Clinical Edge

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Treatment of Nausea and Vomiting of Pregnancy

Obstet Gynecol; ePub 2018 Jan; ACOG, Ramin

Once nausea and vomiting of pregnancy progresses, it can become more difficult to control symptoms, therefore, treatment in the early stages may prevent more serious complications, including hospitalization. This according to new clinical management guidelines from the American College of Obstetricians and Gynecologists (ACOG) that reviewed the best available evidence on the diagnosis and management of nausea and vomiting of pregnancy and offer the following (Level A) recommendations:

  • Treatment of nausea and vomiting of pregnancy with vitamin B6 (pyridoxine) alone or vitamin B6 plus doxylamine in combination is safe and effective and should be considered first-line pharmacotherapy.
  • The standard recommendation to take prenatal vitamins for 1 month before fertilization may reduce the incidence and severity of nausea and vomiting of pregnancy.
  • The appropriate management of abnormal maternal thyroid tests attributable to gestational transient thyrotoxicosis, or hyperemesis gravidarum, or both, includes supportive therapy, and antithyroid drugs are not recommended.


Nausea and vomiting of pregnancy. ACOG Practice Bulletin No. 189. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2018;131:e15–30.