Morning sickness, now known as nausea and vomiting in pregnancy (NVP), is a common experience affecting 50-70% of pregnant women. The term “morning sickness” is thankfully falling out of favour; it doesn’t just happen in the mornings (as anyone who’s been pregnant will tell you!). More importantly, there is increasing concern that the term trivialises a condition which can have a profound impact on a pregnant woman’s quality of life and possibly prevent her from accessing effective treatments.
Studies show that managing NVP EARLY can reduce the risk of progression to its most severe form, hyperemesis gravidarum (HG), a condition which affects around 1-2% of pregnancies and can lead to dehydration, weight loss and often hospitalisation.
The good news is that Australia finally has some guidelines for health professionals on how to manage these conditions, and there are many effective treatments available – ranging from lifestyle tweaks right through to safe prescription medications.
What is NVP?
Nausea, with or without vomiting or dry retching, affects around 4/5 pregnancies. Symptoms can range from mild, occasional nausea, right through to severe and persistent vomiting requiring hospitalisation (HG).
It tends to come on early in the pregnancy, and will often have disappeared by 16-20 weeks, but for some women it can last the whole pregnancy.
NVP can have a BIG impact on a pregnant woman’s physical and mental health. Studies show between 30-50% of women need time off paid work, and around a quarter are unable to manage routine daily activities. Whilst there are lower rates of miscarriage with NVP (the good news!), there are higher rates of depression.
Unfortunately, it’s not often recognised early, or is considered such a “normal” part of pregnancy that treatment may not be sought or provided. It’s certainly something that needs to be taken seriously by health care providers, families and employers.
What is HG?
Hyperemesis gravidarum is the most extreme form of NVP and occurs when the nausea and vomiting become so severe that women can’t eat or drink enough, leading to dehydration, weight loss and sometimes vitamin deficiencies.
It affects between 1-2 in 100 pregnant women and generally resolves between 13-20 weeks, although some have it their entire pregnancy.
What causes it?
We don’t know the exact cause, but there are studies underway looking into it. Hormones seem to play a role and it can run in families.
Can it be prevented?
Some studies indicate that taking prenatal vitamins for three months before falling pregnant may reduce the risk of experiencing NVP.
We also know that early recognition and effective treatment of NVP may reduce the chances of progression to full blown HG.
How do I know if I have it?
The most important thing is to tell your doctor or midwife that you are experiencing symptoms, even if you think they are mild. They will take a history and examine you, asking about the severity and frequency of your symptoms.
There is a scoring system they can use known as PUQE-24, which helps decide what the best course of action is. A score of 13 or more on the scale means a diagnosis of HG is likely, and they will probably recommend further tests to rule out other causes and to see how dehydrated you are.
It’s vital that women with HG are properly diagnosed and treated, not dismissed as “just” having bad morning sickness and being told “it will pass”.
What treatments are available?
We are firm believers in working in partnership with our patients – this is especially important during pregnancy! The aim is to come up with a treatment plan based on your symptoms. Sometimes the nausea and vomiting can’t be stopped completely; the goal is to reduce them enough to allow you to manage normal daily activities, especially eating and drinking.
All of us here at GPC are trained in diagnosing and managing NVP & HG, including being able to offer intravenous fluid treatment at the practice which may avoid hospital admission.
Some of the options we might discuss include:
For mild to moderate NVP
- try to get as much rest as you can; where possible bring in support, shorten your workday, take frequent naps etc.
- eat small amounts of food more often
- stick to mostly bland foods, avoiding spicy, fatty or strong-smelling foods
- ginger may help
- acupressure bands (those used for motion sickness) may help
- certain antihistamines with or without pyridoxine (vitamin B6) may be recommended
- anti-vomiting medication may be prescribed
Severe NVP/HG
Treatment depends on how severe the dehydration or weight loss is but may include:
- intravenous fluids with or without admission to hospital
- anti-vomiting medication
- other treatments based on the severity
The good news is that the medicines we can prescribe to treat NVP are safe to use in pregnancy.
Does NVP/HG affect the baby?
The vast majority of women who experience mild, even moderate NVP go on to have a heathy pregnancy and baby. This is true of HG as well, although there is a higher chance of having a baby prematurely or with a lower birth weight.
Effective treatment EARLY can reduce these risks significantly, so please don’t delay seeking help. NVP can be harder to control the longer it goes on, so talk to your doctor (or midwife) as soon as possible, we are here to help!
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