Nausea and vomiting are among the most common symptoms of early pregnancy. Often referred to as “morning sickness”, pregnancy sickness can occur at any time of the day or night and can range from mild nausea to repeated vomiting that interferes with work, eating and everyday activities.
For most women, symptoms begin early in pregnancy, commonly between the fourth and seventh week, and improve as pregnancy progresses. About nine out of 10 women find that pregnancy sickness settles by 15 weeks, although some continue to experience symptoms for longer. The worst symptoms peak at 10 weeks and then usually get better by 14 weeks.
Why does it happen?
The exact cause is complex. Pregnancy hormones play an important role, and research has increasingly focused on a placental hormone called GDF-15, which can trigger nausea and loss of appetite. Genetic differences may also explain why some women experience much more severe symptoms than others.
Women are more likely to experience pregnancy sickness if they have had it in a previous pregnancy or are carrying twins or triplets. A family history and a history of migraines or motion sickness may also increase the risk.
What can help?
For many women, simple changes can make a significant difference.
Try eating small, frequent meals rather than allowing the stomach to remain empty. Dry crackers or toast before getting out of bed may help. Bland foods and protein-rich snacks can be useful, while foods or smells that trigger nausea should be avoided.
Some women find that cold or room-temperature foods are easier to tolerate because they produce fewer cooking smells. Drinking fluids regularly is most important for staying hydrated. If drinking large amounts at once makes nausea worse, take frequent small sips instead.
Ginger may provide relief for some women with mild nausea. Prenatal vitamins are also important, and evidence suggests that taking a prenatal vitamin before and during pregnancy may reduce the risk of severe nausea and vomiting. Hence the importance of having a preconception doctor’s visit.
When medication is needed
Women do not have to suffer unnecessarily. If nausea and vomiting are affecting daily life or preventing adequate food and fluid intake, medical treatment should be discussed with an obstetrician or other healthcare professional.
Vitamin B6 may be recommended initially, with doxylamine added when necessary. Other anti-nausea medications may be prescribed when first-line treatment is not sufficient. The choice depends on the severity of symptoms, the stage of pregnancy and the woman’s medical history.
When should you seek medical attention?
Vomiting becomes concerning when a woman cannot keep fluids down, is losing weight or develops signs of dehydration.
Seek medical advice if you are passing very little or dark urine, feel dizzy or faint when standing, have a racing heartbeat, cannot keep liquids down, or notice significant weight loss. Abdominal pain, fever or vomiting that begins unusually late in pregnancy may indicate another medical problem and should also be investigated.
The important message is that nausea and vomiting in pregnancy are common, but severe symptoms should not simply be endured. Early assessment and treatment can prevent the condition from becoming more serious and can greatly improve a woman’s quality of life.
If vomiting is persistent, severe or preventing normal eating and drinking, it may be more than ordinary pregnancy sickness. It could be hyperemesis gravidarum, a condition that deserves prompt medical attention.
Dr Sherene Kalloo
MDW, MBBS, DGO, DM, FACOG
Specialist Obstetrician & Gynaecologist
