Why do pregnant women have nausea and vomiting in pregnancy(NVP)?
Nausea and vomiting in pregnancy are common especially in the first trimester (up to 13-14weeks) and in some women can last for several weeks/months beyond that and sometimes till the end of the pregnancy. It is often called “morning sickness”.Its severity can vary in different women in different pregnancies
Around 70 percent of all pregnant women in Australia and around the world suffer from nausea and vomiting during pregnancy. In most women, this resolves by around 14-20 weeks and in 10 percent of women, this can persist throughout their pregnancy.
It is difficult to trace the exact cause, and why it affects some women more than others, but numerous factors are implicated including the role of HCG(human chorionic gonadotrophin) or the “pregnancy hormones” which is why women with multiple pregnancies (twins, triplets, etc) and molar pregnancy are more likely to have NVP.
It is also more common if you are having a girl, if the expectant mother suffers from an overactive thyroid gland, has a previous history of migraines/motion sickness or if she has had it in your previous pregnancy.
There may also be a genetic element to it, in that it is not uncommon to find a similarity in first-degree relatives with this condition.
What happens when women have NVP?
When experiencing morning sickness symptoms women usually feel nauseated for a short time each day and may vomit a couple of times a day. There may also be dry retching associated. Some women can also suffer from heartburn. Your urine can change colour from clear-light yellow-dark yellow to brown in severe cases of dehydration. You may also experience an upset stomach at times.
In severe cases, nausea persists and vomiting can happen more frequently-This severe form of NVP is called Hyperemesis gravidarum(HG).
Hyperemesis gravidarum occurs in 3 percent of all pregnancies and is defined by a severe form of nausea and vomiting in pregnancy leading to a significant reduction of oral intake and weight loss of at least 5% as compared to pre-pregnancy weight with/without dehydration and electrolyte abnormalities.
NVP and HG can affect your mood, your work and your ability to care for your family.
There is no evidence to suggest that pregnancy nausea and vomiting in early pregnancy will harm the growing fetus-in fact-there is a slightly lower chance of miscarriage-but persistent severe NVP for several weeks into the later part of the pregnancy may affect the baby’s growth and you may need serial growth scans to monitor this.
There are a few things you can try to reduce our nausea and vomiting. Here are a few that may help you:
- Small frequent meals rather than large portions will allow the food and drink to remain in the digestive system.
- Stick to eating bland foods
- Avoid having an empty stomach as this may drop your blood sugar levels and may trigger morning sickness
- Find foods that are palatable-there may be certain foods that you are able to tolerate outwith pregnancy that are intolerable in pregnancy-best eat what sustains you and you can keep down.
- Recognise food triggers and stay away from that foods-use a fan while cooking and get someone else to empty the trash.
- Stay hydrated-drink throughout the day and suck on ice lollies/candies if you cannot drink water. Try drink six to eight cups daily.
- Some people find relief with Ginger-if you do, try capsules, candies, ginger ale and/or ginger tea.
- Avoid food with increased fatty content and astringent and spicy and fatty foods as these are more likely to irritate the gastric mucosa.
- In some instances, rest and, modifications of work, dietary and sleep patterns have been found to be beneficial.
- Take your vitamin supplementations regularly. Vitamin B6 is safe and when used with Doxylamine-can relieve NVP and is safe to use in pregnancy.
- Acupressure wristbands may offer some morning sickness relief
- Support from friends, family, and work colleagues is vital in these circumstances and where mental health is affected-extra support like counselling may be required.
You may need to be assessed by your doctor or in ED/assessment unit of a hospital. A thorough assessment will be made of your symptoms and your clinical condition including Blood pressure, weight and urine check for ketones(these are substances released when your body, which is devoid of sugar, starts to breakdown fats instead to produce energy), blood tests and an ultrasound scan.
You may need medical attention or hospital admission if you:
- are experiencing severe morning sickness
- are dehydrated
- have severe vomiting and are unable to tolerate any fluids,
- have abnormal blood tests,
- have lost weight
- have a medical condition like diabetes, or a heart/kidney problem.
Should you be checkin to the hospital due to severe symtoms, you an expect the following:
- You will be given fluids and medication through an IV(intravenous) drip to correct dehydration and fluid and electrolyte imbalances. These may also include a vitamin called Thiamine. You may also be commenced on heartburn medications.
- You may be asked to wear TED stockings or commenced on anti-coagulant medications-as severe dehydration can increase the risk of clotting in pregnancy
- You may be commenced on Antiemetic(medications used to reduce nausea and vomiting). Some of these include Cyclizine,Maxalon(Metoclopramide),Ondansetron.
- In severe cases, Corticosteroids may be given if all the above medications have failed.
The risks of HG( if not treated), to you and your baby, far outweigh any effects of these medications.
Once you are well enough to go home you will need to take extra care and precautions and continue with at home treatment.
- You may be given oral antiemetics or prescription anti-nausea medications to continue.
- Make sure you are having regular bowel movements, as a combination of dehydration and a side effect of some of the medications is constipation-take pregnancy-safe laxatives and modify your diet if you are constipated.
- make sure you have adequate prescriptions for all your medications.
- Contact your service provider if the symptoms become severe again or if you are dehydrated.
- patience is key and whilst it is frustrating to have to go through this process, the symptoms will eventually settle.
- Make sure you are having regular bowel movements
If you feel your NVP has become severe and you are experiencing extreme symptoms or you would like to find out more about treatment options that can help you, please contact Lotus Medics and we can schedule your appointment and assist you in treating your NVP as safely as possible
- RCOG-Royal College of Obstetricians and Gynaecologists-UK
- RANZCOG-Royal Australian and New Zealand College of Obstetricians and Gynaecologists
- Society of Obstetric Medicine Australia and NZ