Morning sickness is something that most woman anticipate having to deal with in the first few months of pregnancy.  Of course some lucky ladies will avoid it all together, whilst others may find that they experience severe nausea and vomiting that lasts way into the afternoon, evening and night.  In fact, according to the The Royal College of Obstetricians and Gynaecologists (RCOG), around  80% of women suffer from nausea and vomiting in the first four months of pregnancy, with as many as 3% suffering from Hyperemesis gravidarum – an extreme form of pregnancy related sickness that can have very serious effects.  This month, RCOG have released new national guidelines, the first of their kind, on the treatment of vomiting and nausea in pregnancy and Hyperemesis gravidarum.

In a nutshell


The guidelines recommend that Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum (HG) should be diagnosed under the following conditions:

  • Onset in the first trimester of pregnancy when other possible causes have been excluded
  • Protracted NVP with a weight loss of more than 5% of pre-pregnancy weight, dehydration and electrolyte imbalance should lead to a diagnosis of HP

Management of the condition

  • Mild NVP should be managed at home with anti nausea medication (antiemetics)
  • Hospitalisation should be considered if one of the following applies:
    • continued nausea and vomiting and inability to keep down anti nausea medication
    • continued nausea and vomiting associated with weight loss greater than 5% of body weight
    • the presence of one or more additional diseases or disorders in addition to the NVP

Therapeutic options

  • Antiemetics
  • Corticosteroids – reserved for cases where standard therapies have failed
  • Rehydration with saline and postassium chloride – with electrolyte levels to be monitored daily

Complementary therapies

  • Ginger – to be used for mild to moderate NVP
  • Acupressure and Accupuncture

The effects of NVP and HG

The guidelines acknowledge the profound effect that prolonged and severe symptoms can have on a woman’s quality of life and social situation, advising that mental health status should be monitored and that psychosocial support should be offered both during the pregnancy and postnatally.

The guidelines in full

RCOG The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum