- Nausea and vomiting of pregnancy is commonly referred to as morning sickness (although it can occur at any time of the day or night), it is one of the most common symptoms as it affects about 70% of pregnant women in varying degrees.
- Symptoms usually appear at 4–9 weeks of gestation, reaching a peak at 7–12 weeks, and subsiding by week 16. About 15-30% of pregnant women’s symptoms will persist beyond 20 weeks, or even up to the time of delivery.
- The etiology of nausea and vomiting of pregnancy remains unknown, but numbers of possible causes have been investigated, including: slowed movement of the stomach contents, hormones, H.pylori, stress and fatigue.
We have to treat pregnancy-related nausea and vomiting to help pregnant women feel better and allow them to eat and drink enough so that they do not lose weight.
When to refer to Doctor?
Many women, especially those with mild to moderate nausea and/or vomiting, do not need to see a healthcare provider for treatment of nausea and vomiting.
Women with more severe nausea and vomiting sometimes need to be evaluated by their doctor. Seek help if you have one or more of the following:
1. Signs of dehydration, including infrequent urination, dark-colored urine, or dizziness with standing.
2. Vomiting repeatedly throughout the day, especially if you see blood in the vomit.
3. Abdominal or pelvic pain or cramping.
4. If you are unable to keep down any food or drinks for more than 12 hours.
5. You lose more than 5 pounds (2.3 kg)
Treatment options:
The treatment of pregnancy-related nausea and vomiting aims to help you feel better and allow you to eat and drink enough so that you do not lose weight. Treatment may not totally eliminate nausea and vomiting. Fortunately, symptoms generally resolve by mid-pregnancy, even if you do not use any treatment.
The management of nausea and vomiting of pregnancy dependson the severity ofthe symptoms. Treatmentmeasures range from dietary changes to more aggressive approaches involving antiemetic medications, hospitalization, or even total parenteral nutrition
Dietary changes:
✓ Avoiding food or not eating may actually make nausea worse. Try eating before or as soon as you feel hungry to avoid an empty stomach, which may aggravate nausea.
✓ Eat snacks frequently and have small meals (eg, six small meals a day) that are high in protein or carbohydrates and low in fat.
✓ Drink cold, clear, and carbonated or sour fluids (eg, ginger ale, lemonade) and drink these in small amounts between meals. Smelling fresh lemon, mint, or orange or using an oil diffuser with these scents may also be useful.
✓ Avoid odors, tastes, and other activities that trigger nausea. Eliminating spicy foods helps some women. Other examples of triggers include (perfumes, coffee, spices, smoke, heat, humidity, being tired, noise).
✓ Brushing teeth after eating may help prevent symptoms.
✓ Avoid lying down immediately after eating and avoid quickly changing positions.
✓ Herbal therapies, like Ginger: A popular alternative treatment for morning sickness.
However, further studies are needed to confirm that this treatment is both safe and effective. Until more data are available, we suggest the use of ginger for mild nausea and vomiting.
PHARMACOLOGIC THERAPIES
üTheAmerican Family Physician consider Vitamin B6 asthe first line therapy for treatment of nausea and vomiting and it is recommended for treatment of nausea and vomiting of pregnancy by the American College of Obstetricians and Gynecologists also.
üOtheroptions includes: antihistamines and anticholinergics, promotility agents (metoclopramide) and antiemetics like ondansetron