Nausea and Vomiting in Pregnancy

The exact cause of NVP remains unclear, but several factors likely contribute:

• Hormones: hCG (human chorionic gonadotropin), a hormone produced by the placenta during pregnancy, has been linked to severe nausea, particularly in women with multiple pregnancies. Estrogen and progesterone may slow digestion and worsen nausea, though symptoms usually improve even when hormone levels remain high later in pregnancy.

• Gastrointestinal changes: During pregnancy, the lower esophageal sphincter relaxes, which can cause heartburn, and in turn, worsen nausea. For some, abnormal gastric rhythms (gastrointestinal dysmotility) may also play a role.

• Metabolic and immune factors: Metabolic or immune problems, like low blood sugar, nutrient deficiencies (particularly in zinc or vitamin B6), and changes in cholesterol levels or immune response can worsen nausea.

• Genetics: Having a family history of severe NVP increases your risk. It also tends to be more common in those who are pregnant with identical twins than fraternal.

• Environmental and lifestyle factors: Motion sickness, fatigue, stress, heat, strong odours, or certain foods can worsen symptoms.

• Medical factors: Other medical conditions, such as having a history of migraines, gastrointestinal problems, or stomach infections, may worsen NVP. Many medications, including prenatal vitamins with iron, can contribute to nausea.

Most women begin experiencing nausea and vomiting in the early weeks of pregnancy, typically during the first trimester. In mild cases, nausea and vomiting have little impact on health, though they may disrupt daily activities. For many, the symptoms reach their peak between eight and ten weeks, although the timing can vary from person to person. In most cases, symptoms improve by the start of the second trimester, around 14 weeks.

However, in rare cases, nausea and vomiting can persist throughout the entire pregnancy. In severe cases, known as hyperemesis gravidarum (HG), symptoms become intense and persistent, occurring four or more times a day and lasting several hours. This condition often leads to complications including dehydration, electrolyte imbalances, and significant weight loss. Women may also experience a loss of appetite and difficulty maintaining adequate nutrition.

Beyond the physical effects, nausea and vomiting can take a toll on emotional health, leading to anxiety, depression, and decreased quality of life. Some women struggle to maintain their usual work performance, and in rare cases, the severity of symptoms may even cause women to consider terminating a pregnancy or avoiding future pregnancies.

When evaluating nausea and vomiting in pregnancy, doctors first rule out other possible causes. They will ask about the timing, frequency, and severity of vomiting, as well as whether food and fluids can be kept down. A medical history of previous pregnancies, abdominal surgeries, or medications is also important. Vomiting that begins after the first trimester or is accompanied by abdominal pain or diarrhea is less likely to be related to pregnancy and may signal another condition.

Nausea and vomiting of pregnancy are generally diagnosed when symptoms begin before 16 weeks of gestation and are unlikely to be from another medical cause. Although most cases resolve by the second trimester, some women continue to experience symptoms beyond 20 weeks. Women with nausea and vomiting typically have normal vital signs, physical exams, and lab results.

Hyperemesis gravidarum, on the other hand, represents the severe end of the spectrum. While there is no single definition, it is often characterized by extreme weight loss, dehydration, ketones in the urine, and vomiting more than three times per day. In these cases, women are unable to eat or drink and often struggle with daily activities.

Blood tests and imaging tests may be used if the symptoms are suspected to be caused by another medical condition.

Mild cases of nausea and vomiting in pregnancy can be managed with lifestyle and dietary changes. Eating small, frequent meals throughout the day, choosing bland foods such as crackers, toast, bananas, or rice, and keeping snacks by the bed to eat before getting out of bed can help. Spicy, greasy, and strong-smelling foods should be avoided. It may also help to eat before becoming too hungry.

Staying hydrated is essential, and some find relief by consuming liquids in smaller amounts, timing it away from meals, or having carbonated drinks. Adequate rest, reducing stress, and avoiding overheated environments can also reduce symptoms.

Natural remedies may provide relief for some women. Ginger has been traditionally used to ease nausea and improve digestion, though research findings are mixed. Acupressure and acupuncture, based on traditional Chinese medicine, may also help with nausea in some cases, however the evidence is not conclusive.

When symptoms are severe or persistent, anti-nausea medications may be necessary. In Canada, a combination of an antihistamine (doxylamine) and vitamin B6 (pyridoxine) is approved for treating nausea and vomiting in pregnancy. Vitamin B6 supplements and antihistamines such as dimenhydrinate (Gravol) or diphenhydramine (Benadryl) may also be used.

For those suffering from hyperemesis gravidarum, intravenous fluids containing electrolytes, sugars, and vitamins may be required to prevent dehydration and malnutrition. In some cases, stronger anti-nausea medications are prescribed.

All material copyright MediResource Inc. 1996 – 2025. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/condition/getcondition/Nausea-and-Vomiting-in-Pregnancy