“Morning Sickness” – Nausea and Vomiting during Pregnancy

Posted On: January 3, 2017 By Nathan D. Fox, MD

With 50 to 90 percent of pregnancies, women experience some degree of nausea with or without vomiting. This common symptom of pregnancy generally begins at five to six weeks of gestation, peaking at nine weeks, and typically decrease by 16 to 18 weeks of gestation.

However, symptoms may continue until the third trimester in 15 to 20 percent of women, and until delivery in 5 percent. Commonly called “morning sickness,” this is misleading to most because pregnancy-related nausea and vomiting may occur at any time of day or persist throughout the day for approximately 80 percent of pregnancies.

Hyperemesis Gravidarum (HEG)

Hyperemesis gravidarum is defined as a severe case of nausea and vomiting that occurs during pregnancy. However, there is no clear definition.  An objective diagnosis of HEG is that it’s persistent vomiting contributes to a weight loss exceeding 5 percent of the woman’s pre-pregnancy body weight and ketones in the urine unrelated to other causes.

HEG is also associated with significant maternal morbidity, and in some cases, mortality in the past. However, the easily obtainable intravenous fluids and parental nutrition has greatly reduced morbidity, and mortality is almost non-existent for patients who are treated. If HEG is left untreated, micronutrient deficiency, Wernicke encephalopathy (vitamin B1 deficiency), and sequelae of malnutrition (poor wound healing, immunosuppression) have been reported. Other rare complications may also include esophageal tears or ruptures.   Hyperemesis gravidarum is likely to recur in subsequent pregnancies.

Treatment of HEG

Treatment is highly recommended and effective for pregnant women who suffer from HEG. Symptoms generally resolve by mid-pregnancy, or 20 weeks’ gestation, regardless of treatment therapy. In most cases, patients respond best to intravenous hydration and a short period of gut rest, followed by a gradual reintroduction of oral intake.

Initial Treatment of HEG

Changing or managing your diet is the first HEG treatment. This management generally focuses on frequent high carbohydrate, low fat, and smaller portioned meals. P6 acupuncture or acupressure wristbands are available without a prescription, and have become a popular way to aide symptoms without medical intervention.

There are many speculated supplements and medication that has been tested to improve the symptoms of HEG, but based on your specific symptoms, you should always consult with your doctor if you find morning sickness or persistent nausea to be affecting your pregnancy or daily routine. Some of these trial interventions include vitamin B6, antihistamines with pyridoxine, and even powdered ginger may help some women with hyperemesis.

Parenteral Nutrition

Parenteral nutrition requires a peripherally inserted central catheter (PICC). The best time for initiating parenteral or enteral nutrition is not established, and is based on the doctor’s best judgment. In general, this process begins with women who cannot maintain their weight due to vomiting, and despite other trial interventions, cannot find a solution to HEG. However, the placement of a PICC line may be associated with serious complications, including bacteremia and thrombosis. Therefore, the risks of the PICC line are always weighed against the possible benefits of the treatment.

If you are experiencing a severe case of morning sickness, or persistent nausea and vomiting throughout the day, contact your doctor as soon as possible to determine if one of several treatment methods may be right for you.

Carnegie Imaging for Women blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!

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