50% of women have nausea and vomiting in early pregnancy. The popular term “morning sickness” is a misnomer. since this condition often persists throughout the day. In a small minority of patients, the symptoms lead to dehydration and weight loss requiring hospitalization. The onset of the nausea is within 4 weeks after the last menstrual period in most patients. The problem typically peaks at approximately 9 weeks of gestation. Sixty percent of cases resolve by the end of the first trimester, and 91% resolve by 20 weeks of gestation. Nausea and vomiting are less common in older women and smokers. Nausea and vomiting are associated with decreased risk of miscarriage. Women with twins are at higher risk for these symptoms. Hyperemesis gravid arum must be distinguished from other conditions that may cause persistent vomiting in pregnancy, including gastrointestinal conditions ( e.g., appendicitis, hepatitis, pancreatitis, or biliary tract disease).
Women should be advised to avoid exposure to odors, foods, or supplements that appear to trigger nausea. Common triggers include fatty or spicy foods and iron tablets.
Eating small amounts of food several times a day and drinking fluids between meals may be helpful, as may bland, dry, and high protein foods. Traditionally, patients have been advised to manage nausea by keeping crackers at the bedside in the morning and avoiding an empty stomach.
Approximately 10% of women with nausea and vomiting in pregnancy require medication. Oral vitamin B has been associated with a 70% reduction in nausea and vomiting. It is recommended by the American College of Obstetricians and Gynecologists (ACOG) as first-line therapy for nausea and vomiting.
Alternative therapies such as acupuncture and ginger have also been studied for nausea and vomiting in pregnancy, with inconsistent results. Ginger is considered to be not a drug rather a food supplement, and therefore, it is not regulated by the FDA. It may not be available in hospital pharmacies.
Pregnant women with dehydration should receive intravenous fluid replacement with multivitamins. If, after 12 hours of intravenous therapy, the vomiting continues, hospitalization may be required.