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Key Features

  • "Morning sickness"

  • Up to 75% of women complain of nausea and vomiting during early pregnancy

  • Vast majority of symptomatic patients note nausea throughout the day

  • Symptoms are particularly common with multiple pregnancy and hydatidiform mole

  • Exerts no adverse effects on the pregnancy and does not presage complications

Clinical Findings

  • Morning or evening nausea and vomiting usually begin soon after the first missed period and ceases after the fifth month

  • Persistent, severe vomiting is hyperemesis gravidarum, a distinct entity (see Hyperemesis Gravidarum)

Diagnosis

  • Clinical

Treatment

  • Reassurance and dietary advice are adequate in most cases

  • Vitamin B6, 50–100 mg orally once daily, is nontoxic and may help some patients

  • Pyridoxine alone or in combination with doxylamine (10 mg doxylamine succinate and 10 mg pyridoxine hydrochloride, two tablets at bedtime) is first-line pharmacotherapy

  • To limit the risk of teratogenicity, drug use in the first half of pregnancy should be limited to those of major importance to life and health (Tables 19–1 and 19–2)

Table 19–1.Common drugs that are teratogenic or fetotoxic.1
Table 19–2.Drugs and substances that require a careful assessment of risk before they are prescribed for breastfeeding women.1

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