Department of Obstetrics and Gynecology, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia.
Curr Opin Obstet Gynecol. 2011 Apr;23(2):87-93. doi: 10.1097/GCO.0b013e328342d208.
Nausea and vomiting of pregnancy (NVP) affects 90% of pregnant women and its impact is often underappreciated. Hyperemesis gravidarum, the most severe end of the spectrum, affects 0.5-2% of pregnancies. The pathogenesis of this condition remains obscure and its management has largely been empirical. This review aims to provide an update on advances in pregnancy hyperemesis focusing on papers published within the past 2 years.
The cause of hyperemesis is continuing to be elaborated. Recent data attest to the effectiveness of the oral doxylamine-pyridoxine in NVP. Follow-up data of children exposed in early pregnancy to doxylamine-pyridoxine for NVP are reassuring. Evidence is increasing for ginger as an effective herbal remedy for NVP. Metoclopramide is effective in NVP and hyperemesis gravidarum, with a good balance of efficacy and tolerability. A recent large-scale study on first trimester exposure to metoclopramide is reassuring of its safety. Evidence is emerging for the treatment of acid reflux to ameliorate NVP. The role of corticosteroids for hyperemesis gravidarum remains controversial. Transpyloric feeding may be warranted for persistent weight loss, despite optimal antiemetic therapy.
Women with significant NVP should be identified so that they can be safely and effectively treated.
妊娠恶心和呕吐（NVP）影响 90%的孕妇，其影响往往被低估。妊娠剧吐是最严重的一种，影响 0.5-2%的妊娠。其发病机制仍不清楚，其治疗在很大程度上是经验性的。本篇综述旨在提供妊娠剧吐的最新进展，重点关注过去 2 年发表的论文。
妊娠剧吐的病因仍在进一步阐述。最近的数据证明了口服多西拉敏-吡哆醇对 NVP 的有效性。在早孕时暴露于多西拉敏-吡哆醇治疗 NVP 的儿童的随访数据令人安心。生姜作为 NVP 的有效草药治疗方法的证据越来越多。甲氧氯普胺在 NVP 和妊娠剧吐中有效，疗效和耐受性平衡良好。最近一项关于早孕时接触甲氧氯普胺的大规模研究对其安全性令人安心。治疗胃酸反流以改善 NVP 的证据正在出现。皮质类固醇治疗妊娠剧吐的作用仍存在争议。尽管进行了最佳的止吐治疗，但对于持续体重减轻的患者，可能需要经皮幽门置管喂养。
应识别出有明显 NVP 的女性，以便对其进行安全有效的治疗。
