In spite of the large number of unpleasant symptoms and discomfort, pregnancy is that: A Pregnancy, not a disease !

Nausea and vomiting of pregnancy (NVP) is perhaps the most frequent complaint of pregnancy and is usually the first evident and earliest manifestation of pregnancy.

50% of pregnant women will develop nausea and vomiting between weeks 6 and 16, 25% will only manifest nausea and the remaining 25% will not manifest any symptoms. Up to 3% of pregnant women will manifest severe, incapacitating nausea and vomiting, a condition known as Hyperemesis Gravidarum (HG).

The time of the day when NVP is most frequently suffered is in the morning (hence the name Morning Sickness of English speakers).

Patience, studies have shown that pregnant women who suffer NVP are less likely to have an abortion, everything has its positive side. It does not mean that if you do not have them you will lose your baby but we take very seriously those patients who suddenly feel perfectly well and without any symptoms, the loss of pregnancy can be the cause.

Risk factors for NVP

• Placental size increase (eg, multiple pregnancies)
• NVP in previous pregnancies
• Having close relatives (mother, sister) who have suffered NVP
• Female fetuses.
• Those who didn’t take prenatal vitamins before pregnancy (taking them 3 months before the beginning of pregnancy reduces the risk of NVP)
• Hyperthyroidism (excess function of the thyroid gland)

Safe medications

• Doxylamine with Vitamin B6 (10 mg / 10mg), is considered the first line therapy.
• Meclizine with Vitamin B6 (Bonadoxin), has been used for years without adverse effects
• Ginger in capsules (health food stores) or tea, could help even when literature is limited
• Metoclopramide, widely used in Latin America, has been shown to be safe for the fetus and the mother. Prolonged use and in high doses can generate certain neurological disorders in the mother (extra-pyramidal disorders and Tardive Dyskinesia: they manifest with involuntary “strange” movements). The maximum dose allowed is 30 mg per day, divided into 10 mg every 8 hours.
• Methylprednisolone (Solumedrol, a steroid) can be used if first-line therapies have failed. It can induce fetal malformations before week 10 (cleft palate, 2/1000, very low risk but to consider). The maximum dose is 48 mg per day for 3 days.
• Ondansetron (Zofran) is very effective but care must be taken in patients with cardiac arrhythmia. Some reports of fetal malformation, should be used with caution. Recommended maximum dose for intravenous route 16 mg.

Rescue, re-hydration and feeding in severe cases, Hyperemesis Gravidarum

In the presence of malnutrition and dehydration due to severe vomiting, the patient must be hospitalized

The initial measures should include intravenous hydration with solutions containing dextrose and thiamine (Vitamin B1) to recover the patient’s hydration status and prevent certain types of neurological problems associated with prolonged vomiting (Wernicke encephalopathy).

A nasogastric tube (small tube placed inside the stomach) should be placed for feeding through the digestive tract.

Obstetric monitoring and ultrasound help to reassure the patient by demonstrating that her pregnancy is evolving correctly

Hyperemesis Gravidarum (HG) is the most severe degree of NVP, producing dehydration, weight loss greater than 5%, alterations in blood pH and metabolic and electrolyte imbalances. Vomiting is so frequent and severe that the patient dehydrates quickly and in a matter of a few days shows severe nutritional alterations. Usually outpatient treatment is insufficient and the patient needs to be hospitalized urgently. It requires the intervention of other specialties to rule out organic conditions such as esophagitis, gastritis, vesicular lithiasis, etc.

We have observed psychological elements associated with this condition: anxiety, reproductive fears, depression, denial or negative responses to pregnancy, couple problems, among others.

Prognosis: Excellent. Sooner or later the situation is controlled.

There are treatments for frequent conditions and discomfort in pregnancy, do not be discouraged, let’s find the solution.