Nausea and vomiting is quite common in pregnancy, affecting a majority (85%) of woman up to 12 weeks. Various names have been used to describe this condition including: Morning sickness, Hyperemesis Gravidarum, and currently Nausea and Vomiting in Pregnancy (NVP). The term Morning Sickness is no longer used because, although most women feel sick between 9 am and 12 noon, many others may experience these symptoms anytime through out the day. If your Provider has excluded the long list of other conditions* that may cause NVP, then rest assured that your pregnancy should proceed without a problem. In my practice I have noticed that Nausea and Vomiting is usually a sign of a healthy pregnancy. I am often worried when my patients tell me that they feel no nausea or change in appetite in their first 12 weeks. My experience was confirmed in a study which showed that women with Nausea and Vomiting (NVP) are LESS likely to suffer a miscarriage than other women. No one knows the true cause of NVP. An interesting question is: why would nature evolve women to have Nausea and Vomiting during a time when seemingly the growing baby would need nutrients the most ?. Some theorize that vomiting serves the purpose of ridding the body of toxins and enviornmental chemicals that may harm the pregnacy during the crucial stage of organ development. Others posit that an empty stomach causes Vomiting and thus should be avoided. Therefore to prevent Nausea, a woman should keep her stomach from being empty at any given time. This would assure , theoretically, that the growing baby has all the necessary nutrients needed in order to develop. What we do know is that HIGH LEVELS of pregnancy hormone is associated with NVP. Perhaps this is why during a failing pregnancy the hormone levels start to fall. Woman in the process of miscarrying usually do not feel sick. My personal theory is that the vomiting rids the body of excess acid and the resulting shift to a less acidic or ALKALINE balance in the body is crucial for DNA developemnt and cell division and growth. Once the baby’s DNA has been synthesised and the cells have formed organs, the body no longer needs a less acidic enviornment, rather more calories are needed in order to support the baby’s growth of new tissues. Here are some tips regarding treatment : Most cases resolve sponteously by 12 weeks. Almost all cases of true NVP, will be resolved by !4 weeks. I have personally never seen it continue beyond the 14th week. If it does continue beyond this time period, then it is probably NOT Nausea and Vomiting in Pregnancy, but a more serious medical condition that needs diagnosing ( see * List of OTHER CAUSE below). Please also consider depression as a cause for cases that last beyond 14 weeks. To successfully navigate through this illness, you first need supportive family members, and partners. Also you need Providers that take your concerns seriously and support you through this difficult period. Do keep hope and know that this is a temporary adjustment period and that you will soon get relief from this condition. Do alter your diet by eating frequent smal meals throughout the day to avoid having an empty stomach. Avoid greasy, fried foods, or hot and spicy dishes. High carb foods are better tolerated. Drink fluids such as sports drinks ,GATORAIDE, and PEDIALYTE, which may replace electroltes and thus decrease stomach muscle spasms during retching. During this period, it is common to LOOSE weight. Most of the weight gain will return after 12 weeks. There are a number of medications that yourProvider may prescibe for you. The most popular today are ZOFRAN ( ondansetron), phenergan, tigan, compazine, and a newer drug call DICLEGIS ( which contains Vitamin B6 “pyidoxine phosphate” ). They have all been shown to be effective. The fact that Vitamin B6 is effective would support my theory of causation of NVP in that vitamins in particular B6, is important for DNA synthesis and growth in the baby. I personally believe that although unpleasant , suppositories work better than oral meds. Pills, oftentimes, are soon vomited after ingestion. For the patients who are interested in natural remedies, accupressure, wrist band, ginger root capsules, and hypnotherapy may be attempted. Their reported success is variable. For woman that have excessive salivation, I have recommended eating GINGER SNAP COOKIES with good success. Ensure and Boost are nutritional supplements that are beneficial in increasing your caloric intake.The next question is : When is hospitalization necessary? The answer is, when there is significant dehydation. I allow patients no more than 2 days to respond to medication and other regimens, after this point they are instructed to present to the hospital for IV HYDRATION and nutrient supplementation. An objective way for you to know that dehydration has set in , even before 2 days, is when there is fainting, parched lips, dry mouth, sunken temples, blood shot eyes , or the inability to even drink water. Your doctor may test your urine for the presence of KETONES, which is a sure indicator of starvation. A positive test would prompt rapid hospitalization. You will then be hospitalized and hydrated, supplemented with vitamins and given stronger IV anti-nausea meds. Once you no longer have ketones in the urine, and you are able to eat, then you are generally discharged to home. During this time , additional tests and exams will be performed to ascertain other more serious causes for your Nausea and Vomiting. In severe and unresponsive cases, not caused by other illnesses, I have used IV STEROIDS with great personal success.
Finally treatment must be tailored to the individual. No two woman will respond in the same way to any one treatment regimen. Therefore, avoid comparing yourself to others. Sometimes through strong support, and a small amount of trial and error, you and your Provider will find the perfect regimen to relieve your suffering. In the end , your reward is a healthy baby.