What is ‘morning sickness’?
Nausea and vomiting in pregnancy are also commonly known as morning sickness. It commonly affects pregnant women, mostly during the first trimester. It is characterized by nausea and vomiting, loss of appetite, fatigue, and other symptoms. While typically not serious, it can be uncomfortable and disruptive to daily life and may lead to dehydration and other complications in severe cases. Occasionally nausea and vomiting extend into the second trimester and, for some women, can continue throughout the pregnancy.
What is Hyperemesis Gravidarum?
Hyperemesis gravidarum is a severe and potentially life-threatening form of nausea and vomiting that can occur during pregnancy, leading to dehydration, weight loss, and other complications.
How is the severity of nausea and vomiting assessed?
The severity of your nausea and vomiting is assessed with the “modified PUQE-24” score:
Scoring:
You should call/email Dr. Porter’s rooms if your score is between 7-12, and consider presenting to your GP or emergency department if your score is >13
Management of nausea and vomiting in pregnancy
Diet:
- Eat small and frequent meals for easy digestion and less load on the stomach. Avoid 3 heavy meals.
- Avoid spicy, fatty, or fried foods and strong odours that may trigger nausea.
- Choose bland, easy-to-digest foods such as crackers, toast, and cereal.
Drink plenty of fluids like water, ginger ale, or herbal tea to stay hydrated. - Avoid drinking large amounts of fluids at once, making nausea worse.
Ginger can be used to improve nausea and vomiting in pregnancy. - Pregnancy vitamins: Occasionally, ceasing your pregnancy vitamin may improve nausea and vomiting. If you are considering doing this, please inform Dr Porter.
Lifestyle:
- Get plenty of rest and avoid overexertion or becoming too fatigued.
- Keep the room well-ventilated and avoid hot or stuffy environments.
Alternative methods:
- Relax by taking deep breaths and doing meditation. It helps manage stress and anxiety; it can worsen nausea.
- Try acupressure, which involves applying pressure to certain points on the body, such as the wrists, to relieve nausea. There is variable evidence for acupuncture, but anecdotally, some patients find it helpful.
- Hypnosis has minimal evidence for treating nausea but has been found to help in some women.
Medications:
There is a stepwise approach to medications for nausea and vomiting in pregnancy. If you require medications, Dr. Porter will assess your individual situation and may recommend the following:
Over-the-counter medications (first line)
- Ginger: 250mg orally, up to 4 times/day
- Vitamin B6 “Pyridoxine”: 10mg – 25mg orally, up to 3-4 times/day (max 200mg/day)
- Doxylamine: 6.25mg to 25mg orally up to 3 times/day (max 50mg/day)
Prescription medications (Second line)
- Cyclizine
- Promethazine/Prochlorperazine
- Metoclopramide
- Domperidone
- Ondansetron
Reflux (heartburn)
Occasionally reflux is the cause of nausea or a contributing factor. In this case, Dr. Porter may recommend anti-reflux medications:
- Antacids (Magnesium, calcium, aluminium), e.g., Mylanta
- Prescription medications: Ranitidine, Omeprazole, Esomeprazole, Pantoprazole.
Hospitalisation:
Occasionally nausea and vomiting become so severe you may require hospitalisation. Hospital management usually includes blood tests to check electrolytes, anti-nausea medications, and intravenous fluids to replace losses.
Note:
If you are worried about vomiting and nausea during pregnancy, please let Dr. Porter know, and he will help you with strategies to manage it.