European Journal of Clinical Pharmacology

, Volume 72, Issue 5, pp 593–604 | Cite as

Treatment of nausea and vomiting during pregnancy —a cross-sectional study among 712 Norwegian women

  • Kristine HeitmannEmail author
  • Anja Solheimsnes
  • Gro C. Havnen
  • Hedvig Nordeng
  • Lone Holst
Pharmacoepidemiology and Prescription



The purposes of this study were to investigate the treatments used for nausea and vomiting of pregnancy (NVP) according to NVP severity among Norwegian women and to assess whether maternal characteristics and attitudes were related to the use of pharmacological treatment of NVP.


This is a cross-sectional Web-based study. Pregnant women and mothers with children ≤1 year of age were eligible to participate. Data were collected through an anonymous online questionnaire accessible from November 10th, 2014 to January 31st, 2015.


In total, 712 women were included in the study, of which 62 (8.7 %), 439 (61.7 %) and 210 (29.5 %) had mild, moderate and severe NVP, respectively, according to the Pregnancy-Unique Quantification of Emesis (PUQE) classification. A total of 277 (38.9 %) women had used one or more antiemetics, of which meclizine, closely followed by metoclopramide, was the most commonly used. Different drug utilisation patterns were found between the groups of women with mild, moderate and severe NVP. Many with moderate or severe symptoms did not use any pharmacological treatment (70.2 and 32.9 %, respectively). Sick leave was given without initiating medical treatment in 266 (62.1 %) women. The women’s beliefs about medicines had an important impact on their use of medicines for NVP.


A large proportion of women suffered from moderate to severe symptoms of NVP, many of whom did not receive any pharmacological treatment. Many women, who had been on sick leave due to NVP, were not prescribed medicines.


Morning sickness Hyperemesis gravidarum Pregnancy Drug therapy Meclizine Metoclopramide 



We thank the providers of the websites for contributions in the recruitment phase, and all the women who participated in the study. KH received funding for her PhD project from The Norwegian Research Council (Grant no. 195475).

Author’s contribution

KH, LH, GCH and HN conceived and designed the study. AS collected the data. KH performed the statistical analyses and drafted the manuscript. All authors contributed to the interpretation of the results and to the final manuscript. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

228_2016_2012_MOESM1_ESM.docx (27 kb)
ESM 1 (DOCX 26.7 kb)


  1. 1.
    Einarson TR, Piwko C, Koren G (2013) Quantifying the global rates of nausea and vomiting of pregnancy: a meta analysis. J Popul Ther Clin Pharmacol 20(2):e171–183PubMedGoogle Scholar
  2. 2.
    Gadsby R, Barnie-Adshead AM, Jagger C (1993) A prospective study of nausea and vomiting during pregnancy. Br J Gen Pract 43(371):245–248PubMedPubMedCentralGoogle Scholar
  3. 3.
    Lacroix R, Eason E, Melzack R (2000) Nausea and vomiting during pregnancy: a prospective study of its frequency, intensity, and patterns of change. Am J Obstet Gynecol 182(4):931–937CrossRefPubMedGoogle Scholar
  4. 4.
    Klebanoff MA, Koslowe PA, Kaslow R, Rhoads GG (1985) Epidemiology of vomiting in early pregnancy. Obstet Gynecol 66(5):612–616PubMedGoogle Scholar
  5. 5.
    Vellacott ID, Cooke EJ, James CE (1988) Nausea and vomiting in early pregnancy. Int J Gynaecol Obstet 27(1):57–62CrossRefPubMedGoogle Scholar
  6. 6.
    Eliakim R, Abulafia O, Sherer DM (2000) Hyperemesis gravidarum: a current review. Am J Perinatol 17(4):207–218. doi: 10.1055/s-2000-9424 CrossRefPubMedGoogle Scholar
  7. 7.
    Vandraas K, Vikanes Å, Vangen S, Magnus P, Støer N, Grjibovski A (2013) Hyperemesis gravidarum and birth outcomes—a population‐based cohort study of 2.2 million births in the Norwegian Birth Registry. BJOG 120(13):1654–1660CrossRefPubMedGoogle Scholar
  8. 8.
    Arsenault MY, Lane CA, MacKinnon CJ, Bartellas E, Cargill YM, Klein MC, Martel MJ, Sprague AE, Wilson AK (2002) The management of nausea and vomiting of pregnancy. J Obstet Gynaecol Can 24(10):817–831, quiz 832–813PubMedGoogle Scholar
  9. 9.
    Smith J, Refuerzo J, Ramin S (2014) Treatment and outcome of nausea and vomiting of pregnancy. UpToDateGoogle Scholar
  10. 10.
    National Collaborating Centre for Women’s and Children’s Health (2008) Antenatal care: routine care for the healthy pregnant woman. National Institute for Health and Clinical Excellence (NICE). Accessed 19 March 2015
  11. 11.
    ACOG (American College of Obstetrics and Gynecology) (2015) Practice bulletin No. 153, nausea and vomiting of pregnancy. Obstet Gynecol 126(3):e12–24. doi: 10.1097/01.AOG.0000471178.18186.d6 CrossRefGoogle Scholar
  12. 12.
    Sosial og helsedirektoratet [The Norwegian Directorate of Health and Social Affairs] (2005) Nasjonale faglige retningslinjer: Retningslinjer for svangerskapsomsorgen [A National Clinical Guideline for antenatal care]. 2005 ednGoogle Scholar
  13. 13.
    Norsk Legemiddelhåndbok [Norwegian Medicines Handbook] (2015)øker/+%2Bsvangerskapskvalme/19493. Accessed 09 April 2015
  14. 14.
    Norsk gynekologisk forening [The Norwegian Society of Obstetrics and Gynecology] (2014) Veileder i fødselshjelp [Obstetric guidelines issued by The Norwegian Society of Obstetrics and Gynaecology (NGF)]Google Scholar
  15. 15.
    BMJ Best Practice (2015) Nausea and vomiting in pregnancy.
  16. 16.
    Park-Wyllie L, Mazzotta P, Pastuszak A, Moretti ME, Beique L, Hunnisett L, Friesen MH, Jacobson S, Kasapinovic S, Chang D, Diav-Citrin O, Chitayat D, Nulman I, Einarson TR, Koren G (2000) Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Teratology 62(6):385–392. doi: 10.1002/1096-9926(200012)62:6<385::Aid-Tera5>3.0.Co;2-Z CrossRefPubMedGoogle Scholar
  17. 17.
    Locock L, Alexander J, Rozmovits L (2008) Women’s responses to nausea and vomiting in pregnancy. Midwifery 24(2):143–152. doi: 10.1016/j.midw.2006.12.001 CrossRefPubMedGoogle Scholar
  18. 18.
    Munch S (2000) A qualitative analysis of physician humanism: women’s experiences with hyperemesis gravidarum. J Perinatol 20(8 Pt 1):540–547CrossRefPubMedGoogle Scholar
  19. 19.
    Smith C, Crowther C, Beilby J, Dandeaux J (2000) The impact of nausea and vomiting on women: a burden of early pregnancy. Aust N Z J Obstet Gynaecol 40(4):397–401CrossRefPubMedGoogle Scholar
  20. 20.
    Attard CL, Kohli MA, Coleman S, Bradley C, Hux M, Atanackovic G, Torrance GW (2002) The burden of illness of severe nausea and vomiting of pregnancy in the United States. Am J Obstet Gynecol 186(5 Suppl Understanding):S220–227CrossRefPubMedGoogle Scholar
  21. 21.
    Mazzotta P, Stewart D, Atanackovic G, Koren G, Magee LA (2000) Psychosocial morbidity among women with nausea and vomiting of pregnancy: prevalence and association with anti-emetic therapy. J Psychosom Obstet Gynaecol 21(3):129–136CrossRefPubMedGoogle Scholar
  22. 22.
    Lacasse A, Rey E, Ferreira E, Morin C, Berard A (2008) Nausea and vomiting of pregnancy: what about quality of life? BJOG 115(12):1484–1493. doi: 10.1111/j.1471-0528.2008.01891.x CrossRefPubMedGoogle Scholar
  23. 23.
    Poursharif B, Korst LM, Fejzo MS, MacGibbon KW, Romero R, Goodwin TM (2008) The psychosocial burden of hyperemesis gravidarum. J Perinatol 28(3):176–181. doi: 10.1038/ CrossRefPubMedGoogle Scholar
  24. 24.
    Mazzotta P, Stewart DE, Koren G, Magee LA (2001) Factors associated with elective termination of pregnancy among Canadian and American women with nausea and vomiting of pregnancy. J Psychosom Obstet Gynaecol 22(1):7–12CrossRefPubMedGoogle Scholar
  25. 25.
    The Norwegian Welfare and Labour Administration (2011) Sickness benefits for employees. The Norwegian Welfare and Labour Administration. Accessed 19 Aug 2015
  26. 26.
    The Norwegian Directorate of Health (2014) Svangerskapskontroller [pregnancy consultations]. Accessed 27 Aug 2015
  27. 27.
    Heitmann K, Holst L, Lupattelli A, Maltepe C, Nordeng H (2015) Treatment of nausea in pregnancy: a cross-sectional multinational web-based study of pregnant women and new mothers. BMC Pregnancy Childbirth 15(1):321CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Ebrahimi N, Maltepe C, Bournissen FG, Koren G (2009) Nausea and vomiting of pregnancy: using the 24-hour pregnancy-unique quantification of emesis (PUQE-24) scale. J Obstet Gynaecol Can 31(9):803–807CrossRefPubMedGoogle Scholar
  29. 29.
    Koren G, Piwko C, Ahn E, Boskovic R, Maltepe C, Einarson A, Navioz Y, Ungar WJ (2005) Validation studies of the pregnancy unique-quantification of emesis (PUQE) scores. J Obstet Gynaecol 25(3):241–244. doi: 10.1080/01443610500060651 CrossRefPubMedGoogle Scholar
  30. 30.
    Birkeland E, Stokke G, Tangvik RJ, Torkildsen EA, Boateng J, Wollen AL, Albrechtsen S, Flaatten H, Trovik J (2015) Norwegian PUQE (pregnancy-unique quantification of emesis and nausea) identifies patients with hyperemesis gravidarum and poor nutritional intake: a prospective cohort validation study. PLoS One 10(4):e0119962CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Nordeng H, Koren G, Einarson A (2010) Pregnant women’s beliefs about medications—a study among 866 Norwegian women. Ann Pharmacother 44(9):1478–1484. doi: 10.1345/aph.1P231 CrossRefPubMedGoogle Scholar
  32. 32.
    Lupattelli A, Spigset O, Twigg M, Zagorodnikova K, Mårdby A, Moretti M, Drozd M, Panchaud A, Hämeen-Anttila K, Rieutord A (2014) Medication use in pregnancy: a cross-sectional, multinational web-based study. BMJ Open 4(2):e004365CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Medical Birth Registry of Norway - Statistics (2015) Accessed 08 July 2015
  34. 34.
    StatBank Norway, Table 08921: Persons 16 years and older, by sex, age and level of education. Numbers and per cent (C) (2015) Statistics Norway. Accessed 08 July 2015
  35. 35.
    Chin J, Gregor S, Persaud N (2014) Re-analysis of safety data supporting doxylamine use for nausea and vomiting of pregnancy. Am J Perinatol 31(8):701–710CrossRefPubMedGoogle Scholar
  36. 36.
    Pasternak B, Svanstrom H, Molgaard-Nielsen D, Melbye M, Hviid A (2013) Metoclopramide in pregnancy and risk of major congenital malformations and fetal death. JAMA 310(15):1601–1611. doi: 10.1001/jama.2013.278343 CrossRefPubMedGoogle Scholar
  37. 37.
    Matok I, Gorodischer R, Koren G, Sheiner E, Wiznitzer A, Levy A (2009) The safety of metoclopramide use in the first trimester of pregnancy. New Engl J Med 360(24):2528–2535CrossRefPubMedGoogle Scholar
  38. 38.
    European Medicines Agency (2013) European Medicines Agency recommends changes to the use of metoclopramide. European Medicines Agency. Accessed 19 March 2015
  39. 39.
    Summary of product characteristics - Stemetil 5 mg tablets (2014) The Norwegian Medicines Agency. Accessed 1 Oct 2015
  40. 40.
    Summary of product characteristics - Chlorpromazine 50 mg tablets (2014) The electronic medicines compendium (eMC). Accessed 1 Oct 2015
  41. 41.
    FDA (2010) Safety information - Reglan (metoclopramide) tablets, ODT (Orally disintegrating tablets), and injection. FDA. Accessed 08 July 2015
  42. 42.
    Koren G (2014) Scary science: ondansetron safety in pregnancy-Two opposing results from the same Danish registry. Ther Drug Monit. doi: 10.1097/FTD.0000000000000020 Google Scholar
  43. 43.
    Andersen JT, Jimenez-Solem E, Andersen NL, Poulsen HE (2013) Abstract 25, pregnancy session 1. Ondansetron use in early pregnancy and the risk of congenital malformations – a register based nationwide cohort study. International Society of Pharmaco-Epidemiology, MontrealGoogle Scholar
  44. 44.
    Pasternak B, Svanstrom H, Hviid A (2013) Ondansetron in pregnancy and risk of adverse fetal outcomes. N Engl J Med 368(9):814–823. doi: 10.1056/NEJMoa1211035 CrossRefPubMedGoogle Scholar
  45. 45.
    Anderka M, Mitchell AA, Louik C, Werler MM, Hernandez-Diaz S, Rasmussen SA, National Birth Defects Prevention S (2012) Medications used to treat nausea and vomiting of pregnancy and the risk of selected birth defects. Birth Defect Res Part A Clin Mol Teratol 94(1):22–30. doi: 10.1002/bdra.22865 CrossRefGoogle Scholar
  46. 46.
    Danielsson B, Wikner BN, Källén B (2014) Use of ondansetron during pregnancy and congenital malformations in the infant. Reprod Toxicol 50:134–137CrossRefPubMedGoogle Scholar
  47. 47.
    Hollyer T, Boon H, Georgousis A, Smith M, Einarson A (2002) The use of CAM by women suffering from nausea and vomiting during pregnancy. BMC Complement Altern Med 2:5CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Holst L, Wright D, Haavik S, Nordeng H (2009) The use and the user of herbal remedies during pregnancy. J Altern Complement Med 15(7):787–792. doi: 10.1089/acm.2008.0467 CrossRefPubMedGoogle Scholar
  49. 49.
    Nordeng H, Havnen GC (2004) Use of herbal drugs in pregnancy: a survey among 400 Norwegian women. Pharmacoepidemiol Drug Saf 13(6):371–380. doi: 10.1002/pds.945 CrossRefPubMedGoogle Scholar
  50. 50.
    Nordeng H, Bayne K, Havnen GC, Paulsen BS (2011) Use of herbal drugs during pregnancy among 600 Norwegian women in relation to concurrent use of conventional drugs and pregnancy outcome. Complement Ther Clin Pract 17(3):147–151. doi: 10.1016/j.ctcp.2010.09.002 CrossRefPubMedGoogle Scholar
  51. 51.
    Dante G, Pedrielli G, Annessi E, Facchinetti F (2013) Herb remedies during pregnancy: a systematic review of controlled clinical trials. J Matern Fetal Neonatal Med 26(3):306–312. doi: 10.3109/14767058.2012.722732 CrossRefPubMedGoogle Scholar
  52. 52.
    Heitmann K, Nordeng H, Holst L (2013) Safety of ginger use in pregnancy: results from a large population-based cohort study. Eur J Clin Pharmacol 69(2):269–277. doi: 10.1007/s00228-012-1331-5 CrossRefPubMedGoogle Scholar
  53. 53.
    Wills G, Forster D (2008) Nausea and vomiting in pregnancy: what advice do midwives give? Midwifery 24(4):390–398. doi: 10.1016/j.midw.2007.05.002 CrossRefPubMedGoogle Scholar
  54. 54.
    Kramer J, Bowen A, Stewart N, Muhajarine N (2013) Nausea and vomiting of pregnancy: prevalence, severity and relation to psychosocial health. MCN Am J Matern Child Nurs 38(1):21–27. doi: 10.1097/NMC.0b013e3182748489 CrossRefPubMedGoogle Scholar
  55. 55.
    Asker C, Norstedt Wikner B, Kallen B (2005) Use of antiemetic drugs during pregnancy in Sweden. Eur J Clin Pharmacol 61(12):899–906. doi: 10.1007/s00228-005-0055-1 CrossRefPubMedGoogle Scholar
  56. 56.
    Markl GE, Strunz-Lehner C, Egen-Lappe V, Hasford J (2007) Prescribing patterns of anti-emetic drugs during pregnancy in Germany. Arch Gynecol Obstet 275(6):461–467CrossRefPubMedGoogle Scholar
  57. 57.
    Maltepe C, Koren G (2013) The management of nausea and vomiting of pregnancy and hyperemesis gravidarum—a 2013 update. J Popul Ther Clin Pharmacol 20(2):e184–192PubMedGoogle Scholar
  58. 58.
    Gadsby R, Barnie-Adshead AM (2011) Severe nausea and vomiting of pregnancy: should it be treated with appropriate pharmacotherapy? Obstet Gynaecol 13:107–111CrossRefGoogle Scholar
  59. 59.
    Dorheim S, Bjorvatn B, Eberhard-Gran M (2013) Sick leave during pregnancy: a longitudinal study of rates and risk factors in a Norwegian population. BJOG 120(5):521–530CrossRefPubMedGoogle Scholar
  60. 60.
    Lupattelli A, Spigset O, Nordeng H (2014) Adherence to medication for chronic disorders during pregnancy: results from a multinational study. Int J Clin Pharm 36(1):145–153. doi: 10.1007/s11096-013-9864-y CrossRefPubMedGoogle Scholar
  61. 61.
    Jasper JD, Goel R, Einarson A, Gallo M, Koren G (2001) Effects of framing on teratogenic risk perception in pregnant women. Lancet 358(9289):1237–1238CrossRefPubMedGoogle Scholar
  62. 62.
    Einarson A, Selby P, Koren G (2001) Abrupt discontinuation of psychotropic drugs during pregnancy: fear of teratogenic risk and impact of counselling. J Psychiatry Neurosci 26(1):44–48PubMedPubMedCentralGoogle Scholar
  63. 63.
    Koren G, Maltepe C, Navioz Y, Wolpin J (2004) Recall bias of the symptoms of nausea and vomiting of pregnancy. Am J Obstet Gynecol 190(2):485–488. doi: 10.1016/j.ajog.2003.08.039 CrossRefPubMedGoogle Scholar
  64. 64.
    Lacasse A, Rey E, Ferreira E, Morin C, Berard A (2009) Epidemiology of nausea and vomiting of pregnancy: prevalence, severity, determinants, and the importance of race/ethnicity. BMC Pregnancy Childbirth 9:26. doi: 10.1186/1471-2393-9-26 CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Eysenbach G (2004) Improving the quality of web surveys: the checklist for reporting results of internet E-surveys (CHERRIES). J Med Internet Res 6(3):e34. doi: 10.2196/jmir.6.3.e34 CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    van Gelder MM, Bretveld RW, Roeleveld N (2010) Web-based questionnaires: the future in epidemiology? Am J Epidemiol 172(11):1292–1298. doi: 10.1093/aje/kwq291 CrossRefPubMedGoogle Scholar
  67. 67.
    Ekman A, Dickman PW, Klint A, Weiderpass E, Litton JE (2006) Feasibility of using web-based questionnaires in large population-based epidemiological studies. Eur J Epidemiol 21(2):103–111. doi: 10.1007/s10654-005-6030-4 CrossRefPubMedGoogle Scholar
  68. 68.
    Whitehead L (2011) Methodological issues in Internet-mediated research: a randomized comparison of internet versus mailed questionnaires. J Med Internet Res 13(4):e109. doi: 10.2196/jmir.1593 CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Ritter P, Lorig K, Laurent D, Matthews K (2004) Internet versus mailed questionnaires: a randomized comparison. J Med Internet Res 6(3):e29. doi: 10.2196/jmir.6.3.e29 CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Touvier M, Mejean C, Kesse-Guyot E, Pollet C, Malon A, Castetbon K, Hercberg S (2010) Comparison between web-based and paper versions of a self-administered anthropometric questionnaire. Eur J Epidemiol 25(5):287–296. doi: 10.1007/s10654-010-9433-9 CrossRefPubMedGoogle Scholar
  71. 71.
    Norwegian media barometer - Table: 04519: percentage internet users and minutes used for internet an average day, by sex and education (2015) Statistics Norway Accessed 08 July 2015

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Kristine Heitmann
    • 1
    Email author
  • Anja Solheimsnes
    • 1
  • Gro C. Havnen
    • 2
  • Hedvig Nordeng
    • 3
  • Lone Holst
    • 1
  1. 1.Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
  2. 2.Regional Medicines Information and Pharmacovigilance Centre (RELIS)Oslo University HospitalOsloNorway
  3. 3.PharmacoEpidemiology and Drug Safety Research Group, School of PharmacyUniversity of OsloOsloNorway

Personalised recommendations