Nausea and Vomiting in Pregnancy

Nausea and vomiting of pregnancy (NVP) also known as “morning sickness” is one of the most common conditions of pregnancy that affect approximately 80% of pregnant women. Although the cause is still unknown (many theories exist), we do know that most women have resolution of symptoms by the time they are 16 weeks pregnant. However, 20% of women continue to experience symptoms throughout their pregnancy. Severe symptoms leading to dehydration and hospitalization is known as “hyperemesis gravidarum." Initial treatment of NVP should always be conservative. Conservative treatment involves dietary changes as well as emotional support.  If conservative treatment does not work and symptoms persist or worsen, then pharmacologic treatment should be sought.

 

Do not mix solids and liquids. Mixing solids and liquids can cause the stomach to feel full and increase the nausea and vomiting. In some women, mixing solids and liquids can also cause acid reflux, gas, and bloating.

 

Eat small portions of food every 1-2 hours to avoid feeling full; and therefore, reduce the nausea and vomiting symptoms. Remember to separate solids and liquids. 

 

Drink plenty of fluids to keep well hydrated. Pregnant women should take approximately 2 liters of fluid a day. Popsicles and ice chips might be easier to tolerate.

If you feel as if you have excessive saliva, it is better to spit it out than to swallow it. Swallowing it can increase the sympoms of nausea and vomiting

 

Vitamins can sometimes make the nausea worse mostly because of their size and the amount of iron they contain. The most important thing, if you cannot tolerate your multivitamins, is to take folic acid alone or take a multivitamin that does not have iron. Once the nausea and vomiting get better then you can resume taking the regular prenatal vitamins.

 

Acid reflux can make the nausea and vomiting during pregnancy worse. 

 

Treatent of minor symptoms: calcium carbonate containing antacids (i.e. Tums, Maalox, Mylanta, Rolaids, Riopan). Make sure these are Sodium-free.

 

Treatment of persistent symptoms: H2 blockers and proton pump inhibitors.

 

 

The use of doxylamine and pyridoxine used in combo is preferred. (Unisom with Vitamin B6 or Diclectin outside the U.S., the normal dose is two tabs at night, each tablet containing 10mg doxylamine/10mg pyridoxine)

Metoclopramide- 5-10 mg (by mouth) every 8 hours

Ondansetron- 8 mg (by mouth) every 8-12 hours

Methylprednisolone- 16 mg orally 3 times a day; then taper

 

 

 

1. Einarson A, Maltepe C, Boskovic R, Koren G. Treatment of nausea and vomiting in pregnancy: an updated algorithm. Can Fam Physician. Dec 2007;53(12):2109-2111.