Nausea and vomiting during pregnancy are common conditions, affecting around 70% to 80% of pregnant women. Although it is called “morning sickness”, it can occur any time during the day. Nausea and vomiting during pregnancy usually do not harm your baby, but they can affect your life, including your ability to work or go about your normal everyday activities.
Morning sickness usually develops during the 5th to 6th week of gestation. The symptoms are usually worst around the 9th week and typically improve by the 16th week of gestation. However, in some women, symptoms can continue until the third trimester. Hyperemesis gravidarum is a term used to refer to a severe form of nausea and vomiting. Women with hyperemesis gravidarum often vomit multiple times every day, are unable to tolerate food and fluid and may lose more than 5% of their pre-pregnancy weight. If left untreated, they can become dehydrated. Prolonged vomiting may also give rise to vitamin and other nutrient deficiencies.
The exact cause of vomiting during pregnancy is still unknown, but it seems to have a connection with human chorionic gonadotropin (hCG). This hormone is created during pregnancy by the placenta and produced in exceptionally large amounts during the early stage of pregnancy. Women with the characteristics listed below are somehow at a higher risk to develop morning sickness:
- Being pregnant with more than one fetus (multiple pregnancies)
- Previous pregnancy with either mild or severe nausea and vomiting
- Women whose mother or sister had severe nausea and vomiting during pregnancy
- Women with a history of motion sickness or migraine
There are a few tips and tricks to overcome this problem. Lifestyle and dietary modifications may help ease the symptoms. It can be made worse from overeating or excessive hunger. Eating too much, avoiding food altogether, or not eating enough food may actually make nausea worse. Try to eat small and frequent meals that are high in proteins and low in fat. Dry crackers, toasts, nuts, and fruits usually help. Stick to a bland diet and drink cold, clear, and carbonated or sour fluids like ginger ale or lemonade in between meals. Consuming foods and drinks containing ginger such as ginger ale or ginger candy can help settle mild nausea and ease an upset stomach. Make it a point to drink a lot of water because dehydration itself can make nausea worse.
The most important treatments for pregnancy-related nausea and vomiting are to avoid odours, tastes, and other activities that trigger nausea. The trigger is different for each woman; it can be the Dior perfume that you previously loved so much or the otherwise delicious smell of chicken curry that your mum cooks. Identify the stuff that aggravates your symptoms, whatever they might be, and avoid them altogether.
The smell of iron in prenatal vitamins can worsen the symptoms, so consider taking the vitamins just before bedtime. If symptoms persist, stop the vitamins temporarily and inform your obstetrician. The chewable prenatal vitamin is another alternative since some women tolerate this better than the vitamin in tablet form. If you still can’t tolerate them and have to stop taking your prenatal vitamins, your obstetrician may suggest taking a supplement that contains 400mcg to 800mcg of folic acid until you are at least 14 weeks pregnant to reduce the risk of birth defects.
If diet and lifestyle modifications failed to suppress the symptoms, do consult your obstetrician for medical treatment. If all other medical causes have been ruled out, some medication can be prescribed to help, such as:
- Vitamin B6 and doxylamine
- Antihistamines such as diphenhydramine (Benadryl), can sometimes help relieve pregnancy-related nausea and vomiting
- Anti-nausea medication such as metoclopramide and promethazine
Severe cases of hyperemesis gravidarum will require hospitalization. Pregnant women who are unable to keep fluids or food down due to constant nausea or vomiting will need to get them intravenously, with IV fluid. Seek help immediately if you have any of the following:
- Signs of dehydration, including infrequent urination, dark-coloured urine, or dizziness while standing
- Vomiting repeatedly throughout the day
- Abdominal or pelvic pain or cramping
- Unable to keep any food or drinks down for more than 12 hours
- Weight loss of more than 5 pounds (2.3kg)
- Fever or diarrhoea in addition to nausea and vomiting
- Feeling hopeless, wanting to end the pregnancy, or having suicidal thoughts because of the severity of nausea or vomiting symptoms
Most women with pregnancy-related nausea and vomiting recover completely without any complications. Women with mild to moderate vomiting may gain less weight during early pregnancy. This is not harmful to the baby. Normal weight gain during pregnancy depends upon your pre-pregnancy height and weight. For women of normal weight, the recommended weight gain is between 10 to 15 kilograms for a singleton pregnancy. However, most of this weight gain normally occurs in the last half of pregnancy, and pregnancy-associated nausea and vomiting are usually resolved by that time in most women. For women with severe nausea and vomiting (hyperemesis gravidarum) who are hospitalized multiple times and do not gain weight normally during pregnancy, there is a small chance that the baby will be underweight at birth.
By Dr Nor Idayu Bte Ahmad Ruslan,
O&G Consultant, Pantai Hospital Ayer Keroh
