title: The outpatient management and special considerations of nausea and vomiting in pregnancy.
abstract: With 50-90% of pregnant women experiencing nausea and vomiting of pregnancy (NVP), the burden of illness can become quite significant if symptoms are under-treated and/or under-diagnosed, thus allowing for progression of the disease. The majority of these women will necessitate at least one visit with a provider to specifically address NVP, and up to 10% or greater will require pharmacotherapy after failure of conservative measures to adequately control symptoms. As a result, initiation of prompt and effective treatment in the outpatient setting is ideal. Once NVP is diagnosed and treatment is started, it is crucial to track symptoms in order to assess for a decrease in or resolution of symptoms as well as an escalation in symptoms requiring additional therapy. Of note, co-existing gastroesophageal reflux disease (GERD), Helicobacter pylori infection, and psychosocial factors may have a negative impact on the management of NVP. Ultimately, every woman has her own perception of disease severity and desire for treatment. It is critical that both the provider and patient be proactive in the diagnosis and management of NVP.
authors.affiliation: Department of Obstetrics & Gynecology, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555. Electronic address: shclark@utmb.edu.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Clark
authors.affiliation: Department of Obstetrics & Gynecology, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555; US Navy Medicine Professional Development Center, Bethesda, MD.
authors.forename: Eryn
authors.initials: E
authors.lastname: Dutta
authors.affiliation: US Navy Medicine Professional Development Center, Bethesda, MD.
authors.forename: Gary D V
authors.initials: GD
authors.lastname: Hankins
mesh_terms: D000553:Ambulatory Care; D000932:Antiemetics / Q000627:therapeutic use*; D004035:Diet Therapy; D004319:Doxylamine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D005440:Fluid Therapy; D005764:Gastroesophageal Reflux / Q000150:complications / Q000628:therapy*; D006634:Histamine H1 Antagonists / Q000627:therapeutic use*; D006801:Humans; D006939:Hyperemesis Gravidarum / Q000150:complications / Q000628:therapy; D008787:Metoclopramide / Q000627:therapeutic use; D048968:Morning Sickness / Q000150:complications / Q000628:therapy*; D017294:Ondansetron / Q000627:therapeutic use; D011247:Pregnancy; D011398:Promethazine / Q000627:therapeutic use; D011736:Pyridoxine / Q000627:therapeutic use; D012720:Severity of Illness Index; D014803:Vitamin B Complex / Q000627:therapeutic use*
chemical_list: D000932:Antiemetics; D006634:Histamine H1 Antagonists; D014803:Vitamin B Complex; D017294:Ondansetron; D004319:Doxylamine; D011398:Promethazine; D011736:Pyridoxine; D008787:Metoclopramide; C035385:doxylamine succinate
keywords: nausea; outpatient management; pregnancy; reflux; vomiting