NICE recommends treatment options for severe pregnancy sickness in new draft guidance

Nausea and vomiting, often referred to as morning sickness, is common in pregnancy. Close to 80% of pregnant women experience these symptoms, with most conditions improving or stopping completely by around 16 to 20 weeks.

In many cases, at-home remedies such as ginger can help to alleviate symptoms, but in a small percentage of pregnant women, the condition can be more serious. Between 0.3 and 3.6% of pregnant women experience excessive nausea and vomiting known as hyperemesis gravidarum, which can sometimes lead to hospitalisation.

In draft guidance published today, NICE recommends treatment options for hyperemesis gravidarum for the first time.

New recommendations advise the use of pharmacological antiemetics (known as anti-sickness medicines), acupressure, and intravenous fluids to treat these extreme cases of nausea and vomiting in pregnancy, in line with guidance from the Royal College of Obstetricians and Gynaecologists.

Dr Paul Chrisp, director of the Centre for Guidelines at NICE, said: “While non-pharmacological treatments may help the majority of women experiencing nausea and vomiting during pregnancy, hyperemesis gravidarum can be extremely serious,  and it is essential that effective treatment options are available.

“It is our hope that this guidance will help inform clinicians of the value of treatments like antiemetics and acupressure, and enable them to provide care that keeps women safe and healthy throughout their pregnancy.”

Dr Edward Morris, President at the Royal College of Obstetricians and Gynaecologists, said: “We’re very pleased that NICE have updated their guidance on antenatal care and have included the debilitating condition hyperemesis gravidarum. This new guidance now reflects and is consistent with the guidance produced by the RCOG in 2016.

“We would encourage all hospitals to implement and follow these guidelines so that women are provided with high quality care throughout their pregnancy. It’s important pregnant women feel listened to and are offered regular check-ups, information and support throughout. We know the pandemic has added a layer of anxiety for many women who are navigating pregnancy under difficult restrictions, and we support a consistent approach to care across all Trusts.”

The new draft guideline replaces the recommendations from NICE’s guidance on antenatal care, published in 2008, and aims to improve consistency of care across the country. The recommendations are based on evidence collected prior to the COVID-19 pandemic.

The update offers practical advice on the care of healthy women and their babies during pregnancy. It aims to ensure that women are offered regular check-ups, information and support, and includes recommendations on a range of topics from monitoring foetal growth to sleep positions to avoid during pregnancy.

Although evidence supports the benefits of new draft recommendations, such as involving partners in antenatal appointments, the committee recognises that alternative arrangements may need to be made throughout the COVID-19 pandemic. The guidance suggests that health care practitioners consider virtual appointments and classes, which may be especially beneficial while government restrictions are in place.

Dr Chrisp added: “We are aware that the sensitivities of the pandemic mean that not all of the new recommendations in this update can be supported at the present time, but our hope is that alternatives may be considered where appropriate.”

The draft guidance is out for public consultation until 24 March 2021. Find the draft and participate in the consultation here