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Practice Bulletins #189 - Published January 2018 Five pearls: 1. The decision to treat should be informed by the woman’s perception of the severity of symptoms, her desire for treatment, and the potential effect of treatment on her fetus 2. Use of prenatal vitamins 1 mo before fertilization may reduce incidence and treating nausea and vomiting of pregnancy (NVP) can prevent progression from NVP to hyperemesis gravidarum (HG) 3. After dietary and nonpharmacologic options (e.g. ginger) have been tried, first-line pharmacotherapy entails trying vitamin B6 alone or vitamin B6 plus doxylamine 4. Antithyroid drugs are not recommended for abnormal maternal thyroid tests attributable to gestational transient thyrotoxicosis or HG 5 .Hospitalization for evaluation and treatment of dehydration and electrolyte imbalance is indicated when a woman can’t tolerate liquids without vomiting and hasn’t responded to outpatient managementShow Notes Wine pairing: 2018 Pinot Noir from Hedgeline Vineyards Theme music by Evan Handyside Logo design by JD Dotson (jddotson1@gmail.com)