Contemporary approaches to hyperemesis during pregnancy

Curr Opin Obstet Gynecol. 2011 Apr;23(2):87-93. doi: 10.1097/GCO.0b013e328342d208.


Purpose of review: Nausea and vomiting of pregnancy (NVP) affects 90% of pregnant women and its impact is often underappreciated. Hyperemesis gravidarum, the most severe end of the spectrum, affects 0.5-2% of pregnancies. The pathogenesis of this condition remains obscure and its management has largely been empirical. This review aims to provide an update on advances in pregnancy hyperemesis focusing on papers published within the past 2 years.

Recent findings: The cause of hyperemesis is continuing to be elaborated. Recent data attest to the effectiveness of the oral doxylamine-pyridoxine in NVP. Follow-up data of children exposed in early pregnancy to doxylamine-pyridoxine for NVP are reassuring. Evidence is increasing for ginger as an effective herbal remedy for NVP. Metoclopramide is effective in NVP and hyperemesis gravidarum, with a good balance of efficacy and tolerability. A recent large-scale study on first trimester exposure to metoclopramide is reassuring of its safety. Evidence is emerging for the treatment of acid reflux to ameliorate NVP. The role of corticosteroids for hyperemesis gravidarum remains controversial. Transpyloric feeding may be warranted for persistent weight loss, despite optimal antiemetic therapy.

Summary: Women with significant NVP should be identified so that they can be safely and effectively treated.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Antiemetics
  • Diet
  • Doxylamine / pharmacology
  • Female
  • Humans
  • Hyperemesis Gravidarum / diagnosis
  • Hyperemesis Gravidarum / therapy*
  • Obstetrics / methods
  • Ondansetron / therapeutic use
  • Plant Extracts / therapeutic use
  • Pregnancy
  • Pregnancy Complications / diagnosis
  • Pregnancy Complications / therapy*
  • Pregnancy Outcome
  • Pyridoxine / pharmacology
  • Zingiber officinale / metabolism


  • Adrenal Cortex Hormones
  • Antiemetics
  • Plant Extracts
  • Ondansetron
  • Doxylamine
  • Pyridoxine