Nausea and Vomiting in Pregnancy: Symptoms & Tips To Control

Nausea and vomiting during pregnancy have been found to affect about 85% of pregnant women (1). It is also known as morning sickness but may occur at any time of the day. The symptoms usually occur during the first trimester of pregnancy but may continue throughout pregnancy for some. A severe form of the condition is termed hyperemesis gravidarum, leading to nutritional deficiencies and dehydration. Read this post to know all about vomiting during pregnancy, its causes, treatments, and preventive measures.

Is Nausea And Vomiting Of Pregnancy A Good Sign?

According to a study published in JAMA Internal Medicine, these symptoms reduce the risk of pregnancy loss by as much as 50 to 75% (2).

The study’s first author Stefanie N. Hinkle says, “Our study evaluates symptoms from the earliest weeks of pregnancy, immediately after conception, and confirms that there is a protective association between nausea and vomiting and a lower risk of pregnancy loss (3).”

A Canadian study claims that women experiencing morning sickness are likely to give birth to intelligent babies (4). After reading this, you must be definitely feeling better that morning sickness is of some good to you.

But let us tell you that pregnancy without any signs of morning sickness is normal too. It just means that you are lucky to have escaped that phase.

When Does Vomiting Start In Pregnancy?

You might begin feeling nauseous between the fourth and the sixth week i.e. the first trimester. This is the period after you miss the period following the process of implantation in your uterus. At around the second month, nausea and vomiting could be at its peak and between the 12th and 18th week the condition may ease up. In some cases, the symptom can extend by a few weeks or months or may last until delivery (5).

NVP may not always be good. If your condition is severe, then it could lead to hyperemesis gravidarum.

What Is Hyperemesis Gravidarum?

Hyperemesis gravidarum (HG) is excessive vomiting (more than three times a day) during pregnancy. About one in 100 women experience this severe morning sickness. It usually begins between five and ten weeks of pregnancy and can go away by the 20th week (6).

You can identify HG through:

• a dry mouth
• faster heart beat
• less urination
• extreme thirst
• low blood pressure
• excessive weight loss

HG could indicate fetal abnormalities such as triploidy, trisomy 21, and hydrops fetalis, and nulliparity (5).

Though HG and morning sickness sound similar, HG is much different from morning sickness. Here’s how:

Morning sickness Vs. Hyperemesis gravidarum

What Are The Causes Of Vomiting And Nausea During Pregnancy?

The exact reason for morning sickness or HG is not known. However, researchers believe that the raising hCG level during the early stage of pregnancy causes nausea and vomiting (7). In addition, the increased levels of hormones slow down the digestion process, resulting in heartburn, indigestion, and acid reflux leading to nausea and vomiting.

Other likely reasons of morning sickness are:

1. Ovarian hormones estrogen and progesterone could lead to hyperacuity of olfactory systems. The heightened sense of odor leads to nausea and vomits.

2. If you are stressed out during pregnancy, it can aggravate morning sickness (8).

3. Your digestive system may find it difficult to break high-fat diet, resulting in NVP.

4. Helicobacter pylori infection or H-pylori (9).

5. Ultrasound studies show that vomiting and nausea are severe in women whose corpus luteum is located in the right ovary, because of a higher concentration of sex steroids.

6. If your mother and other genetically related women in the family had morning sickness, then you are more likely to experience the symptoms during your pregnancy; 28% of women who had HG reported their mothers having it, and in 19% their sisters had similar symptoms (5).

7. If you are pregnant after you are 30 years of age.

8. Rare and abnormal pregnancies, such as molar pregnancy.

9. If you are carrying multiple fetuses, the placenta grows larger. There is an increase in the level of estrogen, progesterone and hCG hormones, leading to excessive vomiting/severe morning sickness.

10. Hyperthyroidism or hypothyroidism.

11. Conditions such as high blood pressure, active migraines, and gestational diabetes.

12. Overweight.

13. Motion sickness.

14. You are carrying a girl.

You can recognize NVP and HG in the first few days itself. But there could be other associated symptoms of the condition.

Symptoms Of Nausea And Vomiting In Pregnancy

Here is what could accompany morning sickness:

• Loss of appetite

• Depression

• Food aversion

• Dehydrated, weakness and lightheadedness

• Weight loss in the case of HG

• Ketosis – a severe condition where the number of ketones (a poisonous chemical) in blood and urine increase due to excessive vomiting

Not all pregnant women necessarily experience these symptoms and at the same intensity. In extreme cases, morning sickness can become severe (HG) and may require hospitalization.

When To Call A Doctor

Sometimes, you need to see a doctor even for a simple condition like morning sickness, if:

• vomiting persists throughout the day making it impossible to eat or drink.

• your vomit is brown in color or has blood or streaks of blood.

• you have a headache, weight loss, dizziness, and decreased urination.

• you are intolerant to odors.

• you have increased heartbeat rate, fatigue, and confusion.

• severe vomiting continues into the fourth month of pregnancy.

• you lose two pounds or more.

• you experience abdominal pain, fever, headache, or swelling in the front of the neck.

After the diagnosis, your physician might suggest some treatments based on the severity of your condition.

What Are The Treatments For Nausea And Vomiting In Pregnancy?

The possible treatments for morning sickness include (10):

• Severe vomiting leads to dehydration. Therefore, you will be administered intravenous fluids to maintain the balance in the body.

• Nasogastric feeding involves feeding through a tube to restore the nutrients. In this, a tube is inserted from the nose into the stomach carrying the essential nutrients (11).

• Providing complex and balanced nutrition to the patient through IV is called total parenteral nutrition (TPN). It is required for treating severe cases of HG.

• Acupressure is used to reduce morning sickness through pressure-points in the wrist band.

• Hypnosis helps in controlling the involuntary psychological changes in the patient.

Before resorting to intravenous administration of fluids and food, the doctor may try to mitigate your condition through pregnancy-safe medication.

Medications For Hyperemesis Gravidarum:

Remember, these medicines must be taken on your doctor’s prescription:

1.  Vitamin B6 and doxylamine are over-the-counter medicines, which are either given in combination or separately depending on your condition. Vitamin B6 taken in the dose of 10mg to 25mg at an interval of eight hours helps reduce vomiting. Doxylamine helps you sleep, thereby reducing the discomforts. A combination of vitamin B6 and doxylamine helps in reducing vomits by 70% and is safe to use during the first trimester (12).

2. Antiemetic drugs are prescribed by your doctor if vitamin B6 and doxylamine are ineffective. Usually, Chlorpromazine and Prochlorperazine are the antiemetics advised for the treatment of nausea and vomiting.

Other antiemetic drugs safe to use during pregnancy are promethazine, metoclopramide (Maxolon), cyclizine (Valoid), ondansetron (Zofran), domperidone (Motilium), and prednisolone (a steroid) (13).

3. Antihistamines target the vestibular system to decrease the vomiting sensation. These drugs include meclizine (Antivert), Diphenhydramine (Benadryl), and dimenhydrinate.

4. Promotility agents, including metoclopramide (Reglan), are often used separately or in combination with vitamin B6. They increase the gastric transit and lower esophageal sphincter pressure, thus controlling vomiting.

5. Acid-reducing medications can help if you have acid reflux. The doctor prescribes Histamine H2 antagonists and proton pump inhibitors that are safe and effective to use during pregnancy.

In addition to the medications, you can make a few changes in your routine to manage your condition.

Tips To Control Vomitings In Pregnancy

Nausea and vomiting of pregnancy can occur at any time of the day. It may be triggered by a particular odor, food, fatigue, low blood sugar, and alcohol. Here are some tips to help you get relief (14):

1. Having frequent but small meals every two hours will help as you are not stuffing your digestive system with too much food to process at a time.

2. Take foods that are high in carbohydrates, like whole-grain bread, cereals, and rice. Protein rich foods such as beans, peas, lentils and lean meats, are also known to subside morning sickness.

3. Keep munching on crackers. As you wake up in the morning, have some crackers and rest for around half an hour. Crackers are a good source of carbohydrates.

4. Food at room temperature or cold food has less aroma, which may help prevent nausea. Moreover, cutting down on spicy, acidic, fatty and fried foods will help overcome the vomiting sensation.

5. Eat fruits such as banana, kiwi, watermelon, apple slices, or dried fruits to increase fiber intake and vegetables, including carrots, celery, melons, lemon, and cauliflower, to overcome dehydration and constipation (14).

6. Keep yourself hydrated. Drink at least two liters of fluid (eight cups) a day. Do not drink during or immediately after meals but give a gap of an hour or two. This will help avoid gastric reflux and bloating.

7. Cold and clear drinks can help ease the vomiting sensation. You can also have herbal teas, ginger ale, ginger soda, lemonade, and mineral water. In the case of excess vomiting, you may take rehydration fluids that are rich in sodium and potassium. These drinks will help replenish your body with lost minerals.

8. Avoid non-food triggers like a car ride, smell of a strong perfume, a quick change in positions, or certain visual stimuli.

9. Keep the windows open to let in fresh air.

10. Take as much as rest you can.

11. Do not rush out of bed. Get up slowly and sit for a few minutes before getting off the bed.

Foods to avoid

1. Stay away from foods whose aroma causes nausea.

2. Avoid fried and fatty foods because they take too long to digest.

3. Cut down on sugary foods and sweetened beverages that can trigger vomiting sensation.

4. Avoid acidic foods that can cause stomach upset and constipation.

5. Avoid carbonated, caffeinated, and alcoholic drinks.

How To Prevent Nausea After Meals?

1. Avoid sleeping immediately after having meals because it slows down the digestion process.

2. Spit out the excessive saliva.

3. Brush and rinse your mouth several times a day to avoid the bad breath caused due to vomiting. The bad odor can trigger nausea again.

Morning sickness or vomiting is a passing phase in pregnancy. No doubt it makes the first few months difficult, but it is gone by the second trimester. The problem arises if you have a severe condition, for which you need some support from medications. Talk to your doctor, and as long as NVP is not harming your baby you do not have to worry. It is a temporary problem and will disappear soon.

Let us now answer some frequently asked questions.

Have any more questions to ask us or information to share? Let us know in the comment section.

References

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