Evidence-Based Approaches to Managing Nausea and Vomiting in Early Pregnancy

Tekoa L. King, CNM, MPH; Patricia Aikins Murphy, CNM, DrPH


J Midwifery Womens Health. 2009;54(6):430-444. 

In This Article

Management: Safety and Efficacy

Regimens to treat NVP and HG have included abortion, antiemetics, complementary and alternative treatments such as herbs, dietary restriction, hydration, psychotherapy, psychotropic medication, and total parenteral nutrition. Historically, treatments have also included cervical dilation, leeches, sensory deprivation, and vocal exercises.[21]

Remedies used in early pregnancy must be safe in that they do not increase the risk of spontaneous abortion, birth defects, or other adverse events of pregnancy. Such assessments require directed investigation and large enough sample sizes to determine if the occurrence of adverse events is higher than expected. For example, the incidence of spontaneous abortion in the first trimester of pregnancy is as high as 20%[28,29] and the prevalence of birth defects detected at birth is 2% to 3%;[30] therefore, any investigation of the risk associated with medication use must follow women long enough to evaluate the newborn and have a large enough sample size to determine with statistical certainty whether or not the risk is increased.

A determination of efficacy requires studies with appropriate outcome measures. For remedies that treat NVP, periodic assessment of nausea (using a validated objective measure) and episodes of retching or vomiting are the most common outcomes. Weight gain or weight loss and some type of QOL evaluation are also used. Because NVP is a time-limited condition, studies with comparison groups are important to assess whether there is a true benefit of the intervention rather than naturally occurring improvement over time.


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