Nausea and Vomiting in Pregnancy

for
patients

Nausea and Vomiting in
Pregnancy
This information leaflet has been given
to you as you are pregnant. It might help
answer some of the questions you may have
about nausea and vomiting in pregnancy and
gives advice on what you can do to try to
help your symptoms.

Maternity Services
Ipswich Hospital
Heath Road
Ipswich
IP4 5PD

(DPS: 03568-18)

What is nausea and vomiting in pregnancy?
Nausea and vomiting are common symptoms during pregnancy,
affecting approximately 80 in 100 pregnant women. It is often called
‘morning sickness’ but can occur at any time of the day or night. It
usually begins in early pregnancy, between 4 – 7 weeks, and settles by
week 12. However, in some women it lasts longer, up to 20 weeks, and
occasionally it continues throughout the pregnancy.
The cause is unclear but it is thought to be related to pregnancy
hormones.
Nausea and vomiting may become severe enough to cause
dehydration, weight loss and abnormal electrolyte levels in your
blood. This severe form of nausea and vomiting in pregnancy is called
hyperemesis gravidarum and it is much rarer, affecting up to 3 in
100 pregnant women.
Symptoms of hyperemesis gravidarum include:
• prolonged and severe nausea and vomiting;
• inability to tolerate fluids and food;
• feeling thirsty;
• drowsiness;
• feeling weak, dizzy or faint when standing up; and
• a change in urine colour to dark yellow or brown.

Will it harm my baby?
There is no evidence that nausea and vomiting has a harmful effect on
your baby. In fact, you have a slightly lower risk of miscarriage.
Women with severe nausea and vomiting or with hyperemesis
gravidarum which persists into later pregnancy may, however, have
a baby with a lower than expected birthweight. You may be offered
scans to monitor the growth of your baby.

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How will it make me feel?
Nausea and vomiting in pregnancy can be a difficult problem to cope
with. It can affect your mood, your work, your home situation and
your ability to care for your family. Support from family and friends
can help. In some women, the symptoms can be so severe that they
become depressed and need extra support such as counselling. If
you find that you persistently feel low then you should speak to a
healthcare professional, such as your GP, midwife or hospital doctor.

What can I do to help?
Most women with nausea and vomiting in pregnancy will be able to
manage their symptoms themselves.
Measures that you can take include:
• drinking plenty (at least two litres of water a day) – little and often
  helps to avoid dehydration;
• avoiding fizzy drinks;
• eating little and often – smaller meals that are high in carbohydrate
  and low in fat, such as potato, rice and pasta, are easier to tolerate;
  try bland foods such as plain biscuits or crackers;
• eating a snack, such as dry crackers or biscuits, before getting out of
  bed in the morning;
• avoiding any foods or smells that trigger your symptoms;
• avoiding fatty foods;
• eating or drinking ginger products is helpful for some women;
• complementary therapies such as acupressure or acupuncture may
  also be helpful;
• rest; and
• asking for help – it is important to get emotional support from
  friends and family.

If your symptoms do not settle, or if they prevent you doing your
day-to-day activities, see your GP who may prescribe anti-sickness
medication. This is safe to take during pregnancy.
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What if my symptoms do not settle with these
measures?
If you are still unable to keep down any food or fluids, contact your
GP or midwife. They will arrange for you to be seen in the assessment
unit.

What happens once I arrive at the assessment
unit?
Your assessment is likely to include the following:
1 A discussion about your symptoms, including:
   –      duration;
   –      severity;
   –      any medications you are taking;
   –      whether you have lost any weight;
   –	whether you have any other symptoms that might suggest
      complications or another cause of nausea and vomiting; and
   –	whether you have any previous history of nausea and vomiting
      in pregnancy.
2 An examination, including:
   –	measurements of your temperature, pulse, blood pressure,
      respiratory rate, weight and assessment of your hydration;
   –      urine tests;
   –      blood tests; and
   –	an ultrasound scan – if you have not yet had a scan during this
      pregnancy, one will be arranged.

If you are able to tolerate some fluids but are unable to drink enough,
you will be offered them (through a drip in your arm). You will also be
given anti-sickness medication. Many women feel much better after
this and are able to go home.

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What is ambulatory day care?
If you need further treatment, and are assessed as suitable for
ambulatory day care, you will be asked to return daily for:
• fluids – through a drip (IV);
• anti-sickness medication – if you are unable to keep down tablets,
  this medication can be given through a drip in your arm. There are
  a variety of anti-sickness medicines that you may be offered. All
  of the anti-sickness medicines we routinely prescribe for nausea
  and vomiting during pregnancy and hyperemesis gravidarum are
  considered safe in pregnancy; and
• vitamin B – either tablets or through a drip.

You will have daily clinical assessments and blood tests while we are
treating you, but you do not need to stay in hospital as an inpatient.

What if I need to be admitted to hospital?
Admission to hospital may be advised if you:
• are dehydrated – having ketones in your urine is a sign of
  dehydration;
• have severe vomiting and are unable to tolerate any fluids;
• have abnormal blood tests;
• have lost weight;
• have a medical condition such as heart or kidney problems, or
  diabetes;
• have symptoms that have not improved with ambulatory day care
  management; or
• have any other conditions (such as a urinary tract infection)
  requiring tablet treatment, which you are unable to keep down.

If you are admitted to hospital you will be given similar treatment
to what is described in ambulatory day care, but we will be able to
monitor you more closely. The IV fluids will be continued until you are
able to keep down fluids you drink.

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You will also be given treatment to prevent blood clots – this includes:
• TED stockings – special compression stockings; and
• heparin injections – to thin your blood.

Your fluid intake and how much urine you are passing will be
recorded. Your temperature, pulse, blood pressure, respiratory rate
and weight will also be monitored.
Patients with hyperemesis gravidarum that has not improved with
IV fluids or first- and second-line anti-sickness medications may be
offered steroids. Steroids improve symptoms in many women who
have not responded to the above measures. Steroids are generally
considered safe for use in pregnancy and only a tiny amount of the
dose used to treat hyperemesis gravidarum passes from you to your
baby.

After discharge
• You should continue taking the anti-sickness tablets when you
  return home.
• Ask your GP for a repeat prescription before your tablets run out.
• If you feel better, you can reduce the number of tablets.
• Continue to eat small meals often and drink little and often to avoid
  triggering symptoms.
• If your vomiting gets worse, stop eating but try to keep sipping
  fluids and taking the anti-sickness tablets until you start to feel
  better.
• If you can’t keep any food and fluid down for at least 24 hours
  without vomiting, please contact your GP, midwife or the Peggy
  Cole Emergency Assessment Unit to be assessed again.

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Further information and support
Pregnancy Sickness Support
www.pregnancysicknesssupport.org.uk
NHS Choices: Nausea and morning sickness
www.nhs.uk/conditions/pregnancy-and-baby/pages/morning-sickness-
nausea.aspx
Hyperemesis Education and Research (HER) Foundation
www.helpher.org

Adapted from: Royal College of Obstetricians and Gynaecologists.
Pregnancy sickness (nausea and vomiting of pregnancy and
hyperemesis gravidarum). Patient Information Leaflet. London: RCOG;
2016, with the permission of the Royal College of Obstetricians and
Gynaecologists.
www.rcog.org.uk/en/patient-leaflets/pregnancy-sickness/
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Please ask if you need this leaflet in an alternative format.
Issued by:
East Suffolk and North Essex NHS Foundation Trust
Ipswich Hospital, Heath Road, Ipswich IP4 5PD
www.esneft.nhs.uk

   DPS: 03568-18(RP)                                           Issue 2: July 2018 Review date: June 2021
                                              © East Suffolk and North Essex NHS Foundation Trust, 2018.
                                            All rights reserved. Not to be reproduced in whole, or in part,
                                                           without the permission of the copyright owner.