Nausea and vomiting in the first trimester of pregnancy:
Up to 80% of pregnant women suffer from nausea and vomiting to some degree. They are more frequent and severe during the first trimester. Although they are usually associated with the morning, they can occur at any time of the day. Symptoms range from mild to severe.
The hyperemesis gravidarum is severe and persistent vomiting of pregnancy. When you have this disorder, you vomit so much that you lose weight and become dehydrated. Not enough food is consumed to provide energy to the body. Because of this, it breaks down fats, resulting in a build-up of waste products (ketones) called ketosis. Ketosis can cause fatigue, bad breath, dizziness, and other symptoms. Often when you have hyperemesis gravidarum, the dehydration is so severe that the electrolyte balance, necessary for the body to function normally, is disturbed.
If you vomit occasionally but gain weight and are not dehydrated, you do not have hyperemesis gravidarum. Morning sickness and hyperemesis gravidarum usually disappear during the second trimester.
Causes of nausea and vomiting in the first trimester of pregnancy
Nausea and vomiting that occur during pregnancy are usually due to pregnancy. But, sometimes, they are the result of a disorder that has nothing to do with pregnancy.
The most common causes of nausea and vomiting are:
- Morning sickness (the most common)
- Hyperemesis gravidarum
- Gastroenteritis (infection of the digestive tract)
It is not known for sure why morning sickness and hyperemesis gravidarum occur during pregnancy. But it may be due to the increased concentration of two hormones produced during this period: human chorionic gonadotropin (hCG), which the placenta produces during the first months of pregnancy, and estrogens, which help to maintain pregnancy. The estrogen concentration is particularly high in the presence of hyperemesis gravidarum. Additionally, hormones such as progesterone (which is produced non-stop during pregnancy) can slow down peristaltic movements, which can also contribute to nausea and vomiting.
Psychological factors may also participate.
Less frequent causes
Sometimes prenatal vitamins with iron cause nausea. In rare cases, severe and persistent vomiting occurs secondary to a hydatidiform mole (overgrowth of placental tissue).
Possible causes unrelated to pregnancy include:
- Disorders of the abdomen such as appendicitis, intestinal blockage ( intestinal obstruction ), or inflammation of the gallbladder ( cholecystitis )
- Brain disorders such as migraine, and intracranial or brain hemorrhage, and increased pressure within the brain (intracranial or intracranial pressure)
But these disorders often cause other more prominent symptoms, such as abdominal pain or headaches.
First, an attempt is made to determine if nausea and vomiting are secondary to a serious disorder. Morning sickness or hyperemesis gravidarum is only diagnosed after other causes have been ruled out.
In pregnant women who experience vomiting, the following symptoms are a cause for concern:
- Abdominal pain
- Signs of dehydration, such as decreased urine volume, less sweating, excessive thirst, dry mouth, palpitations, and dizziness when standing up
- Bloody, black (similar to coffee grounds) or green vomit
- Absence of fetal movements when the fetus is over 24 weeks
- Confusion, weakness or numbness on one side of the body, speech or vision disturbances, or drowsiness, as these symptoms indicate bleeding in the brain
- Vomiting that persists or gets worse.
When to visit the doctor?
The women in the presence of warning signs, you should see a doctor immediately, especially if the same intense suffering vomiting or worsening.
If there are no warning signs, the doctor should be informed. This will help to decide if and when to attend the consultation, depending on the nature and severity of the symptoms. If your nausea and vomiting are mild to moderate in intensity, you have not lost weight, and you can drink something, you may not need to see a doctor unless your symptoms get worse.
The doctor asks about the symptoms and the patient’s medical history. Next, perform a physical examination. What they find during the history and physical examination often suggests a cause of the disorder and the tests that may need to be done (see table Some Causes and Features of Nausea and Vomiting in the First Trimester of Pregnancy ).
The doctor asks about vomiting:
- When they start
- How long do they last
- How many times a day
- What makes them easier or worse
- What they look like
- How much is there
The woman is asked about other symptoms, especially abdominal pain, diarrhea, and constipation, and how these symptoms have affected her and her family (whether she can work or care for her children). She is also asked about vomiting in previous pregnancies, about possible previous abdominal surgeries, and about the intake of drugs that can cause vomiting.
On physical examination, they first look for signs of serious disorders, such as high or low blood pressure, fever, confusion, and drowsiness. A pelvic examination is done to look for possible signs of hydatidiform mole and other abnormalities.
All of the above makes it possible for the doctor to determine if the vomiting is due to pregnancy or a different disorder. For example, vomiting is likely due to pregnancy if:
- They started during the first trimester
- The last or recur several days a week
- They are not accompanied by abdominal pain
They are likely due to another disorder if:
- They started after the first trimester
- Are accompanied by abdominal pain, diarrhea, or both
A handheld Doppler ultrasound device, which is placed on the woman’s abdomen, is often used to check that the fetus’ heart is still beating. If no heartbeat is heard around 11 weeks of pregnancy, it may be a hydatidiform mole. If you vomit frequently or have dehydration or if it may be a hydatidiform mole, more tests are usually done. The tests that are done depend on the suspected cause:
- Hyperemesis gravidarum: Urinalysis to measure the concentration of ketones and possibly blood tests to measure the concentration of electrolytes and other substances
- Hydatidiform mole: ultrasound of the pelvis
- Disorder not related to pregnancy: specific tests for the disorder
If vomiting is secondary to a particular disorder, the appropriate treatment is administered. But if they are due to pregnancy, making some changes in diet or eating habits can alleviate them:
- Drink or eat small amounts more often (5 or 6 small meals a day)
- Eat before you are hungry
- Eat only bland foods, such as bananas, rice, applesauce, and toast
- Always keep crackers by the bed and eat one or two before getting up
- Drink carbonated drinks (sodas)
If vomiting results in dehydration, fluids will be given through an IV. But if they persist, they will proceed to hospitalization. They will be given intravenously along with sugar (glucose), electrolytes, and sometimes vitamins. When the vomiting has subsided, the liquid will be administered orally. If you tolerate liquids, you can begin to eat small and frequent servings of soft foods. Portion sizes are increased as more food is tolerated.
If necessary, medications are given to relieve nausea (antiemetics). The doctor chooses the safest drugs for the first months of pregnancy. First of all, vitamin B 6 is prescribed. If it is ineffective, another drug is also given, such as doxylamine, metoclopramide, ondansetron, or promethazine.
Ginger (available as capsules or lollipops), acupuncture, motion sickness bands, and hypnosis can help, as can substituting prenatal vitamins for children’s chewable folic acid vitamins.
On rare occasions, weight loss continues and symptoms persist despite treatment. In this case, the woman is fed with a tube through the nose and throat into the small intestine. Tube feeding continues for as long as necessary.
- Nausea and vomiting during pregnancy usually do not cause weight loss or other problems, and they resolve before or during the second trimester.
- Hyperemesis gravidarum, a severe and persistent form of vomiting due to pregnancy, is less common, although it can cause dehydration and weight loss.
- Nausea and vomiting can be secondary to disorders not related to pregnancy, such as gastroenteritis, a urinary infection, or, rarely, a bowel obstruction.
- Changing your diet helps to relieve mild nausea and vomiting due to pregnancy.
- If dehydration is observed in the presence of hyperemesis gravidarum, intravenous fluids may be necessary.