FOR DOCTORS

NVP

NVP, or nausea and vomiting of pregnancy, is commonly known as morning sickness and affects an estimated 80% of all pregnant women. It’s usually one of the first symptoms of pregnancy experienced by moms to be. It’s caused by a combination of physical changes in the body such as

Rapidly increasing estrogen levels
An enhanced sense of smell
Excess acids in the stomach
Increased fatigue

In spite of the term "morning sickness”, NVP can strike any time of the day. Its severity varies from woman to woman. Extremely severe NVP is known as hyperemesis gravidarum and may lead to hospitalisation. However, the vast majority of women experience mild to moderate NVP. In some cases, the condition persists until the end of the pregnancy.

Managing NVP

The Doxylamine and Pyridoxine combination is strongly recommended by the Society of Obstetricians and Gynecologists (SOGC) to manage NVP. A body of research has affirmed this combination’s safety and efficacy during pregnancy.

The SOGC also recommends:

• Alternative therapies such as ginger, acupressure, and acupuncture may be beneficial (I-A)
  
  
• H1 receptor antagonists should be considered in the management of acute or breakthrough episodes of NVP (I-A)
  
  
• Pyridoxine monotherapy supplementation may be considered as an adjuvant measure (I-A)
  
  
• Phenothiazines are safe and effective for severe NVP (I-A)
  
  
• Metoclopramide is safe to be used for management of NVP, although evidence for its efficacy is limited (II-2D)
  
  
• Corticosteroids should be avoided during the first trimester due to the possibility of an increased risk of oral clefting, and should be restricted to refractory cases (I-B)
  
  
• When NVP is refractory to initial pharmacotherapy, investigation of other potential causes should be taken (III-A)