANZ Guidelines any plan for the holistic management of NVP and HG must include: 

• Interventions to reduce nausea, retching and vomiting 

• Management of associated gastric dysmotility ie. gastroesophageal reflux and constipation 

• Maintenance of hydration, fluid and electrolyte replacement 

• Maintenance of adequate nutrition including the provision of vitamin supplements where required 

• Psychosocial support 

• Monitoring and prevention of side effects and adverse pregnancy and fetal outcomes 

And the following considerations for treatment choices in NVP and HG should be made: 

• Establish reasonable targets for the treatment plan and manage patient expectation ie. aim for the ability to eat and drink adequately without necessarily complete resolution of NVP 

• Discontinue prenatal multivitamins if they are contributing to symptoms. Many sufferers report an improvement in symptoms after discontinuation of prenatal multivitamins that include iron. The two critical micronutrients which should be continued, if possible, are iodine (150 mcg per day) and folate (at least 400 mcg per day) 

• The timing of taking medications should take into account the pattern of symptoms over a 24 hour period. Symptoms often fluctuate during the day and night and therapy should reflect these individual differences. Using the PUQE-24 or HELP Scores can help you track and establish patterns, see our previous resource on Diagnosis + Assessment

• The choice of antiemetic should be individualised, based on the sufferer’s symptoms, previous response to treatment and potential side effects: 

  • If an antiemetic is ineffective at maximal dose, discontinue before commencing an alternate agent 

  • If an antiemetic is partially effective, optimise dosage and timing, and only add additional agents after maximal doses of the first agent have been trialled 

  • Oral therapy is usually commenced first and parenteral or subcutaneous treatment reserved for severe cases

  • Written instructions should be given regarding titrating therapy (up and down) as symptoms fluctuate, deteriorate or improve 

  • Regular review of therapy is required in all cases

Medications for the treatment of NVP and HG Treatment of NVP and HG may require a range of agents including: 

• Antiemetics: vitamin and prescribed 

• Acid suppression 

• Stool softeners 

• Steroids 

• Other-supplements 

The best way of treating NVP and HG is to layer medications together. If a patient is not responding to first-line treatments, adding another layer to their medications may improve symptom management. NVP and HG are multifaceted conditions that require the management of a number of symptomatic responses. 

It is important to remember that pharmacological treatment for NVP and HG is only one part of the holistic management of a patient’s condition. Other elements will include, where appropriate, non-drug measures, psychosocial support and ongoing obstetric/midwifery care. 

Almost all pharmacological treatment is “off-license” and based on historical experience with the limited amount of high-quality research data described in small trials or systematic reviews or meta-analyses. In all cases, a rational assessment of maternal and fetal risk, particularly teratogenesis, needs to be determined based on the patient’s circumstances. We have a collection of the most recent and relevant research available here.

To download the full SOMANZ guideline please click below

Upon reading the SOMANZ guidelines you will see that ginger is recommended as a first-line treatment for mild NVP. We have chosen not to include this on our website, or in any associated resources because we do not believe that it is an appropriate treatment for suffering women. Evidence shows no therapeutic advantages in using ginger to treat NVP. Additionally, we believe suggesting it contributes negatively to a suffering woman's state of mind.