Vomiting During Pregnancy Overview

While you are pregnant, nausea and vomiting are normal. Up to 70% of all women get mild to moderate symptoms during the first three months (first trimester) of pregnancy. These symptoms are usually gone by the fourth month.

Although this condition is often called morning sickness, most women have symptoms throughout the day.

Very rarely, a pregnant woman may experience a more serious condition involving severe vomiting, dehydration, and weight loss. This is called hyperemesis gravidarum.

Vomiting During Pregnancy Causes

The exact cause of nausea and vomiting in pregnancy is not clear. Most evidence points to rapid changes in hormone levels. These fluctuations may cause changes in the muscle contraction and relaxation patterns of your stomach and intestines, thus leading to nausea and vomiting.

The hormones that seem to have the most to do with this process include the pregnancy hormone human chorionic gonadotropin (hCG), estrogen, and progesterone. Abnormal levels of thyroid hormones have also been reported in women with severe vomiting, although a cause-and-effect relationship remains unclear. Some studies have shown that nausea is worse when your blood sugar level is low.

Some researchers have found that women who are more likely to have nausea from birth control pills, migraines, or motion sickness are at higher risk for nausea and vomiting in pregnancy.

If you have a family history of hyperemesis gravidarum, you are more likely to have the condition. What causes hyperemesis gravidarum remains unknown despite active research. The more popular theories fall into three areas:

1. Hormonal: Elevated levels of human chorionic gonadotropin (hCG) or a component of this

hormone may play a role in inducing vomiting. Thyrotoxicosis or hyperthyroidism is also believed to be associated with the condition. Another hormone thought to be involved is serotonin. Serotonin is a brain chemical that affects both the central nervous system and the gastrointestinal (GI) tract. These effects are believed to induce vomiting. During pregnancy, the upper GI tract may slow down and thus contribute to increased nausea and vomiting. Several studies have shown that this slowdown in the GI tract is increased in pregnant women with severe vomiting.

2. Gastrointestinal: Helicobacter pylori bacteria that live in the intestinal tract may cause the development of peptic ulcer disease. These bacteria are found in a greater percentage among pregnant women and greater still in women with hyperemesis gravidarum. Antibiotics are used to treat all of these conditions.

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3. Psychosocial: Although the idea is controversial, some researchers think the condition may be a woman's psychological reaction against the pregnancy and might arise from conflict within the family and her home environment. In these cases, counseling is recommended.

Vomiting During Pregnancy Symptoms

Morning sickness: Some women experience nausea and vomiting only in the morning. The majority of women have nausea on and off, all day long.

A pregnant woman may also note increased saliva, increased sensitivity to certain smells, and changes in the taste of some foods.

Symptoms usually begin four to eight weeks after the woman's last menstrual period, peak at about 11-13 weeks, and go away by 14-16 weeks into the pregnancy.

Fever , diarrhea, and severe abdominal pain are not associated with nausea and vomiting during pregnancy. If these symptoms occur, be sure to talk with your healthcare provider because it may be something other than morning sickness.

Hyperemesis gravidarum: This condition occurs when a pregnant woman has ongoing vomiting that results in weight loss greater than 5% of her body weight, and evidence of dehydration. Hyperemesis gravidarum is an extreme form of nausea and vomiting in pregnancy that sometimes requires hospitalization. It is different from, and much worse than morning sickness.

When to Seek Medical Care

Call a healthcare provider if self-care at home does not help reduce the symptoms, or if you are unable to take (and keep down) any liquids for more than 24 hours. Also call when you vomit on and off, but more than usual, or if the vomiting is associated with these symptoms, which may stem from other causes:

Fever

Abdominal pain

Headaches

Go to a hospital's emergency department when you vomit continually and you have these symptoms of dehydration:

Dizziness

Fainting

Weakness

Fatigue

Fever

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Diarrhea

Abdominal pain

Exams and Tests

Your healthcare provider may ask for a urine sample to check for ketones, which is a chemical found in dehydration.

In severe cases, your healthcare provider may also take blood samples to check your blood sugar, electrolyte (sodium, potassium, chloride, and bicarbonate) levels, liver function, or levels of certain hormones.

o These tests may help your doctor decide how dehydrated you are.

o They may also help decide if a different condition is causing your nausea and vomiting, such as a urinary tract infection, hepatitis, or gallstones.

Depending on how far along you are in your pregnancy, the doctor may also check the baby's health by listening for a heartbeat with a Doppler instrument, or by ultrasonography.

Your healthcare provider may diagnose hyperemesis gravidarum only after excluding other serious illnesses. The following are other disorders that may show symptoms similar to hyperemesis gravidarum:

o Side effects from too much of a certain drug

o Liver and gastrointestinal disorders

Preeclampsia : A toxic condition that develops in late pregnancy and causes a sudden rise in blood pressure, excessive weight gain, fluid build-up, albumin in your urine, severe headache, and visual disturbances.

Peptic ulcer

Gallstones

Gastroenteritis (food poisoning)

Appendicitis

Migraine

Metabolic disorders: Hyperthyroidism, Addison disease, diabetic ketoacidosis

Vomiting During Pregnancy Treatment

If your symptoms are not severe and you have not already done so, your healthcare provider may suggest you try home care treatments (please see Self-Care at Home). If you have tried

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these and are still vomiting, your healthcare provider may suggest fluids be given to you with an IV. Often these fluids contain sugar as well as electrolytes. Many times fluid intake alone (IV or oral) can break the cycle of nausea and vomiting and temporarily make you feel much better.

Self-Care at Home

As miserable as it may seem, nausea and vomiting are usually part of a healthy pregnancy. The misery typically goes away by the middle of the second trimester. You can try home remedies to reduce your symptoms, and if these do not work, your doctor can help.

No single treatment works best for every woman with nausea and vomiting during pregnancy. Different techniques work for different women. You will have to discover what seems to make your symptoms better. Many women have found the following suggestions helpful:

Diet

Eat small amounts of food frequently so that you are never too hungry or too full.

Avoid spicy and fatty foods, and foods with odors that bother you.

Try eating simple carbohydrates, such as saltine crackers, unbuttered toast, plain baked potatoes, white rice, gelatin desserts, broth, pretzels, popsicles, herbal or decaffeinated tea with sugar, or non-diet ginger ale.

Combine these simple carbohydrates with a serving of protein, especially right before bed to minimize swings in blood sugar that may contribute to nausea.

Drink liquids between meals and not during meals to minimize nausea and vomiting.

Keep crackers at the bedside table to help with nausea in the morning.

Vitamin supplements

If you find that your prenatal vitamin seems to worsen your nausea, take it with food instead of on an empty stomach. If this does not help, talk to your doctor about the possibility of switching to a different vitamin. Chewable vitamins are sometimes easier to tolerate.

Some evidence suggests that pyridoxine (vitamin B-6) supplements help reduce nausea and vomiting. The suggested dose is 25-50 mg every eight hours, and it can be given as an injection up to 200 mg. There are no known harmful effects of vitamin B-6 taken at these doses. Some prenatal vitamins are formulated with extra vitamin B-6.

Acupressure

Stimulation of the P6 (Nei Guan) acupressure point on the wrist (on the inside of the wrist about where a watchband is worn) has been suggested as a method to reduce nausea and vomiting.

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You can press on this area with your finger or thumb or buy an acupressure band. These bands are often sold as motion sickness treatments, so check with a local drug store or auto club.

Hypnosis

Medical hypnosis has been used to reduce nausea and vomiting.

Some women have also used self-hypnosis to control their symptoms.

If you want to try hypnosis, make sure you work with an experienced professional.

Over-the-counter medications

Solutions containing glucose, fructose, and phosphoric acid are available over-the-counter. These solutions may reduce muscle contractions in the wall of the stomach and intestines. The normal dose is 1-2 tablespoons every 15 minutes for no more than 5 doses. These solutions cause no known harmful effects on the fetus.

Two over-the-counter antihistamines, diphenhydramine (Benadryl) and dimenhydrinate (Dramamine), have been shown to improve nausea and vomiting. Although both are generally believed to be safe in pregnancy, you should discuss the risks and benefits of these medications with your doctor.

Herbal remedies

Powdered ginger is used fairly commonly in Europe as a nausea remedy during pregnancy.

The usual dose is 250 mg, three times daily.

The effect of ginger on the fetus has not been extensively studied.

Medical Treatment

Your healthcare provider will try to stop the vomiting either by hydration (giving fluids by IV or by mouth) or with medications.

You will be given plenty of fluids to replace important electrolytes such as potassium.

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You also may receive thiamine (vitamin B-1) either as an injection or IV, depending how long you have been vomiting.

Once these goals are met, you may be given antinausea medications and instructions for care at home.

If you continue to be severely dehydrated, still nauseous, or still vomiting, you may be admitted to the hospital. Rarely, you may need to be hospitalized for fluid and nutritional supplements in very severe cases of hyperemesis gravidarum.

Medications

Your doctor may prescribe medications to reduce nausea and vomiting. Several effective prescription medications have been widely used in pregnancy with no evidence of harm to the fetus or the mother. Your healthcare provider may prescribe one of these antiemetics (drugs that prevent or decrease nausea and vomiting).

ondansetron (Zofran)

promethazine (Phenergan)

prochlorperazine (Compazine)

metoclopramide (Reglan)

trimethobenzamide (Tigan)

Next Steps

Follow-up

Follow the home care suggestions that seem to help your symptoms.

If your doctor prescribes any medications, take them as directed.

Prevention

You may not be able to prevent nausea during the early part of your pregnancy, but you can minimize your symptoms. It can become a vicious cycle, where nausea leads to vomiting, which leads to dehydration, which leads to more nausea. The earlier you can control the symptoms, the better.

"Take home" suggestions to remember:

Nausea and vomiting during pregnancy usually last several weeks.

No one thing helps everyone.

Get to know what techniques work best for you and use them.

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Outlook

Most women who experience nausea and vomiting during the early part of pregnancy go on to have healthy babies. In fact, some evidence indicates that women with mild-to-moderate nausea and vomiting are less likely to miscarry than are women who experience no symptoms at all. Some experts say that mild nausea and vomiting in pregnancy might have served some evolutionary advantage for early humans.

Women with very severe symptoms, especially with dehydration and weight loss, are at higher risk for slowed fetal growth and low birth weight babies.

Most women improve with IV fluids that may be given for several days without other measures.

Women with continual vomiting and dehydration require IV fluid replacement in a medical setting off and on.

Few women with hyperemesis gravidarum require a prolonged stay in the hospital, usually 7-10 days with continued treatment on an outpatient basis for 10-21 days.

While in the hospital or as an outpatient, you may require a nasal feeding tube for placing fluid into your stomach or an IV to place fluid into a blood vessel.

For More Information

Web Links

Grinnen-Barrett Publishing Co, Take Two Crackers

Hyperemesis Education & Research Foundation

Multimedia

Media file 1: Pattern of nausea (dotted line) and vomiting (solid line) during pregnancy. Reprinted with permission from Tierson.

Media type: Chart

Media file 2: Illustration showing location of the PC6 (Nei Guan) acupressure point. The point is

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located on the underside of the wrist, approximately 2 inches above the base of the hand, between the 2 middle tendons.

Media type: Illustration

Synonyms and Keywords

pregnancy, vomiting, morning sickness, hyperemesis gravidarum, nausea, vomiting, pregnancy, signs of pregnancy, early signs of pregnancy, signs of being pregnant, vomiting during pregnancy, nausea during pregnancy

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I can't stop vomiting, and it's got to the stage where I'm afraid to eat or drink anything because nothing stays down. Is this normal?Written for BabyCenter India

The BabyCenter Editorial Team answers:

If things are this bad, you should see your doctor without delay. While morning sickness is common and not usually harmful to you or your baby, severe vomiting can interfere with your nutrition and cause dehydration and weight loss.

This syndrome is called hyperemesis gravidarum, which literally means 'excessive vomiting in pregnancy'. It usually occurs in early pregnancy and requires prompt medical attention. Treatment

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for hyperemesis gravidarum generally involves a stay in hospital where you'll be given anti-nausea medication (this will be safe for your baby) and intravenous fluids. Another good reason to see your doctor is that you may have an underlying disease which is causing the problem.

However, you may like to try some of these ideas:

1. Take your breakfast in bed before you actually get up and start your day.

2. Eat several small meals a day if you can and avoid an empty stomach.

3. Include some protein in your diet, such as well cooked eggs, dairy products, lean meats, beans, whole grains, pulses and seeds.

4. Drink lots of water and other fluids between meals instead of during meals.

5. Have a spoon of ginger juice mixed with honey every morning. You could also try some ginger or lemon tea. Slices of lemon added to sparkling water or iced tea can also help provide some relief. Looking for more options? Check out our healthy and alcohol-free drinks.

6. You may want to try on some homeopathy treatment, which is safe, simple and fast in these conditions. Sepia, Nux Vom, Colchicum, Ant Tart are some homeopathy medicines that may be taken after consulting your doctor.

7. Try to figure out the smells and sights that aggravates this state and avoid them.

Have a tip that worked for you? Why not share it with other pregnant mums in our community?

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Related Links : Simple Vomiting | Severe Vomiting | Clinical Features | Management

Introduction

Vomiting is a common occurence in pregnancy and depending upon the severityit is classified as-

Simple vomiting

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Hyperemesis Gravidarum or severe vomiting

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Simple Vomiting (morning sickness):

There is nausea and occasional vomiting specially on rising in the morning. It could also be seen throughout the day. This is so common that it is considered as one of the symptoms of pregnancy. This does not restrict the normal activities of the woman. It usually disappears by 12 to 14 weeks of pregnancy. It is due to hormonal changes is the body due to pregnancy.

Treatment:

Assurance is given to the woman, adviced to move the limbs before getting up from bed, eating dry food like toast or biscuit before getting out of bed, avoiding fried and spicy food. This is enough to relieve the symptoms. If these fail then antiemetic drugs can be taken after visiting a doctor.

Plenty of fluid intake with glucose or fruit juices are of  help.

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Hyperemesis Gravidarum (severe vomiting)

It is a severe type of vomiting during pregnancy which has got an adverse effect on the health of the woman and/or incapacitates her in day to day activities.

The exact cause of it is not known. It is seen mostly in-

First 12 weeks of pregnancy. Common in first pregnancy. Has family history. More in multiple pregnancies (twins etc) and Hydatidiform mole. Common in unplanned pregnancy. Although the excat cause is not known, it could

be because of hormonal changes Psychological factors can be responssible Dietary deficiencies. Allergic to products secreted from ovum (egg). lmmunological basis- It causes metabolic, biochemical & circulatory changes in

body and affects almost all organs.

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Clinical features:

Early- o Only activities are restricted without evidence of dehydration and/or

starvation. In this vomiting occurs independent of food intake, normal activities are curtailed. Nutrition does not suffer, patient looks well and blood, biochemistry & urinanalysis reveales no abnormalities.

Late- o Evidence of dehydration & starvation are present. The colour of the

vomitus may be coffee ground or blood stained. It may reach a stage where there is no urine formation. There may be constipation or diarrhoea and the patient is confined to the bed. There may be restlessness,

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sleeplessness, convulsions or even coma, diminished vision, increased temperature of the body and breath smelling of acetone.

Investigation: Urinanalysis, biochemical tests, ECG, ophthalmic (eye) examination.

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Management :

Hospitalization of the woman. Correcting fluid imbalance by Intravenous fluids. Adequate sedatives are given. Antihistaminic and antiemeticdrugs can be used. Administer B- complex vitamins. Diet - Before stopping I.V. fluids start oral food. In case the vomiting is extremely

severe and life threatening to the patient termination of pregnancy can be done but it is extremely rare.

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INTRODUCTION

Nausea and vomiting of pregnancy commonly occur between 5 and 18 weeks of pregnancy. Between 50 and 90 percent of women have some degree of nausea, with or without vomiting. The severity of these symptoms can vary.

"Morning sickness" is the term often used to describe mild nausea and vomiting while "hyperemesis gravidarum" is the term used to describe a more severe condition. Hyperemesis may cause you to vomit multiple times throughout the day, lose weight, and usually requires treatment in the hospital.

This article discusses treatments available for nausea and vomiting during pregnancy. A more detailed article is available by subscription. (See "Clinical features and diagnostic evaluation of nausea and vomiting of pregnancy (hyperemesis gravidarum and morning sickness)" and "Treatment of nausea and vomiting of pregnancy (hyperemesis gravidarum and morning sickness)".)

MORNING SICKNESS VERSUS HYPEREMESIS

Morning sickness — Nausea and vomiting often develop by five to six weeks of pregnancy. The symptoms are worst around nine weeks, and typically improve by 16 to 18 weeks of pregnancy. However, symptoms continue until the third trimester in 15 to 20 percent of women and until delivery in 5 percent of women [1]. Although mild pregnancy-related nausea and vomiting is often called "morning sickness," you may feel sick at any time of day and many women (80 percent) feel sick throughout the day.

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Interestingly, women with mild nausea and vomiting during pregnancy experience fewer miscarriages and stillbirths than women without these symptoms.

Hyperemesis gravidarum — Hyperemesis gravidarum is the term used to describe more severe nausea and vomiting during pregnancy. Women with hyperemesis often vomit every day and may lose more than 5 percent of their pre-pregnancy body weight. In most cases, women with hyperemesis gravidarum will have blood and urine tests that show evidence of dehydration.

CAUSE OF NAUSEA AND VOMITING IN PREGNANCY

The cause of pregnancy-related nausea and vomiting is not clear. Several theories have been proposed, although none have been definitively proven. Increased hormone levels, slowed movement of the stomach contents, and psychological factors are among the more common theories.

Some women are more likely to develop nausea and vomiting of pregnancy, including women who:

Developed these symptoms in a previous pregnancy Experience nausea and vomiting while taking estrogen (for example, in birth control

pills) or have menstrual migraines Experience motion sickness

WHEN TO SEEK HELP

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. The suggestions below may help to reduce symptoms and prevent dehydration. (See 'Treatment of nausea and vomiting in pregnancy' below.)

Women with more severe nausea and vomiting sometimes need to be evaluated by their primary care or obstetrical doctor or nurse. Seek help if you have one or more of the following:

Signs of dehydration, including infrequent urination, dark-colored urine, or dizziness with standing

Vomiting repeatedly throughout the day, especially if you see blood in the vomit Abdominal or pelvic pain or cramping If you are unable to keep down any food or drinks for more than 12 hours You lose more than 5 pounds (2.3 kg)

One or more tests may be recommended to investigate the cause and determine the severity of the nausea and vomiting, including blood tests, urine tests, or an ultrasound.

TREATMENT OF NAUSEA AND VOMITING IN PREGNANCY

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.

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Treatment may not totally eliminate your nausea and vomiting. You may need to try several types of treatment over a period of weeks before finding what works best for you. Fortunately, symptoms generally resolve by mid-pregnancy, even if you do not use any treatment. (See "Treatment of nausea and vomiting of pregnancy (hyperemesis gravidarum and morning sickness)".)

Dietary changes — 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 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 triggers — One of the most important treatments for pregnancy-related nausea and vomiting is to avoid odors, tastes, and other activities that trigger nausea. Eliminating spicy foods helps some women. Other examples of triggers include:

Stuffy rooms Odors (eg, perfume, chemicals, coffee, food, smoke) Heat and humidity Noise Visual or physical motion (eg, flickering lights, driving) Being tired

Brushing teeth after eating may help prevent symptoms. Avoid lying down immediately after eating and avoid quickly changing positions.

If you take a prenatal vitamin with iron and this worsens your symptoms, try taking them at bedtime. If symptoms persist, stop the vitamins temporarily. If you stop taking your prenatal vitamin, take a supplement that contains at least 400 micrograms of folic acid until you are at least 14 weeks pregnant to reduce the risk of birth defects.

Medications — Medications that reduce nausea and vomiting are effective in some women and are safe to take during pregnancy. None of the medications discussed below are known to be harmful.

Vitamin B6 and doxylamine — Vitamin B6 supplements (10 to 25 mg three times per day) can reduce symptoms of mild to moderate nausea, but do not usually help with vomiting.Doxylamine is a medication that can reduce vomiting, and may be combined with vitamin B6. Doxylamine is available in the United States in some non-prescription sleep aids (eg, Unisom®, Good Sense Sleep Aid®) and as a prescription antihistamine chewable tablet (Aldex AN).

In the United States, one-half of a 25 mg doxylamine tablet or two of the chewable 5 mg tablets can be used to reduce vomiting, although doxylamine is not "officially" approved for this purpose. Some healthcare providers also prescribe vitamin B6 supplements (10 to 25 mg three times per day) to take with it. Outside the United States, combinations of vitamin B6 and doxylamine are available (eg, Diclectin® in Canada).

Combinations of vitamin B6 and doxylamine were previously available in the United

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States in a prescription medication called Bendectin®. Bendectin® was voluntarily withdrawn from the market in 1983 due to lawsuits claiming that the medication caused birth defects. However, subsequent studies confirmed that the medication is safe, effective, and does not increase the risk of birth defects [2].

Antihistamines and other anti-nausea medications — Antihistamines and other anti-nausea medications are safe and effective treatments for pregnancy-related nausea and vomiting. The following medications may be recommended:

Diphenhydramine (25 to 50 mg) orally every four to six hours, as needed, but this drug causes drowsiness

Meclizine 25 mg orally every four to six hours, as needed, but this drug causes drowsiness

Other antinausea medications that are available by prescription include:

Promethazine (Phenergan®) — Promethazine is available in pill, injectable solution, or rectal suppository form. It is usually taken every four hours, and may cause drowsiness and dry mouth. Rare side effects include muscle contractions that cause twisting or jerking movements.

Metoclopramide (Reglan®) — Metoclopramide speeds emptying of the stomach and may help to reduce nausea and vomiting. It is usually taken by mouth or injection every six hours (four times per day, 30 minutes before eating and at bedtime).

Ondansetron (Zofran®) — Ondansetron is an anti-nausea medication that is usually taken by mouth or injection every eight to 12 hours. Ondansetron is one of the most expensive anti-nausea medications (approximately $500 for 30 pills in the United States) and it may not be covered by some insurance plans.

Fluids and nutrition — If you are unable to hold down food or liquids, you may be treated with intravenous (IV) fluids. This may be done in your doctor or nurse's office or in the hospital, depending upon the severity of your vomiting. For a short time, you may be advised not to eat or drink anything, to allow the gut to rest. You can slowly begin to eat and drink again as you begin to feel better, usually within 24 to 48 hours.

If you continue to lose weight despite treatment, your doctor may consider other forms of feeding, such as the use of a nasogastric tube (a tube that is inserted through your nose into the stomach) or supplemental nutrition through an IV line.

Complementary treatments — The following treatments may be useful when used with the treatments described above.

Acupuncture and acupressure — Acupressure wristbands (picture 1) and acupuncture have become a popular treatment for nausea and vomiting caused by pregnancy, motion sickness, and other causes. Studies have not shown these wristbands to be more effective than sham (fake, look-alike) wristbands [3], although some women find them helpful. Acupuncture and acupressure have no known harmful side effects.

Hypnosis — Hypnosis has been reported to be helpful in some people. Counseling may be helpful for women with anxiety.

Ginger — Powdered ginger may help to relieve nausea and vomiting in some women. However, further studies are needed to confirm that this treatment is both safe and

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effective. Until more data are available, we suggest the use of ginger containing foods (eg, ginger lollipops, ginger ale) for mild nausea and vomiting.

OUTCOME

Most women with pregnancy-related nausea and vomiting recover completely without any complications. Women with mild to moderate vomiting often gain less weight during early pregnancy. This is rarely a concern for the baby unless the mother was very underweight before pregnancy (at least 10 percent under the ideal body weight).

Normal weight gain during pregnancy depends upon your pre-pregnancy weight. For women of normal weight (body mass index 18.5 to 24.9 kilogram/meter2), the recommended weight gain is between 25 and 35 pounds (11.5 to 16.0 kilograms) for a singleton pregnancy.

In women with severe nausea and vomiting (hyperemesis gravidarum) who are hospitalized multiple times and who do not gain weight normally during pregnancy, there is a small risk that the baby will be underweight or small.

Women who have hyperemesis gravidarum in one pregnancy are at risk of severe nausea and vomiting in future pregnancies. The risk is between 15 and 20 percent. Women who do not have severe nausea and vomiting in the first pregnancy are unlikely to have it in future pregnancies [4].

WHERE TO GET MORE INFORMATION

Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed every four months on our web site (www.uptodate.com/patients).

Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient level information

Patient information: Should I have a screening test for Down syndrome during pregnancy?

Professional level information

Approach to the adult with nausea and vomitingCharacteristics of antiemetic drugsClinical features and diagnostic evaluation of nausea and vomiting of pregnancy (hyperemesis gravidarum and morning sickness)Treatment of nausea and vomiting of pregnancy (hyperemesis gravidarum and morning sickness)

The following organizations also provide reliable health information.

National Library of Medicine

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      (www.nlm.nih.gov/medlineplus/ency/article/001499.htm, available in Spanish)

Society of Obstetricians and Gynecologists of Canada

      (www.sogc.org/health/pregnancy-nausea_e.asp)

Organization of Teratology Information Specialists

      (http://otispregnancy.org/otis_fact_sheets.asp, available in Spanish)

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Nausea and vomiting are common during pregnancy. 50-80 percentages of women experience morning sickness or some kind of nausea and vomiting during pregnancy.

Alternative cure effectively helps for pregnant women who are suffering from nausea and vomiting.

Morning sickness usually starts around the 9th week of pregnancy and stops around the 20th week.

Morning sickness during pregnancy usually appears immediately after waking up and nausea can last throughout the day for most of the pregnant women.

Most of the pregnant women prefer alternative cure to help with their morning sickness. The most important three alternative cures are ginger tea, acupressure wristbands and vitamin B6.

Though they are alternative treatments, most of the women are complaining about mild and adverse reactions. The most common effect of these remedies is intolerability due to the strong taste of ginger and irritation due to the wristbands.

Here are some suggestions which help you in relieving from morning sickness during pregnancy.

First identify what are the main triggers of vomiting during pregnancy and then avoid them.

Stay away from fried and fatty foods. Drink more and more fluids, especially in between meals. Try to eat frequent and little amount of meals so that you won’t feel too hungry or too

full.

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Eat any one of the things listed here before you get out of bed in the morning. The list includes bread, cereals, toast, crackers and other bland foods. Keep them nearby you so you can snack throughout the day.

Alternative cure for nausea and vomiting during pregnancy:

Acupuncture:

If you are looking for non-pharmacological solution to your stress during pregnancy then acupuncture is a popular method to help you. This is a safe method for combating morning sickness during pregnancy.

Acupuncture   therapy is beneficial to treat hyperemesis. It is a severe form of nausea and vomiting during pregnancy. It is beneficial if you take acupuncture sessions twice per week.

Acupuncture wrist bands, also known as ‘sea bands’ work by stimulating the pericardium an acupoint.

This is a recognized medicine for alternative cure. Historically it is used to relieve nausea during pregnancy and usually it works immediately. There is a plastic button for the wristband and that introduces pressure on the acupoint inside the wrist.

Wristbands are cheap to buy and you can found them at health food stores, natural remedy stores and online.

Ginger:

Ginger is one of the most popular and well known home remedies for morning sickness. Ginger is generally accepted as safe home remedy.

Many health care professionals will recommend ginger for sickness during pregnancy. You can also make ginger tea by mixing it in hot water.

Most of the practitioners argue that ginger is not safe, especially for pregnant women. Some suggest that ginger can slowdown the enzyme thromboxane synthetase and also it may influence sex steroid differentiation in the foetus‘s brain.

Ginger can prolong bleeding time and interfere with platelet aggregation.

Peppermint essential oil:

Aromatherapy essential oils are the best alternative cure for nausea. Fill a large bowl with hot water and mix two or three drops of peppermint into the bowl and place on a table near you. It can also be used by an aromatherapy diffuser.

The above alternative treatments reduce the symptoms of nausea and vomiting during pregnancy.

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Vomiting is a symptom, which may be related to pregnancy or may be a manifestation of some medical, surgical, gynecological complications, which can occur at any time during pregnancy. Vomiting during pregnancy is common. It is mostly limited to the first trimester. It is more common in first pregnancy, with a tendency to recur again in subsequent pregnancies. It is more common in multiple pregnancies.

The vomiting is related to the pregnant state and depending upon the severity it is classified as:

Simple vomiting or pregnancy Hyperemesis gravidarum or severe type.

The patient complains of nausea and occasional sickness on rising in the morning. Slight vomiting is common in early pregnancy (about 50%) that is considered as a symptom of pregnancy. It may occur at other times of the day. The vomitus is small and clear. It does not produce any impairment of health or restrict the normal activities of the women. The feature disappears with or without treatment by 12-14 th week of pregnancy.

Hyperemesis gravidarum is a severe type of vomiting of pregnancy, which has got harmful effect on the health of the mother and the growing fetus. I t can result in dehydration, acidosis, malnutrition and weight loss. This condition can be dangerous to the fetus if persists. The reason for Hiperemesis gravidarum has not been identified yet, but an association between high levels of the hormones estrogen and chronic gonadotropin ( HCG ) has been found. HCG is a hormone produced by the placenta that increases until the end of the first trimester.

Other possible problems related with abnormal o severe vomiting includes bile duct disease, drug toxicity, pancreatitis, low blood sugar, and problems with the thyroid and inflammatory bowel disorders.

HOME REMEDIES FOR MORNING SICKNESS

To avoid vomiting, try grasping your tongue with a piece of cloth and pulling gently but firmly.

 For excess of vomiting , try limiting your diet to a single food, one that you know you can tolerate. Add one additional food per day as you can tolerate them.

Scent the air by preparing a mixture of three drops of lavender essential oil and one of peppermint in a diffuser or humidifier. This is one of the important home remedies for morning sickness.

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  Place a cool lavender scented compress on your forehead and a warm lavender compress over your rib cage.

Dissolve wheat germ in warm milk, and take a few teaspoons every hour. Dissolve 1 tablespoon of apple cider vinegar and 1-tablespoon honey in cold water

and take it before bed. This is very effective home remedy for morning sickness. Drink red raspberry leaf, peppermint, and squaw vine or spearmint tea. Prepare ginger tea by boiling some ginger root in water. Strain it and add honey to

sweeten. Take this tea when you feel nausea. This is one of the best home remedies for morning sickness.

Don’t brush your teeth immediately after eating. For morning sickness cure, lie completely still with your eyes closed. Taking ½ to 1 tsp of Wild yam root every day will help you fight with the morning

sickness. This is one of the important home remedies for morning sickness. Keep your meals small and to drink plenty of fluids. Smaller meals mean less in your

stomach, and less to make you nauseated. Have a snack such as yogurt, milk, bread, dry cereal, or a small sandwich before

going to bed. Try eating during the night. This may prevent nausea in the morning. Keep your feet up and your head slightly raised on a pillow when resting. Take a short walk or try to sleep with the window open. When you are cooking, open

windows to get rid of odors. Do not eat fatty foods, which take longer to digest, particularly during pregnancy,

when your stomach takes longer to empty. Also avoid rich, spicy, acidic, and fried foods, which can irritate your stomach and digestive system.

Take a few soda crackers or dry toast when getting up early in the morning. This is one of the important home remedies for morning sickness.

Increase vitamin B6 in your diet by eating whole grains, nuts, seeds, and legumes. Acupressure wristbands or acupuncture may help. These bands can be found in drug,

health food, and travel stores. Chew your food thoroughly. Do not keep your stomach completely empty. Carry fruit, cheese and/or crackers

around with you to prevent nausea throughout the day. Chewing gum also helps in reducing the morning sickness.

References:

Peirce, A. Practical Guide to Natural Medicines. William Morrow, New York, 1999.

Werntoft E, Dykes AK. Effect of acupressure on nausea and vomiting during pregnancy. A randomized, placebo-controlled, pilot study. J Reprod Med. 2001 Sep;46

Bryer E. A literature review of the effectiveness of ginger in alleviating mild-to-moderate nausea and vomiting of pregnancy. J Midwifery Women’s Health. 2005 Jan-Feb;50(1):e1-3.

Habek D, Barbir A, Habek JC, Janculiak D, Bobic-Vukovic M. Success of acupuncture and acupressure of the Pc 6 acupoint in the treatment of hyperemesis gravidarum. Forsch Komplementarmed Klass Naturheilkd. 2004 Feb; 11

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7Nausea and vomiting during first trimester of Pregnancy (morning sickness)

Vomiteb

Available as tablet & Syrup

Vomiteb Tablet

(Each bottle of Vomiteb contains 20TAB)

Vomiteb Syrup

(Each bottle of Vomiteb contains 100ml)

IndicationsNausea and vomiting during first trimester of Pregnancy (morning sickness)Motion sickness and Travel sicknessDrug induced and Disease-induced nausea and vomitingRecurrent Bouts of vomiting in children due to unknown origin.

Dosage Tablet

20

Adult: Two teaspoonfuls three to four times a day or as frequently as required.Children: One tablet two to three times a day as often as required. Benefits1) Effective, Safe and Gentle.2) No drowsiness especially useful in children.3) No extra pyramidal symptoms4) Safe during pregnancy and for children & infants.

Do's And Don'tsDo's-Seek Medical advice immediately if the vomiting is very severe.-Drink sufficient water to avoid dehydration-Take Vomiteb before taking any food.

Don'ts-Avoid eating heavy food before starting the journey.-Avoid very spicy food.

* Vomiteb is the Registered Trade Mark of Charak Pharma Pvt. Ltd.** Logos depicted on this page are trade marks or registered trade marks of their respective owners.

Disclaimer

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