Maternal-fetal medicine: Edited by James F. SmithContemporary approaches to hyperemesis during pregnancyTan, Peng C; Omar, Siti ZAuthor Information Department of Obstetrics and Gynecology, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia Correspondence to Peng Chiong Tan, Department of Obstetrics and Gynecology, University of Malaya, Lembah Pantai, Kuala Lumpur 50603, Malaysia Tel: +60 3 79492059; fax: +60 379551741; e-mail: email@example.com Current Opinion in Obstetrics and Gynecology: April 2011 - Volume 23 - Issue 2 - p 87-93 doi: 10.1097/GCO.0b013e328342d208 Buy Metrics Abstract Purpose of review 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. Recent findings 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. Summary Women with significant NVP should be identified so that they can be safely and effectively treated. © 2011 Lippincott Williams & Wilkins, Inc.