Vomiting During Pregnancy Overview
While you are pregnant, nausea and vomiting are normal. Up to 70% of all women get mild to moderate symptoms during the first three months (first trimester) of pregnancy. These symptoms are usually gone by the fourth month.
Although this condition is often called morning sickness, most women have symptoms throughout the day.
Very rarely, a pregnant woman may experience a more serious condition involving severe vomiting, dehydration, and weight loss. This is called hyperemesis gravidarum.
Vomiting During Pregnancy Causes
The exact cause of nausea and vomiting in pregnancy is not clear. Most evidence points to rapid changes in hormone levels. These fluctuations may cause changes in the muscle contraction and relaxation patterns of your stomach and intestines, thus leading to nausea and vomiting.
The hormones that seem to have the most to do with this process include the pregnancy hormone human chorionic gonadotropin (hCG), estrogen, and progesterone. Abnormal levels of thyroid hormones have also been reported in women with severe vomiting, although a cause-and-effect relationship remains unclear. Some studies have shown that nausea is worse when your blood sugar level is low.
Some researchers have found that women who are more likely to have nausea from birth control pills, migraines, or motion sickness are at higher risk for nausea and vomiting in pregnancy.
If you have a family history of hyperemesis gravidarum, you are more likely to have the condition. What causes hyperemesis gravidarum remains unknown despite active research. The more popular theories fall into three areas:
Hormonal: Elevated levels of human chorionic gonadotropin (hCG) or a component of this hormone may play a role in inducing vomiting. Thyrotoxicosis or hyperthyroidism is also believed to be associated with the condition. Another hormone thought to be involved is serotonin. Serotonin is a brain chemical that affects both the central nervous system and the gastrointestinal (GI) tract. These effects are believed to induce vomiting. During pregnancy, the upper GI tract may slow down and thus contribute to increased nausea and vomiting. Several studies have shown that this slowdown in the GI tract is increased in pregnant women with severe vomiting.
Gastrointestinal: Helicobacter pylori bacteria that live in the intestinal tract may cause the development of peptic ulcer disease. These bacteria are found in a greater percentage among pregnant women and greater still in women with hyperemesis gravidarum. Antibiotics are used to treat all of these conditions.
Psychosocial: Although the idea is controversial, some researchers think the condition may be a woman's psychological reaction against the pregnancy and might arise from conflict within the family and her home environment. In these cases, counseling is recommended.
Vomiting During Pregnancy Symptoms
Morning sickness: Some women experience nausea and vomiting only in the morning. The majority of women have nausea on and off, all day long.
A pregnant woman may also note increased saliva, increased sensitivity to certain smells, and changes in the taste of some foods.
Fever, diarrhea, and severe abdominal pain are not associated with nausea and vomiting during pregnancy. If these symptoms occur, be sure to talk with your healthcare provider because it may be something other than morning sickness.
Hyperemesis gravidarum: This condition occurs when a pregnant woman has ongoing vomiting that results in weight loss greater than 5% of her body weight, and evidence of dehydration. Hyperemesis gravidarum is an extreme form of nausea and vomiting in pregnancy that sometimes requires hospitalization. It is different from, and much worse than morning sickness.
Medical Treatment
Your healthcare provider will try to stop the vomiting either by hydration (giving fluids by IV or by mouth) or with medications.
You will be given plenty of fluids to replace important electrolytes such as potassium.
You also may receive thiamine (vitamin B-1) either as an injection or IV, depending how long you have been vomiting.
Once these goals are met, you may be given antinausea medications and instructions for care at home.
If you continue to be severely dehydrated, still nauseous, or still vomiting, you may be admitted to the hospital. Rarely, you may need to be hospitalized for fluid and nutritional supplements in very severe cases of hyperemesis gravidarum.
Self-Care at Home
As miserable as it may seem, nausea and vomiting are usually part of a healthy pregnancy. The misery typically goes away by the middle of the second trimester. You can try home remedies to reduce your symptoms, and if these do not work, your doctor can help.
No single treatment works best for every woman with nausea and vomiting during pregnancy. Different techniques work for different women. You will have to discover what seems to make your symptoms better. Many women have found the following suggestions helpful:
Diet
Eat small amounts of food frequently so that you are never too hungry or too full.
Avoid spicy and fatty foods, and foods with odors that bother you.
Try eating simple carbohydrates, such as saltine crackers, unbuttered toast, plain baked potatoes, white rice, gelatin desserts, broth, pretzels, popsicles, herbal or decaffeinated tea with sugar, or non-diet ginger ale.
Combine these simple carbohydrates with a serving of protein, especially right before bed to minimize swings in blood sugar that may contribute to nausea.
Drink liquids between meals and not during meals to minimize nausea and vomiting.
Keep crackers at the bedside table to help with nausea in the morning.
Vitamin supplements
If you find that your prenatal vitamin seems to worsen your nausea, take it with food instead of on an empty stomach. If this does not help, talk to your doctor about the possibility of switching to a different vitamin. Chewable vitamins are sometimes easier to tolerate.
Some evidence suggests that pyridoxine (vitamin B-6) supplements help reduce nausea and vomiting. The suggested dose is 25-50 mg every eight hours, and it can be given as an injection up to 200 mg. There are no known harmful effects of vitamin B-6 taken at these doses. Some prenatal vitamins are formulated with extra vitamin B-6.
Acupressure
Stimulation of the P6 (Nei Guan) acupressure point on the wrist (on the inside of the wrist about where a watchband is worn) has been suggested as a method to reduce nausea and vomiting.
You can press on this area with your finger or thumb or buy an acupressure band. These bands are often sold as motion sickness treatments, so check with a local drug store or auto club.
Hypnosis
Medical hypnosis has been used to reduce nausea and vomiting.
Some women have also used self-hypnosis to control their symptoms.
If you want to try hypnosis, make sure you work with an experienced professional.
Over-the-counter medications
Solutions containing glucose, fructose, and phosphoric acid are available over-the-counter. These solutions may reduce muscle contractions in the wall of the stomach and intestines. The normal dose is 1-2 tablespoons every 15 minutes for no more than 5 doses. These solutions cause no known harmful effects on the fetus.
Two over-the-counter antihistamines, diphenhydramine (Benadryl) and dimenhydrinate (Dramamine), have been shown to improve nausea and vomiting. Although both are generally believed to be safe in pregnancy, you should discuss the risks and benefits of these medications with your doctor.
Herbal remedies
Powdered ginger is used fairly commonly in Europe as a nausea remedy during pregnancy.
The usual dose is 250 mg, three times daily.
The effect of ginger on the fetus has not been extensively studied.
