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pregnancy nausea and vomiting

Pregnancy associated nausea and vomiting

Most women will experience some sickness in pregnancy, this can range from occasional mild nausea to severe vomiting requiring hospitalisation.  The good news is that there are many ways to manage nausea and vomiting associated with pregnancy, and for the majority of women the symptoms will be mild and won’t endure throughout pregnancy.

Morning sickness is the term commonly used to describe pregnancy-associated nausea and vomiting. The symptoms can occur at any time of the day though, so the name is slightly misleading. About 80% of pregnant women will experience some nausea in the first 12 weeks of a pregnancy; this is due to increasing levels of one of the hormones associated with pregnancy, HCG (human chorionic gonadotrophin). For many women the nausea may be mild and only occasional. Others may find they have significant vomiting and about a third of pregnant women will have to take some time off work as a result of their symptoms.

A small number of pregnant women (about one in a hundred) will experience prolonged and severe sickness and will be diagnosed with hyperemesis gravidarum (HG). These women often need admission to hospital for treatment as they can become severely dehydrated and very unwell.

Thankfully, for the majority of women, symptoms can be managed at home, either with or without medication.

Non drug treatments for pregnancy associated nausea and vomiting include:

  • Rest – tiredness can make nausea worse and the first trimester of pregnancy is often associated with significant tiredness
  • Sipping fluids slowly rather than drinking large quantities quickly
  • Snacking frequently and eating small meals, high in carbohydrate
  • Avoiding strong smells – it may be helpful to eat cold foods as hot foods often give off stronger smells which can make sickness symptoms worse
  • Wearing comfortable clothes and avoiding tight waistbands – pressure on the stomach may add to nausea
  • Ginger has been shown to help mild sickness symptoms and some women take a supplement (just check that anything you purchase over the counter is safe in pregnancy) whilst others may snack on ginger biscuits or sip ginger ale.

 

If the above measures are not working and you are vomiting so much that you can’t keep food or fluids down then you may need additional treatment. Contact your GP or midwife immediately if you:

  • Are unable to keep any food or fluids down for 24 hours
  • Have very dark coloured urine, or if you don’t pass any urine for over 8 hours
  • Experience abdominal pains or a fever
  • Vomit blood.

 

You’ll be assessed for signs of dehydration and your urine checked to ensure you don’t have a UTI (these are common in pregnancy and can also cause sickness). If your sickness is not controlled without medication then you’ll be offered anti-sickness drugs. There are several drugs which are commonly used to treat pregnancy associated nausea and vomiting. These are all thought to be safe in pregnancy, although your doctor will be able to give you more information on individual drug treatments and potential side effects.

In some cases you may need to be admitted to hospital for fluids given via a drip into the veins, and anti sickness medication delivered by injection. Typically a hospital stay for vomiting in pregnancy isn’t too long – your medical team will give you treatment to rehydrate you and give you anti-sickness medication that you can take by mouth so that you can continue taking this medication at home.

Hyperemeises gravidarum (HG) is diagnosed in pregnant women who have severe nausea and vomiting that is not relieved by simple treatments and is associated with weight loss of more than 5% of total body weight (before pregnancy), dehydration and changes to the salts levels in the body as a result of vomiting.

Initial treatments for HG include rehydration and anti-sickness medication, but if vomiting continues despite other treatment then steroid treatment can be given.

Unfortunately for some women, they have such severe symptoms that it is not possible to continue with the pregnancy. Termination of pregnancy as a treatment for pregnancy associated nausea and vomiting, or for hyperemesis gravidarum, should only be offered when all other treatments, including steroid treatment, have been offered first.

For more information and support on nausea and vomiting in pregnancy this group is an excellent resource: https://www.pregnancysicknesssupport.org.uk

Article By

Dr Emma Scott (MBChB, MRCGP) is a qualified GP and mummy to two young children. She works in a GP practice in Edinburgh and in the out of hours GP service in Livingston and she has experience in both obstetrics & gynaecology and paediatrics.

to read more articles by Dr Emma

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