Nausea and Vomiting in Pregnancy

 Obstetrics  Comments Off on Nausea and Vomiting in Pregnancy
May 132012

Nausea and Vomiting occurs commonly during pregnancy and between 50 and 90 percent of women have some degree of nausea, with or without vomiting.  Symptoms may vary between patients but usually develop by 5-6 weeks of pregnancy and peaks at 9 weeks. The majority of patients will have complete resolution of the symptoms by 12-14 weeks of gestation.

Mild to Moderate Nausea and Vomiting of Pregnancy

Although the term for mild pregnancy-related nausea and vomiting is “morning sickness”, symptoms may occur at any time of day and in most cases persist throughout the day.  Many women do not need to see a healthcare provider for treatment of their symptoms and can manage without medication or with over the counter medication. Below are some suggestions for management of your symptoms.

Non-Medical Therapy

  • Dietary Changes — Women with nausea and vomiting in pregnancy should eat before or as soon as they feel hungry in order to avoid an empty stomach, which may aggravate nausea.  Women are advised to eat snacks frequently and have small meals that are high in carbohydrates and low in fat. Eliminating spicy foods and eating salty or high protein snacks/meals appears to help some women.
  • Fluids are better tolerated if cold, clear, and carbonated or sour (ginger ale, lemonade) and if taken in small amounts between meals.  Aromatic therapies involving lemon (lemonade), mint (tea), or orange have also been described as useful.
  • Avoidance of Triggers — One of the most important treatments for nausea and vomiting is to avoid odors, tastes, and other activities that trigger nausea.  Examples of some triggers include: stuffy rooms, odors, heat, humidity, noise, and visual or physical motion. Brushing teeth after eating, quickly changing position, and not getting enough rest may also aggravate symptoms.  If prenatal vitamins worsen symptoms, try taking them at bedtime. If symptoms persist, it is reasonable to stop the vitamins until the nausea passes.
  • Acupuncture and Acupressure — Acupuncture or acupressure wristbands do not require a prescription and have become a popular treatment for morning sickness.  Clinical trials have not shown these wristbands to be more effective than sham (fake, look-alike) wristbands, although some women find them helpful. Acupuncture or acupressure have no known harmful side effects.
  • Ginger — Powdered ginger may help to relieve symptoms of nausea in some women. However, further clinical studies are needed to confirm that this treatment is both safe and effective.

Over the Counter Medical Therapy

Medications that reduce nausea and vomiting have been proven to be effective in some women and are safe to take during pregnancy.

  • Vitamin B6 and Doxylamine — Vitamin B6 and Doxylamine together three to four times per day has been shown to be safe and effective in reducing nausea and vomiting in pregnancy.  Doxylamine is found in the over-the counter medication Unisom Sleep tablets.  Suggested dosing is ½ Unisom tablet and 25 mg Vitamin B6 three to four times per day.  For patients that have only nausea without vomiting, vitamin B6 alone may alleviate symptoms.
  • Antihistamines and other Anti-Nausea Medications — Antihistamines and other over-the-counter nausea medications such as Dramamine and Emetrol are safe and effective treatments for pregnancy-related nausea and vomiting.
  • Antacids — Pregnant women often develop gastroesophageal reflux (heartburn), which can worsen nausea and vomiting. An antacid treatment may be recommended in this case. This is particularly useful for nausea in later pregnancy.

Severe Nausea and Vomiting of Pregnancy

Hyperemesis Gravidarum is the term usually used to describe severe nausea and vomiting. There is an associated weight loss, dehydration and inability to keep down food and liquids throughout the day. Patients with severe nausea and vomiting may need more aggressive medical therapy, IV fluids or even  hospitalization.

When to Seek Help

Women with more severe nausea and vomiting need to be evaluated by their obstetrical provider.  If you have one or more of the following, you are advised to seek care;

  • Signs or symptoms of dehydration, including infrequent urination, dark-colored urine, or dizziness upon standing.
  • Vomiting repeatedly, especially if blood is seen in the vomit.
  • Abdominal or pelvic pain or cramping.
  • Inability to keep down any food or drinks for more than 12 hours.