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Nausea and vomiting in pregnancy

Last reviewed: 3 Apr 2025
Last updated: 01 Apr 2025

Summary

Definition

History and exam

Key diagnostic factors

  • first trimester of pregnancy
  • weight loss of >5%
Full details

Other diagnostic factors

  • absence of thyroid enlargement/nodules
  • dry mucous membranes
  • postural dizziness
  • tachycardia
  • hypotension
  • ketotic breath
Full details

Risk factors

  • family history of hyperemesis gravidarum
  • previous history of NVP
  • multiple gestation or increased placental mass
  • gestational trophoblastic disease
  • other causes of increased placental mass
  • female fetus
  • history of motion sickness
  • history of migraine headache
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
Full details

Tests to consider

  • CBC
  • basic metabolic panel
  • serum LFTs
  • serum BUN and creatinine
  • serum thyroid-stimulating hormone (TSH) and free thyroxine (T4)
  • urinalysis
  • urine or serum ketones
  • fetal ultrasound with nuchal translucency
  • serum analytes
  • Helicobacter pylori breath test
  • urine culture
  • serum amylase and lipase
  • abdominal ultrasound
  • renal ultrasound
  • cranial CT or MRI
Full details

Treatment algorithm

ACUTE

without volume depletion

without volume depletion but failed conservative management

with volume depletion

Contributors

Authors

Professor and Chair

Family Medicine

Carver College of Medicine

University of Iowa

Iowa City

IA

Disclosures

JDQ declares that he has no competing interests.

Peer reviewers

Faculty Physician

Family Medicine Residency

Naval Hospital Jacksonville

FL

Disclosures

SJ declares that she has no competing interests.

Assistant Professor

Head of Department of Obstetrics and Gynecology

Mosul College of Medicine

Mosul

Iraq

Disclosures

YTJ declares that he has no competing interests.

Associate Director

Department of Obstetrics and Gynecology

Florida Hospital

Orlando

FL

Disclosures

DAH declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Goodwin TM. Hyperemesis gravidarum. Clin Obstet Gynecol. 1998 Sep;41(3):597-605. Abstract

American College of Obstetricians and Gynecologists. Practice bulletin no. 189: nausea and vomiting of pregnancy. Jan 2018 [internet publication].Full text

Matthews A, Haas DM, O'Mathúna DP, et al. Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst Rev. 2015;(9):CD007575.Full text  Abstract

Royal College of Obstetricians and Gynaecologists. Green-top guideline no. 69: the management of nausea and vomiting in pregnancy and hyperemesis gravidarum. Feb 2024 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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  • Guidelines

    • The management of nausea and vomiting in pregnancy and hyperemesis gravidarum
    • Nausea and vomiting of pregnancy
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  • Patient information

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