Nausea and vomiting in pregnancy are such common events that they can almost be considered as a physiological manifestation.

In this text, we will address the causes and treatments for simple nausea and pregnancy called hyperemesis gravidarum.

Morning Sickness

Morning nausea is so common and so typical at the beginning of gestation that it is only overcome by menstrual delay as the symptom that causes women to go to a pharmacy to buy a pregnancy test. About 70% – 80% of women suffer from morning sickness in the first trimester. Nausea may come with or without vomiting; occur mainly in the morning, but can manifest at any time of the day.

Pregnancy nausea usually occurs in the 5th or 6th week, usually lasting up to the 12th week, which marks the beginning of the second trimester of gestation.

Some women with less luck remain nauseated until the 18th week, at which time 90% of pregnant women do not suffer anymore. Of these, 10% maintain nausea during more advanced periods of pregnancy and may last until the third trimester.

The severity of nausea during pregnancy varies greatly. Some women almost feel nothing; Others complain of mild nausea in short periods, often without vomiting; There are also cases in which nausea and vomiting are frequent, making the first trimester very disturbing; At the end of the spectrum (that is, when they reach the most intense state of nausea), there are even cases of hyperemesis gravidarum, a picture of nausea and vomiting so frequent that they impede feeding and cause dehydration in the pregnant woman. I will address the hyperemesis gravidarum later in this text.

Why does nausea occur during pregnancy?

The exact mechanism that causes pregnant women to feel nauseous throughout the first trimester of gestation is unknown. However, rapid hormonal changes in early pregnancy (estrogen, progesterone, and hCG) are known to play an important role in the picture. Some studies have shown that the higher the hormone levels, the greater the incidence of nausea in pregnancy.

Pregnancy hormones, mainly progesterone, also act on the motility of the gastrointestinal tract. Pregnant women have a “lazy stomach”, which delays emptying, which in addition to favoring the appearance of nausea also causes a feeling of precocious satiety, preventing the intake of large amounts of food. The pregnant woman feels “full” very easily.

Risk Factors for Nausea in Pregnancy

Although the causes of nausea are not fully elucidated, some factors are widely known to be at risk for the development of nausea and vomiting:

Women, who experienced nausea more easily, such as during some movements or after stimuli caused by strong odors and flavors, are at increased risk of severe nausea during pregnancy.

Very anxious or pregnant women also have a higher incidence of nausea. Pregnant women with a history of migraines are at greater risk. Some studies suggest the hypothesis that women who have Helicobacter pylori bacteria may be at increased risk of nausea during pregnancy. Pregnant women of twins have a higher incidence and greater intensity of nausea.

Symptoms of nausea in pregnancy

In most pregnant women, nausea is intermittent. It is common that there is an alternation between hunger and nausea throughout the day. Ideally, the pregnant woman should try to make her meals whenever nausea disappears.

Despite the discomfort, nausea in pregnancy rarely causes any problems to the fetus. Most pregnant women are able to feed during periods of relief from nausea, thus maintaining adequate nutrient intakes.

Associated with nausea, it is possible that the pregnant woman presents alterations in her nose and palate. Foods that were previously wanted can lose all their delight. On the other hand, it is common for the desire to eat foods that have never been preferred before. It can happen, for example, that women who do not eat red meat have a desire for hamburgers; Or pregnant women who were fond of chocolate, now cannot eat a single candy.

When to go to the doctor?

Unlike other types of nausea and vomiting, in the case of nausea typical of pregnancy, there are no other associated gastrointestinal or systemic symptoms, such as fever, diarrhea, and severe colic. The presence of these symptoms should be reported to the physician.

Another sign of pregnancy is unreliable vomiting, which makes the pregnant woman unable to feed or drink fluids. The nausea of pregnancy can be so intense that they even cause weight loss and dehydration of the pregnant woman. If you are pregnant, have frequent vomiting, and have lost at least two pounds because of these, see a doctor, as we may be facing a diagnosis of hyperemesis gravid arum.

Hyperemesis gravidarum

Hyperemesis gravidarum is an irregular appearance of morning sickness. It is a serious form of nausea and vomiting of pregnancy. Hyperemesis gravidarum occurs between 0.5% – 2% of gestations and is characterized by frequent vomiting, without response to treatment, associated with dehydration, hydro electrolytic disorders, and weight loss. As the pregnant woman cannot feed herself or drink fluids, hospital admission may be necessary to be able to administer fluids and some nutrients intravenously.

Treatment for nausea during pregnancy

The first trimester of pregnancy is the most important because it is when the fetus is forming. In this phase, it is very important to keep away from taking any kind of prescription or material without the explicit permission of your obstetrician.

In most pregnant women, morning illness does not need medication, just some dietary changes, and some lifestyle habits:

– Avoid large amounts of food. The stomach of the pregnant woman empties more gradually, so small portions are better tolerated. Eating a lot and staying full stomach can precipitate nausea.

– Pregnancy nausea tends to be intermittent throughout the day. Try to feed at any time you feel fine. Hunger can prompt nausea. Do not stop feeding for fear of vomiting.

– Avoid ingestion after that go to bed. Avoid eating near bedtime.

Eat what you like. It is better to eat anything than anything.

– Have someone prepare the food for you. Some pregnant women lose hunger and begin to feel nauseous when they need to prepare their own food.

– Try to always be well hydrated. If you have vomiting, try to replenish lost fluids when nausea has gone. Again, eat small volumes little by little. Cold fluids are better tolerated.

– Recognize the nausea triggers and avoid them. Strong odors, for example, are often poorly tolerated. Other common triggers are heat, humidity, noise, and moving, as well as travel by car or plane.

– Avoid fatigue. It is common to have exercise intolerance in the first trimester. If you are an active person, do not try to maintain the same load of exercise you did before you were pregnant. It is not necessary to remain completely sedentary, but the idea is to avoid tiredness at this stage.

– Ginger, lemon, and watermelon are usually very well tolerated by pregnant women. Avoid spicy, high-fat foods.

– If your nausea does not arise when you wake up, but soon after getting out of bed, keep a pack of crackers at the headboard to eat one or two before getting up. That “calms” the stomach.

The most important thing is to recognize what is right for you and what is wrong for you. The above suggestions work for most women, but you may have to find out what the care for your case is.

If there is no improvement in nausea, with the usual measures, it may be necessary to use some medicines to control them. The list of possible medications is vast; however, as some can be sold without a prescription I will not list them here so as not to stimulate self-medication, which is even more severe when done by a pregnant woman in the first trimester.

Myths about nausea during pregnancy

Does the woman who does not feel nauseous have an increased risk of miscarriage?

Not necessarily. Theoretically, a troubled pregnancy would not produce adequate levels of hormones and the symptoms of nausea and vomiting would be less intense. However, it is common to have a normal pregnancy without having to go through the suffering of nausea.

Can nausea during pregnancy affect the fetus?

No. Except in the most serious cases, requiring hospitalization, the fetus suffers nothing with its occasional nausea and vomiting.

If nausea does not go away after the first trimester, does it mean that there is something wrong with the pregnancy?

No. Some pregnant women have nausea throughout their pregnancy, although this is not the most common. Any nausea that lasts beyond the 20th week should be evaluated by the obstetrician, which does not necessarily mean that there is a problem for the pregnant woman.

Does sucking ice often improve nausea?

Yes and no. As already mentioned, these small suggestions may be the solution for some pregnant women and a complete failure for others. The advantage of ice is that, ultimately, it is water in small amounts, which favors the hydration of the pregnant without causing distension of the stomach.