Women suffering with nausea and vomiting and hyperemesis gravidarum during pregnancy “need more support”, according to guidelines published today.
Healthcare professionals should address the severity of such symptoms and impact on mental health, said the guidance revealed at the Royal College of Obstetricians and Gynaecologists World Congress in Birmingham.
“This is the first edition of this guideline on this important topic”
Nausea and vomiting in pregnancy – commonly known as “morning sickness” – affects up to 80% of pregnant women. Hyperemesis gravidarum, which is more severe, is much rarer and affects around 1-3% of pregnant women.
The guidance noted, for most women, symptoms of nausea and vomiting or hyperemesis gravidarum improved or disappeared by around week 14, although for some it could last longer.
The new Green-top Guideline, the first national guideline on the area, looks at the management of nausea and vomiting of pregnancy and hyperemesis gravidarum.
It provides healthcare professionals with guidance on diagnosis, monitoring severity, treatment, effects of condition, particularly on mental health and follow up care, said college.
Treatment options for women include the use of anti-emetics as well as complementary therapies, including analysis of the usefulness of ginger, acupressure and hypnotherapy.
“It is important that women know how to contact services when vomiting becomes persistent or debilitating”
The new guidance addresses the effect the symptoms can have on quality of life and states that clinicians should consider the effect on a woman’s mental health during pregnancy and postnatally and refer her for psychological support if needed, such as counselling.
Women with hyperemesis gravidarum have been found to be three to six times more likely to have low quality of life compared to women with the more common nausea and vomiting in pregnancy.
Furthermore, numerous studies have shown a link between depression and poor psychological health in women with nausea and vomiting in pregnancy and hyperemesis gravidarum.
Lead guideline author Manjeet Shehmar, consultant obstetrician and gynaecologist, said: “Women with persistent nausea can often feel that there is a lack of understanding of their condition.
“It is therefore vital that women with this condition are given the right information and support and are made aware of the therapeutic and alternative therapies available to help them cope,” she said.
She added: “Women should be encouraged to rest as much as they can as this has been shown to relieve symptoms.”
Guidance on reducing impact of ‘morning sickness’
Professor Alan Cameron, college vice president for clinical quality, said: “This is the first edition of this guideline on this important topic, which affects many women at a crucial time in their lives.
“Women suffering severely may need input from a multi-disciplinary team including midwives, nurses, dieticians and a mental health team. This will ensure they receive the best possible care and support,” he said.
Louise Silverton, director for midwifery at the Royal College of Midwives, said: “This is an important guideline that acknowledges how disruptive nausea and vomiting can be for women during pregnancy, as well as providing treatment options.
“In addition it covers guidance for care for women with excess vomiting that requires admission to hospital for the management of dehydration and under-nutrition,” she said.
She added: “Much nausea and vomiting is in early pregnancy sometimes before women have entered the maternity care services. Where women have received midwifery care, it is important that women know how to contact services when vomiting becomes persistent or debilitating.”