Approach to treating nausea and vomiting during pregnancy
For patients with nonsevere nausea and vomiting during pregnancy, a common approach to treatment is to trial nondrug therapy for 1 week. If this is ineffective, add oral antiemetic therapy.
For patients with severe nausea and vomiting, consider starting treatment with a parenteral antiemetic regimen.
The antiemetics recommended in this topic can be added in a stepwise fashion, or used to replace antiemetics that are not tolerated. At each step, discuss the risks and benefits of antiemetic therapy with the patient before escalating therapy. The Australian Therapeutic Goods Administration (TGA) pregnancy categories are explained in Australian categorisation of drugs in pregnancy. The TGA pregnancy category should not be the sole basis of decision-making in the use of a drug during pregnancy, in part because it does not provide information about the balance of harms and benefits in a particular patient.
For pregnant people who had severe nausea and vomiting with a previous pregnancy, consider starting antiemetic therapy (eg pyridoxine plus doxylamine) pre-emptively. The risk of nausea and vomiting in pregnancy may be reduced by taking a multivitamin around the time of conception.