A 26-Year-Old Primigravid Patient at 8 Weeks Gestation Comes to the Office

A 26-year-old primigravid patient at 8 weeks gestation comes to the office to establish prenatal care.  She has felt intermittently nauseous for the past 2 weeks, resulting in vomiting once every morning.  Her appetite is unpredictable; at times, she does not eat breakfast or lunch and then eats more than she intended for dinner.  The patient shares that she has noticed that she already looks pregnant, and that she recently had to switch to wearing maternity clothing.  She does not use tobacco, alcohol, or illicit drugs.  The patient takes a prenatal vitamin every morning.  Vital signs are normal.  Weight has decreased by 2 kg (4.4 lb) compared to her prepregnancy weight; BMI is 21 kg/m².  Physical examination shows no abnormalities.  Transvaginal ultrasound shows a single intrauterine gestation with a heart rate of 150/min.  Complete blood count and comprehensive metabolic panel are normal.  Urinalysis is negative for ketones.  Which of the following is the best next step in management of this patient's vomiting?

A) Advise the patient to eat small, scheduled meals
B) Evaluate for disordered eating behaviors
C) Prescribe vitamin B₆ (pyridoxine) and reevaluate in 2 weeks
D) Provide reassurance and routine prenatal care
E) Recommend changing prenatal vitamin dose to the evening

Correct Answer:

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