Ask Dr. Darria: I’m Pregnant and I Can’t Stop Vomiting. Is This Normal?

Ask Dr. Darria: I’m Pregnant and I Can’t Stop Vomiting. Is This Normal?

I’m two months pregnant, and I’m vomiting so much that it’s hard for me to go to work. Is this harming my baby? Is there any way to find relief?

As I turned the corner to meet my next patient, I immediately recognized her -- at 10 weeks pregnant, she had already come to the ER twice before for excessive vomiting. As I had the nurse place an IV for fluids and medication, we worked with her OB/GYN to come up with a plan for some relief.
 
My patient had a condition -- you may have read about it earlier this year when Katherine Middleton, the Duchess of Cambridge and wife of Prince William, was similarly afflicted. In medical terms it’s called “hyperemesis gravidarum” (HG). It literally means “too much throwing up when you’re pregnant”. It usually starts in the first trimester, with most women improving by 16-20 weeks, although some women suffer from it throughout their entire pregnancy.
 
What are signs that you have HG?
  • HG is usually defined as vomiting four or more times per day. You’ll notice that you’re losing, not gaining weight. Your doctor will likely order a urinalysis. Ketones in the urine are further evidence that you’re suffering from HG.
  • I advise my patients to NOT wait until they’ve lost weight before seeking medical care. If you’re vomiting so much that you can’t keep food or fluids down, it’s time to see your doctor.
What are signs that you’re dehydrated and require immediate medical attention?
  • Urinating less than usual or having dark urine
  • Feeling dizzy when you stand up, or like your heart is racing
  • Weight loss
  • In addition to the discomfort, HG becomes a potentially dangerous condition when you’re unable to keep down sufficient fluids and calories to feed yourself and your baby.
What can I try at home?
  • Eat very small meals—little snacks. The best foods have protein and carbs, but not fat. Try really bland/dry foods like crackers, bread, pretzels and nuts. If you can stomach it, try low-fat yogurt, which will also give you calcium.
  • Avoid spicy, greasy or acidic foods.
  • For quick calories and hydration? Try the ER favorite -- popsicles! Lollipops can also work, but I find that the cold and slow nature of eating a popsicle seems to help.
  • Avoid lying down right after eating.
  • Pamper yourself! Let someone else make your meals for you, in case the prep and smell of food make you feel worse.
  • Try wearing acupressure bands on your wrists -- these can be found at drug stores and can help alleviate both morning and motion sickness.
Are there medications for HG?
  • If you have any of the signs listed above of dehydration, see your doctor. He or she can prescribe anti-nausea medications such as Odansetron, Prochlorperazine or Meclizine. These can be given either by IV (if you’re in the ER) or by mouth as an outpatient medication.
  • If you’re very dehydrated, you may need IV fluids in the ER.
  • Vitamin B6 (Pyridoxine) has also been found to improve moderate nausea. Try 25mg orally every six to eight hours -- the maximum dose is 200mg/day.
Will my baby be in danger?
There are many medications available now to help you feel better and eat –- giving you (and therefore your baby) the nutrients you need. Even babies that are born to women with HG throughout their entire pregnancy are only a little more likely to be smaller than average. Taking medications for the nausea and vomiting do not seem to have significant long-term effects either. So, speak with your doctor about meds, but don’t let that be an additional stressor for you. Focus on getting yourself better -- the better you feel and the healthier you are, the better it is for your baby, too.