Is nausea and vomiting NVP the first pregnancy sign and symptom?
NVP is one of the first signs of pregnancy, and despite its name, morning sickness may occur at any time during the day. Generally, it begins around the sixth week of pregnancy and stops around the 12th week. Some women experience morning sickness throughout the entire pregnancy, and some who never experience it at all. It does not harm your baby unless the sickness becomes so severe that you are unable to hold down food enough to keep nutrients in your body to allow the baby to grow. However, if your morning sickness is unbearable you could have hyperemesis gravidarum and your treating physician should be notified.
How common is nausea and vomiting (morning sickness) in pregnancy NVP?
Nausea and vomiting during pregnancy are common and usually occur early in pregnancy in up to one out of every 2-3 women. It usually happens before 9 weeks of the pregnancy. Between 50-80% of pregnant women have morning sickness. About 50% of pregnant women will have nausea plus vomiting, 25% will have nausea only, and 25% of women will have neither nausea nor vomiting.
Do nausea and vomiting happen only in the morning?
Though the name suggests it only occurs in the morning, nausea and vomiting can occur anytime throughout the day. Although women experiencing morning sickness may feel as though it will last forever, nausea and vomiting usually go away after the first trimester. NVP usually happens prior to 9weeks of the pregnancy. If it happens later in pregnancy then other conditions should be evaluated in the differential diagnosis.
Symptoms of NVP Nausea and Vomiting in Pregnancy
Symptoms can range from mild to severe, with no known definitive cause as to why some pregnant women suffer from mild symptoms as opposed to severe symptoms. If you have nausea and vomiting in the 2nd and third trimester, especially if it's associated with diarrhea, then other conditions than simply the pregnancy could be responsible and must be looked for.
Nausea and vomiting are separate from the much more severe form of hyperemesis gravidarum which often requires medical treatment.
The term morning sickness can be a bit deceptive. It alludes to the fact that nausea only occurs in the morning, but this is a myth. Feelings of nausea can spring up at all times of day and may be triggered by certain scents, odors or foods.
Morning Sickness as First Symptom of Pregnancy
Morning sickness, nausea, and vomiting can be among the first early pregnancy symptoms and signs. It typically begins around 4 weeks to 6 weeks into the pregnancy or around the time you miss your period and is one of the most common (and most irritating) parts of early pregnancy. Although women may feel as though it will last forever, nausea and vomiting usually go away after the first trimester.
Unexplained nausea leading to vomiting during the first month or so may mean you are eating far less than you should while also spending more time in the bathroom than you would like. It often presents as a set of symptoms that characterize early pregnancy. These often include tender breasts, back pain, constipation, and an increased sense of smell. Unfortunately, constipation and increased sense of smell may make the condition worse.
Nausea and vomiting may last up until the 16th week of pregnancy in most cases, but this is not a number set in stone. There are some women who suffer from nausea for the duration of the pregnancy.
Morning sickness most likely occurs at the following times:
- Between 4 weeks and 8 weeks after conception and fertilization
- Around the time you miss your first period
Causes of Morning Sickness
Hormones, specifically estrogen, are thought to be a primary cause of morning sickness. Estrogen levels suddenly increase and fluctuate during the first month or so of pregnancy. As this hormone fluctuates, women often see changes in their sense of smell, which may be linked to nausea. Other causes of morning sickness may include hCG, relaxing digestive muscles, and skipping meals due to fear of vomiting.
Other Causes of Nausea And Vomiting
- Biliary tract disease
- Intestinal obstruction
- Peptic ulcer
Conditions of the urogenital tract
- Torsion of the ovary
- Kidney stones
- Uterine leiomyoma
- Addison's disease
- Pseudotumor cerebri
- Vestibular lesions
- CNS tumors
- Lymphocytic hypophysitis
- Drug toxicity
- Drug intolerance
- Psychologic conditions
- Acute fatty liver of pregnancy
From: ACOG Practice Bulletin 2015
When Morning Sickness Gets Out of Control
If your nausea and vomiting become unbearable or so frequent that you have trouble keeping anything down at all, you should contact your doctor right away. You could potentially have a condition known as hyperemesis gravidarum. This condition is noted by severe nausea and vomiting, along with weight loss, and electrolyte imbalances. Mild cases are often treated with dietary measures, rest and antacids. Severe cases often require a stay in the hospital so that the mother can receive fluid and nutrition through an intravenous line. Do not take any medications to solve this problem without consulting your healthcare provider first.
Treating Morning Sickness
If you allow yourself plenty of time to get out of bed, (about an hour or so before you actually need to get up) and start slow then you should experience less morning sickness. Another tip: drink fluids either before or after your meal (about half an hour) but not with your meals. If the smells of food cooking bother you, open a window while you cook/or have someone cook for you.
Slow and steady wins the race and the same goes for nausea and morning sickness. Eating meals slowly can greatly reduce nausea associated with pregnancy. Crackers and water are perfect in the morning when nausea tends to be strongest. If morning sickness happens later in the day, as “morning” is not the same for every pregnant woman, eat only light meals when nausea is the strongest. Eating before bed may also help prevent sickness upon waking, as the stomach tends to feel nauseous when empty.
Most recently, the FDA approved a safe and effective drug for nausea and vomiting in pregnancy called "Diclegis" which contains 10 mg doxylamine and 10 mg pyridoxine in a delayed release formulation. Diclegis is usually started at 2 tablets at night, and if symptoms persist 1 tablet is added in the morning on day 3, and if that does not work, 1 tablet is added in the afternoon.
Small, Frequent Meals
Keep snacks such as dry toast, cereal, and crackers near you at all times. Get up slowly in the morning and have a snack such as Shredded Wheat bite-sized biscuits kept near your bedside to avoid moving around on an empty stomach. Then make sure your stomach is not empty throughout the rest of the day by eating five or six small meals including easy-to-digest foods such as bananas, rice, applesauce, and tea. Try to eat at least every two hours.
Your body needs more water during the first few months of pregnancy so it’s important to stay hydrated. Have beverages, soup, and fruit juices mixed with carbonated beverages to settle your stomach between meals. You may want to try avoiding drinking beverages with your meals as the fluid will fill up your stomach making less room for food and worsening feelings of nausea. Strive to consume 6-8 eight-ounce servings of fluids per day.
Control Your Environment
By avoiding smells that do not appeal to you (some of which may have never bothered you before) you can prevent nausea. Have someone else cook for you so you do not become nauseated by a certain ingredient used in the cooking process. Also, try to create a restful environment since reducing stress has been shown to reduce nausea and vomiting. Try listening to relaxing music, practicing yoga or meditation, or breathing exercises. These techniques may also help you get a better night’s sleep which has also been associated with decreased nausea.
Fresh ginger has been shown to help alleviate nausea. Try flat ginger ale, ginger tea, gingersnaps, gingerbread, shredded fresh ginger, and ginger candies. Peppermint is another food known to soothe nausea. Citrus fruits also tend to be helpful- just smelling a lemon when you feel queasy may alleviate nausea.
Vitamin B6 Supplementation
Pyridoxine or vitamin B6 may help women with severe and persistent nausea and vomiting. Even for women without these symptoms, vitamin B6 is an important vitamin that is required in greater amounts especially during later stages of pregnancy when the fetus is increasing the most in size. The reason is unclear why vitamin B6 may help prevent nausea and studies are inconclusive regarding its effectiveness. You should consult with your physician before taking B6 since large doses taken for long periods of time may affect the growing baby’s nutritional status.
To help alleviate morning sickness, the recommended dose of vitamin B6 is 50 mg which can be obtained through an additional supplement. This is much higher than the amount recommended during a normal pregnancy, which is 1.9 mg/day.
Dos and Don'ts of Morning Sickness
- Eat small meals often
- Drink fluids 1/2 hour before or after a meal, but not with meals
- Drink small amounts of fluids during the day to avoid dehydration
- Eat soda crackers 15 minutes before getting up in the morning
- Avoid foods and smells that increase nausea
- Ask someone else to cook for you and open the windows or turn on fans if the odor bothers you
- Get plenty of rest and nap during the day
- Avoid warm places (feeling hot adds to nausea)
- Sniff lemons or ginger, drink lemonade or eat watermelon to relieve nausea
- Eat salty potato chips (they have been found to settle stomachs enough to eat a meal)
- Do not lie down after eating
- Do not skip meals
- Do not cook or eat spicy food
Avoid making Morning Sickness Worse
Just as there are things that will help to alleviate morning sickness, there are things that will actually make it worse. Skipping meals will enhance the morning sickness, as will lying down after meals. Eating spicy foods (or cooking them) could also make your morning sickness worse.
You should contact your doctor if your morning sickness prevents you from keeping any food down, if your morning sickness is accompanied with a fever, or the morning sickness persists into the second trimester, after the 13th week of the pregnancy. Relax! You will get through it.
Hyperemesis Gravidarum is a life-threatening disease
For some women, the nausea of the first trimester is so severe that they become malnourished and dehydrated. These women may have a condition called hyperemesis gravidarum (HG). HG refers to women who are constantly nauseated and/or vomit several times everyday for the first 3 or 4 months of pregnancy.
Hyperemesis gravidarum keeps pregnant women from drinking enough fluids and eating enough food to stay healthy. Many women with HG lose more than 5 percent of their pre-pregnancy weight, have nutritional problems, and have problems with the balance of electrolytes in their bodies. Persistent nausea and vomiting also make going to work or doing other daily tasks very difficult.
Many women with HG have to be hospitalized so they can be fed fluids and nutrients through a tube in their veins. Usually, women with HG begin to feel better by the 20th week of pregnancy but in some cases, the symptoms may persist throughout all three trimesters.