Treatment and Management

For milder symptoms, some simple changes can help alongside any medication:

• Eating little and often, rather than large meals
• Plain, carbohydrate-based foods (dry toast, rice, plain biscuits) are often easier to tolerate than spicy or fatty food
• Sipping fluids regularly, in small amounts, rather than large drinks at once
• Resting when you can, and avoiding known triggers like strong smells

Acupressure may also help some people and is considered safe in pregnancy. Hypnotherapy isn't currently recommended as a treatment, despite sometimes being suggested informally.

If lifestyle measures aren't enough, medication is the next step, and it's used in a stepwise way — starting with the safest, best-evidenced options, then adding or changing medication if needed:

• First-line: antihistamines, or a doxylamine/pyridoxine combination (brand name Xonvea®). These have good safety data in pregnancy.
• Second-line: if first-line medication isn't enough, ondansetron or metoclopramide may be added or used instead.
• Third-line: corticosteroids, kept in reserve for cases where other treatments haven't worked, usually reduced gradually rather than stopped suddenly.

On medication safety:it's completely understandable to worry about taking anything during pregnancy. The evidence reviewed by RCOG supports these medications as safe and effective when needed — and the risk of leaving severe HG untreated is generally greater than the risk from appropriate medication. Your team can talk through the evidence with you if you'd like more detail before deciding.

If you don't respond to a single medication, combining different types (rather than increasing one alone) is a recognised approach.

If you need treatment in hospital — either as a short day-case visit or a longer stay — this usually includes fluids through a drip to treat dehydration, alongside anti-sickness medication. Your team will also monitor your blood salts (electrolytes) and adjust your fluids accordingly.

One important safety point:if you've been vomiting for a while and aren't eating properly, your team should give you vitamin B1 (thiamine) before or alongside certain fluids. This is because, in rare cases, prolonged vomiting without enough thiamine can lead to a serious condition called Wernicke's encephalopathy — and giving the wrong type of fluid first, without thiamine, can make this risk worse. This is a recognised, if uncommon, risk that your care team should be actively managing — not something you need to bring up yourself, but reassuring to know is being looked out for.

Because dehydration and reduced movement in hospital can increase the risk of blood clots, your team may also offer blood-thinning injections during your stay if needed.