Nausea And Vomiting In Pregnancy

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by Dr. Nicole Calloway Rankins

It was a beautiful sunny day and I was sitting at my desk getting ready to do some work. I had awesome huge windows in my office and I was looking forward to finally accomplishing some tasks while enjoying the sunny view.

And then it hit me. I had to throw up NOW.

I was about 10 weeks pregnant at the time with my second child. Thankfully there was a bathroom across the hall from my office so I made a beeline for the bathroom. I made it to the bathroom! But unfortunately I didn’t make it to the toilet. As soon as I hit the bathroom door, what seemed like everything I’d eaten for my entire life came spewing out of me. Before I knew it vomit was on 3 walls of the bathroom - yes 3 walls - and none of it was in the toilet.

I hope you can’t relate to this story. I wouldn’t wish that on anyone. But based on how common nausea and vomiting of pregnancy is (it affects 50-80% of pregnant women), chances are you can relate. Read on to learn more about nausea and vomiting in pregnancy and what you can do about it.

Morning sickness? Yeah right….

So let’s clear something up right away. It’s called morning sickness because it tends to be worse in the morning. But nausea and vomiting of pregnancy can occur anytime of the day or night.

It starts early and ends (fairly) early

We don’t know what causes nausea and vomiting in pregnancy. But we do know that it almost always begins early, around 5 or 6 weeks gestation. It tends to peak at about 9 weeks and for most women has completely resolved by 16 weeks. For about 15% of women, it will continue into the 3rd trimester. And for about 5% of women it will continue until delivery.

Extreme nausea and vomiting is referred to as hyperemesis gravidarum. There’s not an accepted definition for hyperemesis gravidarum, but most accept that it’s persistent vomiting with accompanying weight loss. With hyperemesis gravidarum, hospitalization, a feeding tube in the stomach, or parenteral nutrition may become necessary. 

It’s annoying but not harmful

Nausea and vomiting in pregnancy is extremely annoying and can be downright miserable. However, unless it’s a very extreme case and malnutrition becomes a problem, it’s not harmful to you or your baby. In fact, there’s strong evidence that women with nausea and vomiting in pregnancy have a lower miscarriage rate.

What can I do that doesn’t require medication?

A key treatment for nausea and vomiting in pregnancy is prevention. At least 2 studies have found that women who were taking a multivitamin at the time of conception were less likely to need treatment for vomiting. So taking a prenatal vitamin for at least one month before pregnancy may help prevent nausea and vomiting from developing.

If you’re already pregnant, you can start with dietary changes. To be honest, there’s not a lot of scientific evidence about how dietary changes affect nausea and vomiting in pregnancy. But in my experience they definitely help.

Instead of big meals, eat small meals every couple hours. This helps prevent your stomach from feeling empty or getting too full at any given time (both extremes can aggravate nausea).

You should also avoid spicy and fatty food. One small study has shown that eating protein is better at reducing nausea and vomiting in pregnancy. So stick with protein rich foods like almonds, eggs, greek yogurt, lean chicken and turkey.

There will be some trial and error as you figure out what foods work for you. Foods you previously ate without problem may now bother you. That was the case with Cheerios for me. I used to eat them all the time before pregnancy but during pregnancy they made me throw up every single time I ate them. You may also find that certain smells or motions tip you over the edge. Do your best to avoid avoid the triggers.

Another non medication option is ginger. Ginger has been shown to improve nausea (but not vomiting). You can use ginger lollipops, ginger chews, or ginger tea.

Finally, acupuncture or acupressure wrist bands may help with nausea and vomiting of pregnancy. Results from research studies are conflicting. However, considering the low risk, it’s reasonable to give them a try.

Medication options

It’s fairly common that non-medication options aren’t enough and medications are needed.

The first line of medication treatment is vitamin B6 (pyridoxine). It can be taken alone or in combination with an antihistamine called doxylamine. Diclegis® is a prescription medication that is a combination of vitamin B6 and doxylamine. However, both vitamin B6 and doxylamine are available over the counter. Check with your doctor for directions on how to take it.

If symptoms persist then other medications are added (not replaced). Typical next medications are promethazine (Phenergan®) and ondansetron (Zofran®). Promethazine is safe for you and your baby but it may cause significant sedation. Ondansetron doesn’t cause sedation, but there is a small increased risk of causing problems for your baby including heart malformations and cleft palate. Metoclopramide (Reglan®) is another commonly used medication for nausea and vomiting in pregnancy. In rare cases it can cause movement disorders in women who take it, but doesn’t appear to increase risks for your baby.

In addition to medicines that treat nausea and vomiting, acid reducing medications such as Tums®, Zantac®, or Pepcid® may also be helpful.

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