Nausea and Vomiting in Pregnancy

Frequently Asked Questions

1. What is "morning sickness"?
2. What is the treatment for morning sickness?
3. What triggers your nausea?
4. Can you control nausea and vomiting with your diet?
5. What medications are used to manage nausea and vomiting?
6. How common is persistent nausea and vomiting (NVP) during pregnancy?
7. Who is at risk for NVP?
8. How long can NVP exist before it becomes harmful to the mother or the fetus?
9. What options exist for management of this condition?
10. What services does Matria offer?
11. What are Matria's protocols for NVP therapy?
12. When should a patient be hospitalized?
13. What medications have been used during pregnancy for this condition?
14. What are the benefits of Matria's NVP therapy program?

1. What is "morning sickness"?

It is not clearly understood what causes nausea and vomiting in pregnancy (commonly referred to as morning sickness). However more than one-half of all pregnant women experience symptoms of this condition early in pregnancy. Experts believe there may be a combination of factors that lead to morning sickness. It is thought that morning sickness may be caused by a change in hormones or metabolism during pregnancy. Since morning sickness occurs in so many women, the causes are probably related to some factor that is common to many pregnancies.

Usually, nausea and vomiting begins between the first and second missed menstrual period and may last until the end of the third month of pregnancy. Sometimes nausea and vomiting will occur in the morning and last until later in the day, or it may occur in the evening or night. In other words, morning sickness can happen at any time of the day. Weight loss may occur if nausea and vomiting becomes severe. If vomiting is severe enough to result in dehydration or nutritional deficiencies, it is called hyperemesis gravidarum, or simply hyperemesis. Fortunately, nausea and vomiting severe enough to produce weight loss, dehydration and an upset in the body's chemical balance occurs in a small number of pregnancies.

2. What is the treatment for morning sickness?

When nausea and vomiting persists, your physician may prescribe various treatment options. Treatment goals for continued nausea and vomiting include the following:

• Minimize nausea and vomiting
• Reverse the effect of fluid loss
• Provide dietary and lifestyle education
• Provide emotional support to deal with stress related to morning sickness

Treatments that may be considered for your nausea and vomiting may include:

• Dietary changes
• Medications
• Intravenous fluids (IVs)
• IV nutrition

Your physician, along with your input, will determine what is best for you.

In some cases, help with problems that occur from a longer-than-expected illness may be needed. Significant nausea and vomiting may strain any household, especially if you must miss work or you have small children at home. Gaining understanding and support are important for anyone with this problem. Do not be afraid to ask your family, friends and neighbors to help you until you feel better.

Above all, patience is a very big part of therapy for both you and your family. It is common to have many "good days" followed by a few days when you don't feel quite so well. Overall, there are many options available to help you have an enjoyable pregnancy experience without overwhelming nausea and vomiting.

3. What triggers your nausea?

What time of day does your nausea and vomiting usually occur? Is the time of day the only issue or is there a person, event or environmental situation that triggers it as well? Bright light, such as early morning sunshine, loud music or abrupt motion have been known to trigger nausea in some women.

Estrogen, a hormone in your body, is thought to enhance the sense of smell in pregnancy, and nausea is said to increase sensitivity to odors. Smells, then, can trigger bouts of nausea. Some smells that trigger nausea are more obvious than others, and some are so ordinary that they are overlooked. These smells can include body smells (breath odor, food odors on hands, perfume, hair products, etc.) kitchen smells, bathroom smells, pet odors, etc.

4. Can You control nausea and vomiting with your diet?

When nausea and especially vomiting first occurs, it is best to allow the stomach to rest for a few hours by not eating or drinking anything. Then you may begin taking small amounts of very cold liquids like ginger ale or lemon-lime soda. After a day or two, if you are feeling better, you may then begin to eat small amounts of solid foods like crackers, dry toast, cereal or baked potatoes every couple of hours.

Some women find it works well to switch between taking liquids and eating solid food. Just remember that liquid or solid food should be eaten in small, frequent amounts. Weak tea, carbonated drinks, cold fruit juices and crushed ice are easier on your stomach. You may continue to add different beverages and foods when you feel like it. Taking it a little slower at first will help you get used to a regular diet.

Try to avoid anything that upsets your stomach. Most people have certain foods they like better than others. Eat a balanced diet, keeping in mind the foods you prefer. It is helpful to tell the people who prepare your meals what tastes good to you. Also, be sure to tell them what foods and smells bother you. Anything that you are craving can be eaten (within reason), but you should avoid spicy, fatty or greasy foods.

It may be helpful to ask yourself what food you feel would ease your nausea. Consider the taste: salty, sweet, sour, bland, bitter; the texture: soft, hard, smooth, lumpy, crunchy, wet or dry; and the temperature: hot, cold, warm. You may be able to keep certain types of food down at certain times of the day and help break the cycle of nausea and vomiting so other foods can follow. Keeping a food diary can help you find out which foods are helpful and which are upsetting you.

5. What medications are used to manage nausea and vomiting?

With nausea and vomiting in pregnancy, your physician may give you medication as part of your treatment. Several different medications are commonly prescribed. Your physician will discuss the use of these medications as well as the risks and benefits of taking each medication. Your doctor will decide the type and amount of medication that is safe for both you and your baby.

6. How common is persistent nausea and vomiting (NVP) during pregnancy?

Nausea and vomiting occurs in 45 percent to 50 percent of all pregnancies. Persistent nausea and vomiting associated with weight loss, fluid/electrolyte imbalance and metabolic disturbances (better known as hypermesis gravidarum) occurs in 1.5 percent to 3 percent of pregnancies. More common in first pregnancies, NVP occurs in the first trimester and early second trimester and is usually resolved by 15 to 16 weeks of gestation.

7. Who is at risk for NVP?

Risk factors include:

• Younger women/first baby
• Very high or very low birth weight

8. How long can NVP exist before it becomes harmful to the mother or the fetus?

As in all illnesses, tolerance varies with each patient. Because of the fluid and electrolyte imbalance and nutritional deficiencies involved, maternal and fetal well-being must be monitored closely. In addition, the fetus should be evaluated for appropriate growth for gestational age.

9. What options exist for management of this condition?

Dietary adjustments focused on easier food digestion can improve the condition. Other dietary considerations include:

• Small, frequent feedings
• Oral fluids between meals
• Avoiding caffeine, carbonated beverages, alcohol, tobacco and high-fat foods

When vomiting persists, fluid replacement is advised and antiemetic (prevention of vomiting) therapy is often considered. Nutritional supplementation is a therapeutic option. Each of these services is available with Matria's NVP program.

10. What services does Matria offer?

Matria follows a critical pathway approach to patient care. Critical pathways include:

• Hydration therapy
• Antiemetic therapy
• Total intravenous nutrition

11. What are Matria's protocols for NVP therapy?

When prescribed, Matria can provide:

• An initial home visit that includes home assessment and appropriate patient education
• Nursing support as required
• Provision of equipment and medical supplies as required
• Pharmacy consultations
• Detailed clinical reports

12. When should a patient be hospitalized?

Hospitalization should be considered when the following conditions are present:

• Vomiting and symptoms of nausea persist
• Weight loss is greater than 5 percent
• The patient cannot eat by mouth
• Fluid and electrolyte replacement is required for stabilization
• Differential diagnosis is required to rule out other causes

13. What medications have been used during pregnancy for this condition?

No medications to control this condition have been approved by the FDA for use during pregnancy. However, some antiemetics commonly prescribed to address the symptoms of NVP are:

• Compazine
• Phenergan
• Reglan
• Tigan
• Dramamine
• Zofran

14. What are the benefits of Matria's NVP therapy program?

• Experience/expertise in obstetrical homecare
• Comprehensive patient education
• 24-hour support by registered nurses with labor and delivery experience
• Obstetrical pharmacy consultations
• Patient-specific dosing guidelines
• Microinfusion pump technology
• Patient-specific nutritional consultation
• Improved patient compliance
• Return to activities of daily living
• Detailed clinical reports
• Reduced antepartum hospitalization
• Pregnancy outcomes comparable to hospital management
• Cost savings (based on reduced antepartum hospital days)