“Don’t worry, I’m not sick. I’m just pregnant,” I overheard a coworker relay to another colleague in the locker room at work. She was likely trying to reassure her friend that she was not contagious with the awful norovirus that has been going around this season. But her remark highlighted that often women and even obstetric providers minimize the very prevalent and challenging condition of nausea and vomiting in pregnancy.
As many as 50-80% of women experience a spectrum of nausea and vomiting during pregnancy. Symptoms can range from a basic queasiness and aversion to various foods and smells to severe intractable vomiting, known as hyperemesis gravidarum, leading to weight loss, dehydration and sometimes hospitalization.
Anyone who has experienced these symptoms or who has a spouse, family member or friend who has suffered from this during pregnancy, knows the impact these symptoms can have. Rather than being a joyful and exciting time, pregnancy can become a stressful and difficult experience both for the pregnant woman and her loved ones.
Intense nausea can even be a deterrent for future pregnancies. Imagine the lawyer who has competently represented her clients for years but now abruptly leaves meetings because looking at screens constantly prompts vomiting. Or the charismatic and patient kindergarten teacher who finds herself making excuses to avoid coloring time and other such activities because smells make her gag. Perhaps it is the mother who can barely drag herself out of bed because mornings mean juggling unpleasant trips to the bathroom while getting her kids ready for school. For many women, this is the picture of early pregnancy. They are desperately trying to function, with few people in their lives aware of the challenges they are facing.
What many do not realize, however, is that the symptoms of nausea and vomiting in pregnancy can be addressed in an effective and safe way, enabling women to not only tolerate pregnancy, but to perform akin to their pre-pregnancy state. Women today are active members of society, whether at home, in their communities or in the professional sphere, and they should not have to feel that pregnancy and its associated symptoms will inevitably limit their capacities. As someone who struggled with these symptoms myself, I have always been determined to help women through this challenging aspect of pregnancy.
The cause of nausea and vomiting in pregnancy is not entirely known, but has been hypothesized to relate to hormonal changes and/or evolutionary adaptations. At the beginning of pregnancy, there is a surge of HCG, the “pregnancy hormone,” typically hitting its peak between weeks eight and 12, which coincides with peak symptoms of nausea for many women. Another hormone, estrogen, increases to varying degrees in women in pregnancy, and may also contribute to nausea. The evolutionary theory posits that nausea and food aversions helps protect a woman from consuming foods that could be harmful to her or her fetus.
Let’s also address a few myths about nausea in pregnancy: “Morning sickness” is somewhat of a misnomer. Though many women feel nausea the worst in the morning (perhaps due to the longer duration without eating), nausea is not confined to the morning hours. In fact, some experience it increasingly as the day progresses. Additionally, some believe nausea is limited to the first trimester, which can lead it to become minimized and untreated, even by obstetric providers.
While nausea is usually more severe in the beginning weeks of pregnancy, women can experience it well into the second trimester, and some even have symptoms the entire pregnancy.
Regardless of the form nausea takes, it is not simply a side effect of pregnancy that women must endure without relief. For women who experience the symptoms of nausea and vomiting in pregnancy, the key to effective treatment is to address the issue early and assertively. Waiting until symptoms escalate can be detrimental and can lead to a downward spiral of poor appetite, dehydration and weight loss, each of which exacerbates the nausea and makes it more difficult to emerge from the vicious cycle. (I have encountered patients who have already lost upwards of 10 pounds and had multiple ER visits, unaware of treatments available to them.)
The best start to treatment of nausea is prevention, or as I tell my patients, beat the nausea at its own game. Some preventative methods include avoiding both an empty and a very full stomach by eating frequent and small meals every one-two hours. Typically the longest stretch of time without food will be first thing in the morning, and one may consider keeping bland crackers and a glass of water at bedside, consuming these immediately upon waking. It is also critical to prevent dehydration, which can worsen nausea and cause electrolyte imbalances. While it can be difficult to drink large amounts of water at one time, taking small sips every 10 minutes throughout the day or adding some flavor to water, such as citrus, can provide adequate hydration. Some find that ginger can be helpful in reducing nausea, as another nonpharmacologic preventative. And it goes without saying, women with nausea should avoid any aversions! (Yes, partners, this may mean changing your cologne or showering more frequently, but consider it taking one for the team.)
Certain lifestyle measures can lessen the burden of nausea as well. Though challenging, particularly in the first trimester when fatigue can be prevalent, it is imperative that women try to incorporate some pregnancy appropriate exercise in their daily routines. Sometimes, getting yourself out for a walk can feel like attempting Mount Everest, but it can make a huge difference and reduce feelings of nausea, at least temporarily. Additionally, trying to maintain an active daily schedule can be helpful. Though not scientifically proven, some find interventions such as acupuncture or acupressure can help alleviate symptoms of nausea as well.
Of course, for some women, the above treatments can help but won’t eliminate nausea and vomiting. Thankfully, there are multiple pharmacologic therapies that can prove transformational. While many women hesitate to take medication in pregnancy, there are several over-the-counter and prescription treatments that have been found to be safe and effective in pregnancy. A first line preventative regimen includes taking additional vitamin B6 in combination with an antihistamine called doxylamine. If this regimen is not sufficient to control nausea symptoms, several other prescribed medications that are typically taken on an as-needed basis can substantially reduce nausea and vomiting. These medications can be administered in various doses and forms, some of which need to be swallowed orally, but others that can dissolve under the tongue or can be taken rectally for those who cannot tolerate an oral regimen.
Furthermore, women can experience reflux or heartburn symptoms that exacerbate nausea. Addressing these symptoms with antacids and lifestyle/dietary changes can help manage nausea as well. Some women who have tried pharmacologic therapy in a previous pregnancy and did not find relief from the intense nausea may be more successful in managing the nausea in a subsequent pregnancy if they are able to address the symptoms immediately upon onset and by taking certain medications more regularly (as opposed to only on an as-needed basis). Women who are having difficulty with nausea and vomiting in pregnancy that is not improved with conservative measures should be encouraged to discuss treatment options with their providers to establish an individualized therapeutic approach.
While the condition of nausea and vomiting can seem like a pervasive and insurmountable element of pregnancy, there are ways to treat it so that women can continue to function as effectively as possible. Treatments may not fully eliminate nausea, but they can make it significantly more manageable. Whatever roles you fill in your life, you are not alone in facing these symptoms of pregnancy, and you deserve the support tackling this challenge so that you can feel like your strongest possible self!
Dr. Leora Joel is a board-certified OB/GYN who has been in practice since 2017. She is a strong believer in supporting women’s birth choices to achieve the birth they desire. She is a physician at Maternal Resources, a thriving boutique style practice, with offices in Hackensack, Jersey City, Hoboken, Howell and New York City.
