Nausea & vomiting in pregnancy (NVP) is a common condition affecting approximately 70% of pregnant women. About 45% have vomiting with nausea, while an additional 25% have nausea alone.
A more severe from of NVP is a condition called Hyperemesis Gravidarum, which affects approximately 1 – 1.5% of pregnancies.
For the majority, the sickness improves around 12-14 weeks but for others it can persist until 20 weeks or beyond.
“Morning sickness” is a very inadequate term to describe the condition because it usually occurs both before and after midday, and it does not do justice to the range of severity that can occur. I prefer to use the term ‘nausea and vomiting in pregnancy’ (NVP).
This topic is one I get contacted about frequently, and its effects can be profound and persist far beyond the end of the pregnancy! I have been wanting to share some useful tips for a while, but it was since experiencing NVP myself in my second pregnancy, it felt even more relevent!
Much of the information you find in this blog post has come from a combination of the RCOG Green-top guideline, and the brilliant resource that is the Pregnancy Sickness Support charity website.
What is Hyperemesis Gravidarum?
This is when the nausea and vomiting becomes so severe that the woman looses over 5% of her pre-pregnancy weight and becomes dehydrated and depleted of nutrients.
The causes of HG are not completely understood; however, many people believe a combination of hormonal factors affect these symptoms.
Its effects are not just limited to the vomiting itself; it can be deeply traumatic, with implications on mental health, finances, practicalities such as childcare as well as the physical symptoms.
What are the risks of untreated NVP & HG?
Women experiencing any degree of HG are at risk of dehydration and malnutrition. There are other more severe complications that can occur such as blood clots and metabolic problems.
If the vomiting is so severe that a woman cannot keep down any fluids, has more than 5% weight loss or shows signs of the effects of dehydration such as strain affecting the kidneys or liver, she may need admission to hospital for intraveous fluids.
HG can have profound psychosocial consequences, such as loss of identity, social isolation, feelings of guilt and suicidal ideation, and pressure to terminate the pregnancy.
Up to 20% may suffer post-traumatic stress symptoms.
Families may experience financial hardship, strain on relationships, and difficulty caring for children, as well as a sense of grief over the loss of a normal pregnancy experience
What can the doctors prescribe?
Whilst it is difficult to perform trials on medicaitons in pregnant women, all available evidence reported by Cochrane and other systematic reviews and meta-analyses show many anti-sickness medications used for NVP and HG are safe, and do not demonstrate any increased risk of birth defects or other adverse pregnancy outcomes.
These drugs include:
- antihistamines (histamine H1 receptor antagonists) such as promethazine, cyclizine;
- dopamine antagonists including metoclopramide and domperidone
There is good safety data for ondansetron, but there has previously been suggestion of a slight risk in fetal cardiac defects (but this is controversial) so it is a second-line option in view of insufficient evidence.
References for this safety data can be found in this RCOG guideline.
More Coping Tips:
Getting enough fluid
It is very common to find it difficult to drink water and/or keep it down.
You may have to become quite creative about how to take fluids.
Here are some ideas:
- Lucozade/ lemonade
- milkshakes (try to fortify with extra calories)
- orange squash
- apple juice
- lime juice
- ice cubes made of flat coke or just tap water or bottled water
- ice lollies
- sips of tepid water
- continually sipping tiny amounts of liquid through a straw
- just holding water/drinks in your mouth
- if you can’t tolerate tap water try freeze a half empty bottle of mineral water and then top up with fridge cold water – this keeps it cold for hours.
What to eat?
It can be helpful to initially keep a note of what times of day the nausea and vomiting happen, so that you can try to identify and predict when it will be. It is a good idea to eat at your nausea-free times.
Eati immediately if feeling hungry, or as soon as the nausea lets up.
Try to have frequent small meals (5 or more per day) and stop eating as soon as you feel full.
Importantly, allow yourself to eat your cravings (apart from the obvious exceptions like liver, soft cheeses etc). Focus more on being able to take in sufficient calories, by eating whatever will stay down rather than worrying about the balance of your diet. This is of course important, but it can be almost impossible to stick to the ideal diet when HG is at its worst.
Whether you can eat or not, have plenty of drinks in small frequent
quantities and avoiding all alcoholic drinks. Avoid more than a total of 3 cupfuls of either tea or coffee per day
When solids do become bearable suggestions to try are:
- tinned fruit
- ice lollies/ ice cream/ ice cold cherries
- frozen grapefruit segments
- crisps
- fish fingers
- potato cakes
- crumpets
- soda bread
- other potato based or salty foods
- If you are able to eat food with a high water content such as melon, cucumber, apples and other fruits, it is a good way of taking some fluids on board without having to drink water.
Loneliness
It can be a very isolating experience when you cannot confidently leave the house, never knowing when you will need to be near a toilet. Well-meaning friends and family may not know what to say that will help.
Check out the Pregnancy Sickness Support website, or join the Pregnancy Sickness Support Facebook page to help you connect with other women who are going through or have been through the same.
Odours
If odours bother you, eat cold food and hopefully your family will agree to do the same.
Your sensitive nose is possibly your worst enemy at present. The smell of cooking, especially fatty foods, coffee, tea, cigarette smoke, or perfume are
the most common items stated by NVP suffers to make their symptoms worse.
Normal odours can become unpleasantly nauseous, making shopping and cooking impossible – I personally found I couldnt go past the butcher in my first trimester.
So, it may be time to call in favours from family/ friends, or buy whatever you can online or pre-prepared!
Employment
Studies have shown that 30% of pregnant women in paid employment need time off work due to NVP. This statement indicates the significance of the condition. You are not alone if you need to ask for time off; it is temporary but it can be debilitating.
- Accept whatever help is offered, especially when it comes to managing your daily routine and household tasks.
- Do not beat yourself up. You are not alone in needing time off for pregnancy-related sickness. It is important that you rest and you cannot do this properly if you are working.
- If you have been off for more than 7 days, ask your GP to give a sick note indicating that you are unfit for work because of a pregnancy-related illness which you can then give to your employer.
- If you take sick leave for a pregnancy-related reason you are entitled to receive the same sick pay as other employees.
This post from the @pregnancysicknesssuport instagram page has some great advice from other mums who have been through it:
Planning a subsequent pregnancy after HG
The rates of recurrence vary widely, and can be very difficult to predict. Typically the statistic of 80% recurrence rate is used, but this has recently been disputed.
Nonetheless, once you have had an affected pregnancy, it is best to prepare for a future HG pregnancy. With advanced planning, women may feel more empowered to cope with the condition and therefore experience less associated trauma despite recurring physical symptoms
Here are some suggested ways to prepare:
- Physical preparation – try to establish a healthy pre-pregnancy weight and fitness level.
- Prophylactic medication – if you know which medications worked in your previous pregnancy, ask your doctor to prescribe these in advance so you don’t have to wait for symptoms to worsen.
- Further treatment options for if symptoms worsen can be planned in advance with your medical team eg being able to have IV fluids on an outpatient/ ambulatory basis.
- Social preparations – in anticipation of the debilitating symptoms, you can make a plan with family or employers to negotiate the times when you may struggle with childcare and work. It may mean planning the timing of pregnancy where possible so you have people around you when you need them.
If you have any other helpful tips for expectant mums, please leave them below!