Health Tips

Why do I experience nausea and vomiting during my pregnancy?

Is it normal?

Feeling nauseous is not unusual for most women especially during the first trimester of pregnancy. You get out of bed and experience the morning sickness feeling sick in your stomach, drinking a glass of water or eating feels like an impossible task.

So, why does this happen? Severe nausea and vomiting in pregnancy that results in 5% weight loss from the pre-pregnancy period, dehydration and electrolyte imbalance is known as Hyperemesis gravidarum. 

How do I deal with it?

1) Nausea Only

• Eat small quantity of meals or snacks every 2 hours to avoid an empty or an extremely full stomach that may worsen nausea

• Take fluids half an hour before or after a meal to prevent a full stomach as above. Small volumes of electrolyte-replacement fluids can be taken if one can tolerate. 

• Avoid triggers such as stuffy rooms, odors (i.e. perfumes, smoke etc), changing positions too quickly, noise, motion and gastric irritation. Triggers differs from one person to another, one needs to recognise their own trigger and learn how to avoid it.

• Ginger - the age old remedy. Studies have shown that ginger helps with nausea. Any ginger products from ginger tea to ginger sweets or food containing ginger could help. 

• Initial pharmacotherapy - Vitamin B6 (Pyridoxine) may help to decrease the symptoms

2) Nausea and Vomiting (without hypovolemia)

The important thing to take note of when one is vomiting is if there is hypovolemia. The symptoms (postural dizziness, thirst, tachycardia, decrease urine output and frequency, lethargy) should serve as a warning sign that one is suffering from hypovolemia and needs to seek medical attention.

1. Initial pharmacotherapy: doxylamine-pyridoxine

2. Start dimenhydrinate if vomiting still persists with step one and stop doxylamine.

3. Add metoclopramide if vomiting still persists with step two.

4. Add ondansetron if vomiting still persists with step three.

5. Add glucocorticoids. 

• At any step where vomiting stops, continue medication for a week (then gradually discontinue) and follow the *nausea tips above. Resume medications if vomiting occurs.

• Talk to your doctor on which medication to take especially if you have allergies, or you are taking any other medications that might interact with these medications or if you have any other health issues.

Things to take note of:

• Small steps of prevention 

  • Start taking folic acid one month prior to conception as it may decrease nausea and vomiting besides preventing congenital anomalies (i.e.neural tube defects) 

  • Manage heartburn and acid reflux to decrease the symptoms as it may worsen nausea and vomiting

• Maintain good hydration (continuous or large volume vomiting puts your body in a dehydrated state)

• Look out for electrolyte abnormalities - just like the reason above, we lose electrolytes when we vomit. 

When do I need to see a doctor?

• Persistent nausea and vomiting

• Positive symptoms of HYPOVOLEMIA

• Inability to keep food or drink down for more than 12 hours

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Reference :

1. https://www.uptodate.com/contents/treatment-and-outcome-of-nausea-and-vomiting-of-pregnancy#H531461081

2. https://www.rcog.org.uk/globalassets/documents/guidelines/green-top-guidelines/gtg69-hyperemesis.pdf

Picture credits:

1. https://www.clinicaladvisor.com/home/topics/ob-gyn-information-center/early-treatment-of-nausea-vomiting-in-pregnancy-may-prevent-complications/

2. https://www.whaonline.net/hyperemesis-gravidarum-an-overview-of-severe-morning-sickness/

3. http://cpcbenvis.nic.in/noise_pollution_control.html

4. https://www.powerofpositivity.com/ginger-tea-health-benefits/

5. https://depositphotos.com/283738378/stock-illustration-dehydration-symptoms-infographic-dry-mouth.html

6. https://podbay.fm/podcast/921659583