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How to Manage Nausea and Vomiting During Pregnancy?

“Morning sickness” is common during pregnancy and can actually occur at any time throughout the day. I was very fortunate and did not experience “morning sickness” with either of my pregnancy’s. Nausea and vomiting associated with pregnancy occurs in up to 90% of pregnant women, particularly in the first trimester.  

In most cases, the nausea is mild and can be controlled with a variety of diet changes and conservative management.  

In rare cases, 1% of pregnant women can develop hyperemesis gravidarum, which is severe and requires medical attention.  I will be discussing only mild to moderate symptoms in this post.  

Why do women get “morning sickness”?

The true cause of nausea and vomiting in pregnancy is unknown but there are a various theories about why:

  • Hormone changes
  • Abnormal gastrointestinal motility in pregnancy
  • Genetic factors

Nausea and vomiting of pregnant typically appears within 4 weeks gestation, and normally resolves by 20 weeks gestation.  Sometimes symptoms can continue throughout the duration of pregnancy.

What can pregnant women do to help ease symptoms?

The first step in managing pregnancy related nausea is diet and lifestyle changes.  Sometimes prescription medication is required if the nausea is accompanied by vomiting, or diet and lifestyle changes are not helping.

Some diet changes to consider:

  • Eat small, frequent meals and snacks
  • Determine what foods you can tolerate and eat those.  Avoid triggering foods such as spicy, acidic, or very sweet foods. 
  • Eat protein dominant foods
  • Drink plenty of fluids, but not with your meal to avoid being over-full
  • Eat ginger-containing foods

If diet changes fail to help with nausea and/or vomiting, some health care practitioners may offer prescription doxylamine/pyridoxine (vitamin B6) (Diclectin®).

  • This prescription product has slight benefit over placebo, but the studies have shown bias, questioning clinical efficacy.

If doxylamine/pyridoxine (vitamin B6) fails to provide relief, speak to your health care practitioner about other nausea medications that can be used during pregnancy.  

What about other options for nausea and vomiting?

Acupressure has shown to have some positive evidence for treating nausea and vomiting.  

Cannabis products should not be used during pregnancy for management of nausea and/or vomiting.  

When should you see your doctor?

Sometimes nausea and vomiting in pregnancy can become severe.  You should seek medical attention if your pregnant and have the following symptoms:

  • Signs of dehydration (dark urine, dizziness, infrequent urination)
  • Vomiting repeatedly throughout the day
  • Blood in vomit
  • Unable to keep down any food or fluids for more than 12 hours
  • Weight loss
  • Fever or diarrhea in addition to nausea and vomiting
  • Abdominal or pelvic pain or cramping

This post was co-authored by Erin Manchuk, BScPharm, BCGP and Stephanie Liu, MD, MSc, CCFP, BHSc.

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