Nausea and vomiting in early pregnancy

What is nausea and vomiting in pregnancy?

Nausea and vomiting are common symptoms in early pregnancy, affecting up to 80% of women (8 out of 10).

It often starts between the fourth and seventh week of pregnancy and for most women, usually settles by 12-14 weeks. It is often called ‘morning sickness’, but symptoms can occur at any time of the day or night and some women may feel sick all the time.

There is no evidence that nausea and vomiting have a harmful effect on your baby. In fact, women that experience this have a slightly lower risk of miscarriage.

However, nausea and vomiting can also be a sign of other things such as a urine infection or gastrointestinal problem, so it is important that these are considered and looked in to as necessary.

What is hyperemesis gravidarum?

Hyperemesis gravidarum is an extreme form of nausea and vomiting in pregnancy and may affect 1-3 in 100 pregnant women (between 1-3%).

Signs and symptoms of hyperemesis gravidarum include:

• Prolonged and severe nausea and vomiting.
• Dehydration (symptoms can include feeling thirsty, tired, dizzy, or lightheaded, not urinating very much, and having dark yellow and strong-smelling urine.
• Weight loss.
• Low blood pressure when standing.

Other symptoms may include:

• Extremely heightened sense of smell.
• Excessive saliva production.
• Headaches and constipation from dehydration.

What can I do to help?

To help alleviate the symptoms of nausea and vomiting, you should:

• Eat and drink small frequent meals that are high in carbohydrates and low in fat (such as bread, rice, crackers, and pasta).
• Avoid any foods or smells that trigger symptoms.
• Get plenty of rest (tiredness can make nausea worse).
• Eat something like dry toast or a plain biscuit before you get out of bed.
• Drink plenty of fluids, such as water (sipping them little and often may help prevent vomiting).
• Eat foods or drinks containing ginger – there is some evidence that ginger may help reduce nausea and vomiting.
• Consider using acupressure – there is some evidence that putting pressure on your wrist, using a special band or bracelet on your forearm may help relieve the symptoms.

Treatment in our early pregnancy unit (EPU)

Most women who require treatment for nausea and vomiting are seen as a day case patient or have a short term (a day or two) admission to hospital. A few women will need a longer stay in hospital.

When you arrive, you will meet a nurse who will take your medical history and discuss how you are feeling. They will also take your blood pressure, pulse rate and temperature to help us understand your physical health.

During your treatment, you will receive fluids containing salt and glucose which will make you feel better. This is done by inserting a small plastic tube (known as a cannula) into your vein. We will also take blood samples at this time, so we know how much fluid you need, and to check your general health.

We will then offer you anti-sickness medications as tablets (to be taken by mouth) or injections. These are safe for use in pregnancy and will be discussed with you further during your appointment.

You may also need tablets to supress acid secretion from your stomach (tummy) such as antacids.

We will also offer you vitamin supplements. After vomiting for a long period of time, you may have lower than normal levels of vitamins. Vitamins can be given in tablet form (to be taken by mouth) or as an injection.

We recommend that you wear the special stockings we give you and take a safe blood thinning medication to minimise the risk of developing a blood clot in the vein in your legs.

A small proportion of women with serious complications may need more specific investigations and management, which will be discussed by your doctors.

If you are in the early stages of pregnancy and have not yet had an ultrasound, we will arrange one for you.

When will I be able to go home?

Once your treatment is complete, you may be able to go home if you feel well enough and staff on the unit are happy with your progress throughout the day.

In some cases, you may be well enough to go home, but will need to return the next day for further care. In this case, we will ask you to return to the unit by 10am the following morning. If you are not able to return, you must contact the unit and let us know. Our contact details are included below.

What happens if I need to stay in hospital?

We will continue to offer you fluids and repeat any required blood tests to make sure you are improving. Your urine, blood pressure, pulse rate, and temperature will also be taken regularly. You will also continue to be offered anti-sickness medicine regularly, anti-acid medication, and vitamins.

We strongly recommend that you continue to wear the stockings you are given and begin to take gentle exercise to avoid developing a blood clot in the veins of your legs. You will also receive an injection of a blood thinner; this will also help prevent blood clots developing.

What happens when I go home?

We will provide you with anti-sickness tablets to take home with you.

You should try to eat and drink regularly. Often, eating smaller amounts more regularly can help you feel better. If you do start to feel sick again, try to continue to sip fluids and take the anti-sickness tablets we have given you.

It is important that you do not run out of your anti-sickness tablets. If you require more, ask your GP for a repeat prescription.

If you cannot tolerate fluids and start to feel very unwell again, please call us for an assessment over the phone. Our contact details are provided below.

References

1. Hospital protocol: Early pregnancy and Emergency Gynaecology Unit, Royal Free London.
2. RCOG Guidance: Feb 2024. The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum.