Written by Laura, Co-founder of Replenish.
If you've experienced Pregnancy Sickness, you’ll know just how life-altering it can be. I’ve been there, trapped in the cycle of nausea, vomiting, and dehydration, and it can feel utterly overwhelming.
That’s why the recent update to the Royal College of Obstetricians and Gynaecologists’ (RCOG) guidelines published in 2024 on the management of Nausea and Vomiting in Pregnancy (NVP) and Hyperemesis Gravidarum (HG) is a real step in the right direction for those of us who’ve suffered.
Let’s talk about the key points from these new guidelines and what they mean for you, as someone navigating Pregnancy Sickness.
The guidelines focus on clearer, evidence-based practices that I wish I’d known about during my own journey.
1. Early, Effective Medication Matters
The guidelines emphasise that first-line antiemetics (medications that help with nausea) such as the combination of doxylamine (an anti-histamine) and pyridoxine (Vitamin B6), now licensed in the UK as Xonvea®, should be the first go-to.
These treatments are safe and have proven effective for managing NVP and HG, so don’t hesitate to ask your GP or midwife about them if you're struggling.
I know it’s easy to feel like this will pass on its own, but early treatment is key to preventing the condition from worsening.
2. Ondansetron & Metoclopramide are safe
For many, ondansetron (a second-line antiemetic) has been a lifesaver.
The new guidelines reaffirm its safety and effectiveness, although it does carry a very small risk of orofacial clefts when used in the first trimester.
However, this risk is minuscule and should be weighed against the severe consequences of untreated HG.
If your first-line medication doesn’t work, Ondansetron or Metoclopramide could offer you much-needed relief.
3. Hydration is crucial
Dehydration is a serious concern with HG, but the guidelines point out that ketonuria (the presence of ketones in urine) shouldn’t be used as a primary measure of dehydration severity.
What really matters is proper hydration, and normal saline with potassium chloride is the recommended intravenous fluid to keep you hydrated.
I remember the constant struggle with water - sometimes, just keeping liquids down was the hardest part.
4. Thiamine supplementation is a must
One of the key takeaways is the importance of thiamine (Vitamin B1) supplementation (either orally or intravenously), particularly for those of us who’ve experienced severe vomiting or significantly reduced food intake.
This step can help prevent extra complications caused by thiamine deficiency.
5. The importance of multidisciplinary support
Pregnancy Sickness can feel isolating, but the guidelines stress the importance of a multidisciplinary approach to care.
Whether you’re seeing your GP, midwife, or a hospital consultant, they should work together to manage your symptoms.
I was lucky - I found that having a supportive team around me made a huge difference - people who really understood the condition.
6. Termination of pregnancy should be a last resort
Lastly, the guidelines make it clear that every possible treatment option, including steroids, should be exhausted before considering termination of pregnancy.
This was such an important point for me, and it’s reassuring to know that doctors are now guided to offer every available treatment and support before even contemplating such a decision.
Conclusion
The updated guidelines provide hope and practical steps for managing Nausea & Vomiting in Pregnancy.
If you're going through this, you’re not alone, and there are solutions out there - many of which weren’t as well known when I went through my experience.
I hope this gives you a clearer understanding of the options available to you.
Always remember, if you’re struggling, don’t hesitate to reach out to your healthcare provider.
The NHS is there to help, and with the right support, you can get through it, one day at a time.
Laura x
PS - find people that understand what you're going through on your favourite social channel: Instagram, Facebook or TikTok.
