During the first trimester of pregnancy, many women experience the bouts of nausea and vomiting commonly described as morning sickness. It usually begins around the 6th week of pregnancy, peaks around week 9, and in 95% of women it disappears by the 12th week of pregnancy, but can continue up to 16 to 18 weeks as well. rarely this concern can go up to delivery. Although unpleasant, morning sickness is considered a normal part of a healthy pregnancy.
Though it is commonly called morning sickness it is not confined to only the morning hours and can happen during any part of the day.
It is just a physical reaction of the body to the high level of circulating pregnancy related hormones.
“Hyperemesis gravidarum” is the term used to describe a more severe condition. Hyperemesis may cause you to vomit multiple times throughout the day, lose weight, be unable to consume food and liquids, and typically requires evaluation in the hospital and treatment with intravenous fluids and medication(s).
Women who are more likely to develop nausea and vomiting of pregnancy include those who:
- developed these symptoms in a previous pregnancy,
- experience nausea and vomiting while taking estrogen (for example, in birth control pills)
- or have menstrual migraines,
- have a history of gastrointestinal problems (ie, reflux, ulcers),
- have twins, triplets, or other multiples,
- have a molar pregnancy (a type of abnormal placenta and pregnancy)
Of mild to moderate vomiting where one is not dehydrated, is mainly dietary and lifestyle change:
- Dietary intervention, we encourage multiple small feeds of your choice that are high in protein or carbohydrates and low in fat.
- Remember your taste buds don’t like your routine tastes but will be comfortable with slight variations in taste. Eg. Ginger – powdered ginger or ginger tea may help to relieve nausea and vomiting in some women.
- Distract yourself while having food so that your concentration is not on your food plate.
- Try eating before or as soon as you feel hungry to avoid an empty stomach.
- Treatment may not totally eliminate your nausea and vomiting.
- The goal is to make symptoms tolerable so that you can eat and drink enough to keep you hydrated and not losing much weight.
- Smelling fresh lemon, mint, or orange or using an oil diffuser with these scents may also be useful, just remember to keep changing the scents often.
- Avoid triggers— one of the most important treatments for pregnancy-related nausea and vomiting is to avoid odors, tastes, and other activities that trigger nausea.
- Eliminating food triggers, like spicy foods, helps some women.
- Brushing teeth after eating may help prevent symptoms so that lingering taste of food can prevent trigger of nausea.
If you are unable to hold down food or liquids, you may get dehydrated and need to be treated with intravenous (iv) fluids. This may be done in your doctor or nurse’s office or in the hospital, depending upon the severity of your vomiting. For a short time, you may be advised not to eat or drink anything, to allow the gut to rest. You can slowly begin to eat and drink again as you begin to feel better, usually within 24 to 48 hours. Antiemetics drugs to prevent vomiting, are prescribed in severe cases not responding to the above, even steroids for a short term may be prescribed.
Most women with pregnancy-related nausea and vomiting recover completely without any complications. Women with mild to moderate vomiting often gain less weight during early pregnancy. This is rarely a concern for the baby unless the mother was very underweight before pregnancy.
In women with severe nausea and vomiting (hyperemesis gravidarum) who are hospitalized multiple times and who do not gain weight normally during pregnancy, then there is a small risk that the baby might be underweight or small.
Women who have hyperemesis gravidarum are at 15-20% risk of recurrence in future pregnancies.