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Introduction

Nausea and vomiting in pregnancy (NVP) is common and often considered a normal part of pregnancy.  It affects up to 80% of pregnant women, usually during the first trimester.  Symptoms range from mild to severe (ie, hyperemesis gravidarum), which can lead to dehydration, electrolyte imbalances, and weight loss.  NVP is usually self-limited and resolves by the second trimester.

Pathogenesis and risk factors

The exact mechanism of NVP is not fully understood, but several factors, including hormonal and gastrointestinal, are believed to contribute.

Hormonal factors

The rising hormone levels of early pregnancy are likely contributors to NVP and include:

  • hCG:  NVP symptoms peak around the same time that hCG levels peak (eg, 9-12 weeks gestation ( Image 1)); symptoms tend to slowly improve as hCG levels decline.  In addition, because hCG is produced by the placenta, any condition leading to increased placental mass (eg,

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