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Why do pregnant mothers have nausea and vomiting ?

Nausea or feeling sick, and vomiting is a very common symptom in early pregnancy. Nausea and vomiting can be one of the first signs of pregnancy and usually begins around the 6th week of pregnancy.

About 50 – 75% of pregnant women feel nausea or vomit during early pregnancy. It is important to understand that some pregnant ladies do not have any sort of nausea or vomiting and it is not uncommon for some pregnant ladies to panic when they do not have nausea and vomiting thinking that pregnancy is not healthy in the absence of nausea and vomiting.

Nausea and vomiting in pregnancy is often called morning sickness, but symptoms can occur at any time - not just in the morning and also it may start as early as 4-5 weeks or later within first 12 weeks of pregnancy. Symptoms are mild in most cases. Feelings of sickness (nausea) typically come and go. They usually last between 1 and 4 hours at a time. Some women have more severe symptoms and have frequent and/or longer bouts of vomiting. In most cases the symptoms have gone by 12-14 weeks of pregnancy. However, about 10 out of 100 pregnant women have some nausea throughout their pregnancy.

If you experience excessive vomiting and cannot keep your food down, you may have ‘hyperemesis gravidarum’.ie severe vomiting specific for the pregnancy. Hyperemesis gravidarum can be harmful to you and your baby if severe and left untreated. This is due to the possible lack of nutrients and electrolyte imbalance. The most important thing is to inform your doctor when these symptoms appear and discuss possible options for treatment.

The cause of the sickness is not known. It is probably due to the hormone changes of pregnancy. Some think that it is related to the amount of a hormone produced by the placenta called Human Chorionic Gonadotrophin(hCG) and hence excessive vomiting is commonly seen in twins where the placental mass is more with increased production of hCG. This is a reason for every pregnant woman who has severe vomiting to undergo an ultrasound scan to see if she is carrying twins.

But it not usual to get excessive vomiting for the first time after 12 weeks of pregnancy. If you get excessive vomiting for the first time after 12 weeks it may be due to a hidden infection like a urine tract infection.

Can vomiting affect my baby?

Not usually. The baby gets nourishment from your body’s reserves even though you may not eat well when you are vomiting. The effort of retching and vomiting does not harm your baby or cause a miscarriage. The only time your baby may be affected is if you become very ill with dehydration which is not treated , resulting in accumulation of a harmful substance called ketones in blood and urine. When there is dehydration and lack of energy, the liver produces this substance (ketones) to provide energy, but this substance can be harmful to the baby.

Other causes of vomiting in pregnancy

Remember, not all vomiting may be due to the pregnancy - you can still get other illnesses. For example diarrhoea, blood in vomit, jaundice (yellow skin and eyes), high temperature (fever), and stomach pains may be due to an infection or some other problem unrelated to pregnancy. See your family doctor or Gynaecologist if these symptoms occur, or if the vomiting is severe and you suspect that you are becoming dehydrated. Even urinary tract infection, respiratory tract infection can give rise to vomiting. Hepatitis is another cause for vomiting. Hyperemesis gravdarum(excessive vomiting in pregnancy) should be diagnosed after exclusion of above causes for vomiting.

There are a number of do’s and don’ts you can try to help alleviate your symptoms.

Helpful Do’s and Don’ts:

Do:

Eat small meals often
Drink fluids 1/2 hour before or after a meal, but not with meals
Drink small amounts of fluids frequently during the day to avoid dehydration
Eat something ( Eg-cream crackers, toast ) 15 minutes before getting up in the

morning

Eat whatever you feel like eating, whenever you feel you can
Ask someone else to cook for you and open the windows or turn on fans if the odor bothers you
Get plenty of rest and nap during the day
Avoid warm places (feeling hot adds to nausea)
Sniff lemons or ginger, drink lemonade, or eat what you feel will relieve nausea
Eat salty potato chips (they have been found to settle stomachs enough to eat a meal)
Exercise

Don’ts:

Do not lie down after eating
Do not skip meals
Do not cook or eat spicy food

When do I have to seek medical help?

If you are experiencing excessive nausea and vomiting that prevents you from keeping any food down
If vomiting is accompanied by pain or fever
If nausea and vomiting persists well into the second trimester (after 13th week)
If you just don’t feel right

Morning sickness is the nauseated feeling you experience in your first trimester. It usually starts out in the morning and wears off as you become active throughout your day. Not all morning sickness remedies will work for you, but these are just a few remedies and comforts that have helped other women get through their day.

Hyperemesis gravidarum is a condition characterized by severe nausea, vomiting, weight loss, and sometimes electrolyte disturbance. Mild cases are often treated with dietary measures, rest and antacids. Severe cases often require a stay in the hospital so that the mother can receive fluid and nutrition through an intravenous line. DO NOT take any medications to solve this problem without consulting your doctor first.

Do I need any treatment?

No treatment is needed in most cases as the symptoms are often mild.

Eating small but frequent meals may help. Foods high in carbohydrate are best, such as bread, crackers, etc. Some people say that sickness is made worse by not eating anything at all. If you eat some food regularly, it may help to ease symptoms. Eating a plain (or ginger) biscuit about 20 minutes before getting up is said by some women to help.

Some women find that a ‘trigger’ can set off the sickness. For example, a smell or an emotional stress. If possible, avoid anything that may trigger your symptoms.

Have lots to drink to avoid dehydration (low body fluid). Drinking little and often rather than large amounts may help to prevent vomiting. Try to aim to drink at least two litres a day. Water is probably the best drink if you are feeling sickly.

An anti-sickness medicine

may be advised if symptoms are severe, or do not settle. It is generally best to avoid medicines when you are pregnant (including herbal remedies as the contents are often uncertain). However, most medicines that have been used for morning sickness or hyperemesis have been used for a number of years and are safe. For example, many women have used promethazine , cyclizine, metoclopromide etc and there is no evidence that they harm a developing baby. Always see a doctor before taking an anti-sickness medicine when you are pregnant. If you have to take this medicine you have to take the pill with a sip of fluid you like most and wait for about half an hour for the pill to get absorbed.
Hospital care is needed to give fluids by a ‘drip’ in small number of women who become quite ill and dehydrated (low in body fluid).

What will the doctor do when I see him?

In addition to listening to your story, you will be examined for signs of dehydration ( water depletion)

As other illnesses like hepatitis, urine tract infections and chest infections also can give rise to vomiting. Your doctor will do some investigations to exclude a cause other than pregnancy for your vomiting.Therefore, your doctor will order some blood and urine investigations to aid diagnosis. An ultrasound scan will also be done if you have hyperemesis gravidarum to exclude a twin gestation etc.

Following history, examination and investigations, your doctor will decide on further management of your condition and admit you to the ward if necessary for correction of dehydration, electrolyte imbalance and vitamin deficiencies.