Nausea and Vomiting in Pregnancy: Morning sickness

• How common is the situation?

It is a very common condition. Although it is called commonly as “Morning Sickness”, it can occur any time of the day. It is usually not harmful to the foetus, but it can have serious effect on your life, including your ability to work or to do your normal daily activities.

• When does it start?
Usually it starts before 9 weeks of pregnancy. For most women it subsides by 14 weeks. For some it may last several weeks or months. For few it may last throughout the entire pregnancy.

• What is Hyperemesis Gravidarum?
Most severe form of nausea vomiting in pregnancy is called hyperemesis gravidarum. It occurs in up to 3% of pregnancies. The condition is diagnosed when woman has lost 5% of her pre-pregnancy body weight and has complications of dehydration. The mother should be admitted at hospital and managed to restore body fluids.

Usually it is accompanied with

• Multi-fetal pregnancy [Twin, Triplet, Quadruplet, etc.]
• History of past pregnancy with nausea and vomiting
• Mother or sister had severe nausea and vomiting in pregnancy
• History of motion sickness or migraines

• What are the medical conditions which can be associated with nausea & vomiting in pregnancy?

1. Ulcer
2. Food related illness
3. Thyroid disease
4. Gall bladder disease

• Can nausea & vomiting affect my baby?
Usually it does not harm your or baby’s health. If it is severe it can have effect on your fluid balance and baby’s weight.

• How can you feel better?

1. Try eating dry toast or crackers in the morning before you get out of bed to avoid moving around in empty stomach.
2. Drink fluids often.
3. Avoid smells that bother you.
4. Eat small frequent meals instead of three large meals.
5. Try bland foods. BRATT diet – Banana, Rice, Apple, Toast, Tea.
6. Eat Ginger – Ginger tea, Freshly cut ginger pieces.

• What is the Medical treatment?

1. Lifestyle and diet modifications
2. Vit B6 + Doxylamine – To be taken alone or in combination 30 minutes before each meals. Once to thrice daily.
3. Antiemetic drugs – If not controlled by Vit B6, Doxylamine antiemetic drugs can be used to prevent vomiting. Many antiemetic drugs can be used safely in pregnancy.

• How to treat severe nausea and vomiting?
Hospitalization.
Liver Function Tests.
Urine for ketone bodies.
Serum Electrolytes.
IV fluids, IV antiemetics.
Further management depends upon mother’s condition.