Nausea and vomiting during pregnancy

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When Does NVP Happen?

Nausea and vomiting of pregnancy (NVP) usually starts at about seven weeks into the pregnancy, and it usually does not last beyond twelve weeks. For many women, the symptoms happen only in the morning—’morning sickness.’ About nine percent of women, however, continue to experience nausea and/or vomiting beyond 20 weeks.

The Toll Of NVP

Different women experience NVP with varying degrees of severity; 50 percent have nausea and vomiting, while 30 percent have nausea only. For some women, symptoms are manageable. For others, they can be devastating. Women with severe symptoms may experience nausea throughout the day and may vomit up to 15 times per day. Nausea and vomiting negatively affects a pregnant woman’s quality of life and affects her family members. It can be especially difficult if the woman has a job to go to in the workforce, and/or if she has other children to care for. Research by Motherisk, a program affiliated with Sick Kids Hospital in Toronto, has shown that many women with NVP experience depression and anger and can sometimes feel isolated. Some women may even consider terminating otherwise wanted pregnancies due to extreme NVP.

Extremely Severe NVP (Hyperemesis Gravidarum)

In rare cases—less than one percent—women may develop Hyperemesis Gravidarum. This extreme form of NVP involves persistent nausea and vomiting. The medical complications caused by this include dehydration, metabolic abnormalities, and weight loss, and can be dangerous and lead to a visit to the hospital.

Ways Some Women Cope

Thankfully, NVP is treatable. Many pregnant women find it easier to cope with NVP by:

• Eating small, frequent meals rather than large meals each day.
• Drinking liquids before or after eating meals but not during meals.
• Avoiding certain foods and smells, and avoiding cooking.
• Acupressure techniques.
• Hypnotherapy.

NVP Can Be Treated

NVP can be safely and effectively treated with specific medications. Diclectin is the only approved medication that is meant specifically for NVP. Diclectin is a delayed-release combination of vitamin B6 and doxylamine succinate, an antihistamine.

Other medications found to be safe:

• dimenhydrinate (Gravol)
• hydroxyzine (Atarax)
• promethazine (Phenergan)
• prochlorperazine (Stemetil)
• Ondansetron (Zofran)

These medications are available in formulations that provide immediate relief.

What About Future Pregnancies?

You may have NVP in one pregnancy, but not in another.

How to Find Out More

You can read more information, including studies, about NVP on the Website of Motherisk: motherisk.org. Motherisk also has a morning sickness helpline that women across the country can access: 1-800-436-8477.

This article is adapted from the book, The Complete Guide to Everyday Risks in Pregnancy & Breastfeeding, by Dr. Gideon Koren, MD, FRCP(C). Dr. Koren is the founding director of the Motherisk program at Sick Kids Hospital in Toronto.

Originally published in 2013.