Significant Variation in Nausea and Vomiting of Pregnancy Care Across England, Scotland, and Wales

Strategic Insights -

Nausea and vomiting of pregnancy (NVP) affects a significant number of pregnant women in England, Scotland, and Wales, with up to 90% of women experiencing symptoms. However, many struggle to access care that adheres to national guidelines. A recent study published in BMC Health Services Research aimed to describe NVP services in these countries and compare them to national guidance.

Key Takeaways:

  • The study found significant variation in NVP care across hospitals in England, Scotland, and Wales, with some hospitals not providing evidence-based treatment.
  • Only 28.7% of hospitals offered routine screening for NVP/HG at a woman's booking visit, and treatment in the community was offered in only 14.8% of hospitals.
  • A combination of recommended first, second, and third-line antiemetics was prescribed correctly in only 47% of hospitals.
  • A proton pump inhibitor was prescribed in 49.6% of units, and thiamine for patients with persistent vomiting in 69.8%.
  • Routine mental health screening occurs in only 41.9% of units.
  • Pre-pregnancy counselling is offered to women with a history of severe NVP/HG planning a future pregnancy in only 17.1% of units.

Statistics:

  • 92.8% of hospitals responded to the online survey distributed to all 139 maternity units in England, Scotland, and Wales.
  • 108/129 (83.7%) of hospitals that responded have ambulatory management available for NVP/HG.
  • 93/129 (72.1%) of units use guideline-recommended intravenous fluid management (0.9% normal saline).
  • 5/36 (13.9%) of units not using 0.9% normal saline solution use dextrose solution, which can cause harm to patients.

Sources:

  • Guy's and St Thomas' NHS Foundation Trust
  • BMC Health Services Research (https://doi.org/10.1186/s12913-025-12909-0)
  • Melanie Nana, Department of Obstetric Medicine, Guy's and St Thomas' NHS Foundation Trust
  • Natalie Suff, Maria Gregori, Catherine Nelson-Piercy, Catherine Williamson, additional authors on the research
  • NewsRx, OBGYN & Reproduction Week, September 15, 2025, p 103