Pregnancy sickness (nausea and vomiting of pregnancy and hyperemesis gravidarum)

Nausea and vomiting of pregnancy is a common condition that settles by 20 weeks in 9 out of 10 pregnant women.

 

Hyperemesis gravidarum is a severe form of this condition and can affect up to 3 in
100 pregnant women. 

 

Nausea and vomiting and hyperemesis gravidarum can affect your mood, your work, your home and your social life.

 

While most women can be treated at home or as outpatients in hospitals, 1 in 5 affected women may need admission to hospital for treatment.

 

Several different anti-sickness medicines are available that may help your symptoms. While some of these medicines may not be licensed for use in pregnancy, they are considered safe for you and your baby.

Nausea and vomiting are symptoms of pregnancy that affect most women. It starts early in pregnancy, usually between the 4th and 7th week. It settles by 20 weeks in 9 out of 10 women, although in some women it may last longer. It is often called ‘morning sickness’ but it can occur at any time of the day or night. 

The cause is thought to be hormones which are produced in pregnancy in all women. Research suggests that some women get pregnancy sickness worse than others due to genetic differences, which causes them to have higher levels of a hormone called GDF-15. GDF-15 is a hormone produced by the placenta that causes a loss of appetite and nausea. 

You are more likely to have pregnancy sickness if:

• you have had it before

• you are having more than one baby (twins or triplets)

It is important that other causes of vomiting are considered and looked into, particularly if you have pain in your tummy or you have other symptoms for example pain passing urine (UTI), you have had other medical conditions for example a stomach ulcer or gall stones, or your vomiting only starts after 16 weeks of pregnancy.

If the nausea and vomiting become so severe that it stops you from doing your daily activities and you are unable to eat and drink normally, it is known as hyperemesis gravidarum. This may affect up to 3 in 100 pregnant women. It can cause you to become dehydrated. Signs of dehydration include feeling ‘dry’ or very thirsty,
becoming drowsy or unwell, or your urine changing from a light yellow to a dark yellow or brown colour. Women with this condition may need to be admitted to hospital.

Most women with nausea and vomiting of pregnancy will be able to manage their symptoms
themselves. You could:

Eat small amounts of foods that are high in carbohydrate and low in fat, such as potato, rice and pasta, or foods that are easier to tolerate such as plain biscuits or crackers.

Avoid any foods or smells that trigger symptoms.

If your symptoms do not settle or if they stop you doing your daily activities, see your Doctor.

Your doctor can prescribe anti-sickness medication that is safe to take in pregnancy.

There are several different types of anti-sickness medicines that you may be offered.

An oral medication that is a slow-release combination of doxylamine and pyridoxine
(vitamin B6) called Xonvea is the only licensed treatment of nausea and vomiting in
pregnancy in the UK.

Cyclizine can be taken by mouth or by an injection. Prochlorperazine, chlorpromazine and promethazine can also be tried if cyclizine has not worked.

All the medications above are considered to be safe in pregnancy. Occasionally, you may require a combination of two or more anti-sickness medications.

Metoclopramide, domperidone and ondansetron are other medications that may be
prescribed for nausea and vomiting and can be taken by mouth or by an injection.
These are also considered safe to use in pregnancy. They are usually used if the previous medications have not worked. This is due to a small risk of side effects. Your health care professional can discuss this with you.

Corticosteroids may also be considered if you are still suffering from hyperemesis gravidarum despite fluids being given through a drip and regular anti-sickness medication has not helped you have lost a lot of weight.

Corticosteroids are successful in helping nausea and vomiting in many women where all other measures have not helped. Most women will be able to stop corticosteroids by 18–20 weeks but a few women will need to continue them at a low dose for the rest of the pregnancy. If you are taking corticosteroids, you will be offered a test for gestational diabetes. If hyperemesis gravidarum is not treated, it may cause more harm to the baby than any possible effects of a medicine recommended by your doctor.

Hope you found this information helpful.