Modern Approaches to the Treatment of Vomiting in Pregnant Women: Review of Clinical Recommendations
https://doi.org/10.31550/1727-2378-2025-24-5-93-100
Abstract
Aim. To evaluate current approaches to the treatment of vomiting in pregnant based on modern clinical guidelines.
Key points. Nausea, vomiting, decreased appetite and changes in taste sensations are frequent companions of pregnancy. Such disorders occur in 80-90% of women. In most cases, they do not require medical intervention. However, some patients develop severe vomiting (hyperemesis gravidarum). This condition is dangerous for both the mother and the fetus, so it requires active treatment.
Conclusion. The analysis of Russian and international approaches to the treatment of vomiting in pregnant women shows adherence to uniform principles of therapy and good consistency in the recommendations for choosing treatment based on the principle of safety, stepby-step and individualization.
Keywords
About the Authors
I. I. BaranovRussian Federation
Moscow
N. I. Klimenchenko
Russian Federation
Moscow
E. M. Limonova
Russian Federation
Moscow
A. I. Robertus
Russian Federation
Moscow
References
1. Gadsby R., Rawson V., Dziadulewicz E., Rousseau B. et al. Nausea and vomiting of pregnancy and resource implications: the NVP Impact Study. Br. J. Gen. Pract. 2019;69(680):e217–23. DOI: 10.3399/bjgp18X700745
2. Gadsby R., Barnie-Adshead A.M., Jagger C. A prospective study of nausea and vomiting during pregnancy. Br. J. Gen. Pract. 1993;43(371):245– 8. Erratum in: Br. J. Gen. Pract. 1993;43(373):325.
3. Brown H.L. Nausea and vomiting of pregnancy. Contemp. Ob. Gyn. 2016;61(4):48–50.
4. Kramer J., Bowen A., Stewart N., Muhajarine N. Nausea and vomiting of pregnancy. MCN Am. J. Matern. Child Nurs. 2013;38(1):21–7. DOI: 10.1097/NMC.0b013e3182748489
5. Gadsby R., Ivanova D., Trevelyan E., Hutton J.L. et al. Nausea and vomiting in pregnancy is not just ‘morning sickness’: data from a prospective cohort study in the UK. Br. J. Gen. Pract. 2020;70(697):e534–9. DOI: 10.3399/bjgp20X710885
6. Jansen L.A.W., Koot M.H., Van’t Hooft J., Dean C.R. et al. The Windsor definition for hyperemesis gravidarum: a multistakeholder international consensus definition. Eur. J. Obstet. Gynecol. Reprod. Biol. 2021;266:15–22. DOI: 10.1016/j.ejogrb.2021.09.004
7. Garg R., Sanjay, Das V., Usman K. et al. Spontaneous pneumothorax: an unusual complication of pregnancy — a case report and review of literature. Ann. Thorac. Med. 2008;3(3):104–5. DOI: 10.4103/1817-1737.41915
8. Joshi A., Chadha G., Narayanan P. From discomfort to distress: a critical analysis of hyperemesis gravidarum in the emergency room. Cureus. 2023;15(8):e44004. DOI: 10.7759/cureus.44004
9. Goodwin T.M., Montoro M., Mestman J.H. Transient hyperthyroidism and hyperemesis gravidarum: clinical aspects. Am. J. Obstet. Gynecol. 1992;167(3):648–52. DOI: 10.1016/s0002-9378(11)91565-8
10. Fejzo M.S., Sazonova O.V., Sathirapongsasuti J.F., Hallgrímsdóttir I.B. et al. Placenta and appetite genes GDF15 and IGFBP7 are associated with hyperemesis gravidarum. Nat. Commun. 2018;9(1):1178. DOI: 10.1038/s41467-018-03258-0
11. Fejzo M., Arzy D., Tian R., MacGibbon K. et al. Evidence GDF15 plays a role in familial and recurrent hyperemesis gravidarum. Geburtshilfe Frauenheilkd. 2018;78(09):866–70. DOI: 10.1055/a-0661-0287
12. Fejzo M., Rocha N., Cimino I., Lockhart S. et al. Fetally-encoded GDF15 and maternal GDF15 sensitivity are major determinants of nausea and vomiting in human pregnancy. bioRxiv [Preprint]. 2023:2023.06.02.542661. DOI: 10.1101/2023.06.02.542661
13. Fejzo M.S., MacGibbon K.W., First O., Quan C. et al. Whole-exome sequencing uncovers new variants in GDF15 associated with hyperemesis gravidarum. BJOG. 2022;129(11):1845–52. DOI: 10.1111/1471-0528.17129
14. Nelson-Piercy C., Dean C., Shehmar M., Gadsby R. et al. The management of nausea and vomiting in pregnancy and hyperemesis gravidarum (Green-top Guideline No. 69). BJOG. 2024;131(7):e1– 30. DOI: 10.1111/1471-0528.17739
15. Veenendaal M.V.E., van Abeelen A.F.M., Painter R.C., van der Post J.A.M. et al. Consequences of hyperemesis gravidarum for offspring: a systematic review and meta-analysis. BJOG. 2011;118(11):1302– 13. DOI: 10.1111/j.1471-0528.2011.03023.x
16. Tan A., Foran T., Henry A. Managing nausea and vomiting in pregnancy in a primary care setting. Aust. Fam. Physician. 2016;45(8):564–8.
17. Depue R.H., Bernstein L., Ross R.K., Judd H.L. et al. Hyperemesis gravidarum in relation to estradiol levels, pregnancy outcome, and other maternal factors: a seroepidemiologic study. Am. J. Obstet. Gynecol. 1987;156(5):1137–41. DOI: 10.1016/0002-9378(87)90126-8
18. Rhodes V.A., McDaniel R.W. The index of nausea, vomiting, and retching: a new format of the index of nausea and vomiting. Oncol. Nurs. Forum. 1999;26(5):889–94.
19. Rhodes V.A., Watson P.M., Johnson M.H. Development of reliable and valid measures of nausea and vomiting. Cancer Nurs. 1984;7(1):33–41.
20. Koren G., Boskovic R., Hard M., Maltepe C. et al. 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. understanding):S228–31. DOI: 10.1067/mob.2002.123054
21. Koren G., Piwko C., Ahn E., Boskovic R. et al. Validation studies of the Pregnancy Unique-Quantification of Emesis (PUQE) scores. J. Obstet. Gynaecol. 2005;25(3):241–4. DOI: 10.1080/01443610500060651
22. Lacasse A., Rey E., Ferreira E., Morin C. et al. Validity of a modified Pregnancy-Unique Quantification of Emesis and Nausea (PUQE) scoring index to assess severity of nausea and vomiting of pregnancy. Am. J. Obstet. Gynecol. 2008;198(1):71.e1–7. DOI: 10.1016/j.ajog.2007.05.051
23. Ebrahimi N., Maltepe C., Bournissen F.G., Koren G. Nausea and vomiting of pregnancy: using the 24-hour Pregnancy-Unique Quantification of Emesis (PUQE-24) scale. J. Obstet. Gynaecol. Can. 2009;31(9):803–7. DOI: 10.1016/S1701-2163(16)34298-0
24. MacGibbon K.W., Kim S., Mullin P.M., Fejzo M.S. HyperEmesis Level Prediction (HELP Score) identifies patients with indicators of severe disease: a validation study. Geburtshilfe Frauenheilkd. 2021;81(1):90–8. DOI: 10.1055/a-1309-1997
25. Savelyeva G.M., Sukhikh G.T., Serov V.N., Radzinsky V.E., eds. Obstetrics: national leadership. 2nd ed. M.: GEOTAR-Media; 2022. 1080 p. (in Russian)
26. Ezberci İ., Güven E.S.G., Ustüner I., Sahin F.K. et al. Disability and psychiatric symptoms in hyperemesis gravidarum patients. Arch. Gynecol. Obstet. 2014;289(1):55–60. DOI: 10.1007/s00404-013-2934-5
27. Koot M.H., Grooten I.J., Post J.A.M.V., Bais J.M.J. et al. Ketonuria is not associated with hyperemesis gravidarum disease severity. Eur. J. Obstet. Gynecol. Reprod. Biol. 2020;254 315–20. DOI: 10.1016/j.ejogrb.2020.08.014
28. Mitchell-Jones N., Gallos I., Farren J., Tobias A. et al. Psychological morbidity associated with hyperemesis gravidarum: a systematic review and meta-analysis. BJOG. 2017;124(1):20–30. DOI: 10.1111/1471-0528.14180
29. Fiaschi L., Nelson-Piercy C., Gibson J., Szatkowski L. et al. Adverse maternal and birth outcomes in women admitted to hospital for hyperemesis gravidarum: a population-based cohort study. Paediatr. Perinat. Epidemiol. 2018;32(1):40–51. DOI: 10.1111/ppe.12416
30. Petry C.J., Ong K.K., Beardsall K., Hughes I.A. et al. Vomiting in pregnancy is associated with a higher risk of low birth weight: a cohort study. BMC Pregnancy Childbirth. 2018;18(1):133. DOI: 10.1186/s12884-018-1786-1
31. Jarvis S., Nelson-Piercy C. Management of nausea and vomiting in pregnancy. BMJ. 2011;342:d3606. DOI: 10.1136/bmj.d3606
32. Koren G., Hankins G.D.V., Clark S., Caritis S.N. et al. Effectiveness of doxylamine-pyridoxine for morning sickness. Am. J. Obstet. Gynecol. 2016;214(5):664–6. DOI: 10.1016/j.ajog.2016.01.186
33. Erick M., Cox J.T., Mogensen K.M. ACOG Practice Bulletin 189: nausea and vomiting of pregnancy. Obstet. Gynecol. 2018;131(5):935. DOI: 10.1097/AOG.0000000000002604
34. Smith J.A., Fox K.A., Clark S.M. Nausea and vomiting of pregnancy: treatment and outcome. UptoDate 2023. URL: https://www.uptodate.com/contents/nausea-and-vomiting-of-pregnancy-treatment-andoutcome#H21389680 (дата обращения — 15.04.2025).
35. Figueroa Gray M., Hsu C., Kiel L., Dublin S. Getting through the day: a pilot qualitative study of U.S. women’s experiences making decisions about anti-nausea medication during pregnancy. BMC Pregnancy Childbirth. 2018;18(1):475. DOI: 10.1186/s12884-018-2093-6
36. Widnes S.F., Schjøtt J. Risk perception regarding drug use in pregnancy. Am. J. Obstet. Gynecol. 2017;216(4):375–8. DOI: 10.1016/j.ajog.2016.12.007
37. Monograph U. Use of ondansetron in pregnancy. 2019.
38. Jennings L.K., Mahdy H. Hyperemesis gravidarum [Internet]. StatPearls. 2022.
39. Pacei F., Tesone A., Laudi N., Laudi E. et al. The relevance of thiamine evaluation in a practical setting. Nutrients. 2020;12(9):2810. DOI: 10.3390/nu12092810
40. Hayakawa S., Nakajima N., Karasaki-Suzuki M., Yoshinaga H. et al. Frequent presence of helicobacter pylori genome in the saliva of patients with hyperemesis gravidarum. Am. J. Perinatol. 2000;17(5):243–8. DOI: 10.1055/s-2000-10005
41. Niemeijer M.N., Grooten I.J., Vos N., Bais J.M.J. et al. Diagnostic markers for hyperemesis gravidarum: a systematic review and metaanalysis. Am. J. Obstet. Gynecol. 2014;211(2):150.e1–15. DOI: 10.1016/j.ajog.2014.02.012
42. Regan L.A., Hoffman R.S., Nelson L.S. Slower infusion of metoclopramide decreases the rate of akathisia. Am. J. Emerg. Med. 2009;27(4):475– 80. DOI: 10.1016/j.ajem.2008.03.044
43. Boelig R.C., Barton S.J., Saccone G., Kelly A.J. et al. Interventions for treating hyperemesis gravidarum: a Cochrane systematic review and meta-analysis. J. Matern. Fetal Neonatal Med. 2018;31(18):2492–505. DOI: 10.1080/14767058.2017.1342805
44. Grooten I.J., Vinke M.E., Roseboom T.J., Painter R.C. A systematic review and meta-analysis of the utility of corticosteroids in the treatment of hyperemesis gravidarum. Nutr. Metab. Insights. 2015;8(suppl.1):23– 32. DOI: 10.4137/NMI.S29532
45. O’Brien B., Relyea M.J. Use of indigenous explanations and remedies to further understand nausea and vomiting during pregnancy. Health Care Women Int. 1999;20(1):49–61. DOI: 10.1080/073993399245953
46. Bustos M., Venkataramanan R., Caritis S. Nausea and vomiting of pregnancy — what’s new? Auton. Neurosci. 2017;202:62–72. DOI: 10.1016/j.autneu.2016.05.002
47. Basirat Z., Moghadamnia A.A., Kashifard M., Sarifi-Razavi A. The effect of ginger biscuit on nausea and vomiting in early pregnancy. Acta Med. Iran. 2009;47(1):51–6.
48. Vandraas K.F., Vikanes A.V., Vangen S., Magnus P. et al. Hyperemesis gravidarum and birth outcomes-a population-based cohort study of 2.2 million births in the Norwegian Birth Registry. BJOG. 2013;120(13):1654–60. DOI: 10.1111/1471-0528.12429
49. Koch K.L. Gastrointestinal factors in nausea and vomiting of pregnancy. Am. J. Obstet. Gynecol. 2002;186(5 suppl. understanding):S198–203. DOI: 10.1067/mob.2002.122598
50. Nijsten K., Dean C., van der Minnen L.M., Bais J.M.J. et al. Recurrence, postponing pregnancy, and termination rates after hyperemesis gravidarum: follow up of the MOTHER study. Acta Obstet. Gynecol. Scand. 2021;100(9):1636–43. DOI: 10.1111/aogs.14197
51. O’Hara M. Experience of hyperemesis gravidarum in a subsequent pregnancy. MIDIRS Midwifery Digest. 2017;27:309–18.
52. Sanghvi U., Thankappan K.R., Sarma P.S., Sali N. Assessing potential risk factors for child malnutrition in rural Kerala, India. J. Trop. Pediatr. 2001;47(6):350–5. DOI: 10.1093/tropej/47.6.350
53. Liu S., Rouleau J., Joseph K.S., Sauve R. et al. Epidemiology of pregnancy-associated venous thromboembolism: a population-based study in Canada. J. Obstet. Gynaecol. Can. 2009;31(7):611–20. DOI: 10.1016/S1701-2163(16)34240-2
54. Pope E., Maltepe C., Koren G. Comparing pyridoxine and doxylamine succinate-pyridoxine HCl for nausea and vomiting of pregnancy: a matched, controlled cohort study. J. Clin. Pharmacol. 2015;55(7):809– 14. DOI: 10.1002/jcph.480
55. Doxylamine/pyridoxine for nausea and vomiting in pregnancy. Drug Ther. Bull. 2019;57(3):38–41. DOI: 10.1136/dtb.2018.000053
56. Shohin I.E., Noskov S.M., Globenko A.A., Bagaeva N.S. et al. Study of pharmacokinetic parameters and safety of the drug Duonica in comparison with the original combination of doxylamine and pyridoxine under fed conditions. Pharmacokinetics and Pharmacodynamics. 2024;2:3–11. (in Russian). DOI: 10.37489/2587-7836-2024-2-3-11
Review
For citations:
Baranov I.I., Klimenchenko N.I., Limonova E.M., Robertus A.I. Modern Approaches to the Treatment of Vomiting in Pregnant Women: Review of Clinical Recommendations. Title. 2025;24(5):93-100. (In Russ.) https://doi.org/10.31550/1727-2378-2025-24-5-93-100
















