NAUSEA AND VOMITING IN PREGNANCY (NVP)

 

Nausea and vomiting in pregnancy (NVP) are common problems occurring in about 70-80% of pregnancies, especially during the first trimester. During this period, a mother will feel uncomfortable and might have episodes of vomiting and lethargy. However, most of these women can be managed at home without any medical intervention. Commonly it will start at 6 weeks of pregnancy. By weeks 9th to 12th, it will be worsening and normally will stop in the 16th to 18th week of pregnancy. However, a different mother may have different periods of symptoms. Some mothers may experience it throughout the pregnancy.

Nausea and vomiting in pregnancy are commonly due to hormonal factors which are human Chorionic Gonadotropin (hCG) and changes in estrogen levels. Besides that, NVP also results from increased levels of progesterone that causes delayed gastric emptying. Nausea and vomiting are often worse in pregnant women with molar pregnancies and twin pregnancies due to extremely elevated hCG levels.  Women who had NVP in their first pregnancy have a higher chance of recurrence in subsequent pregnancies than women who did not have NVP in their first pregnancy. In addition to being a first-time mother, psychological and emotional stress can also contribute to NVP. However, NVP is less common in older women, women who have had more than one child, and women who smoke and this observation has been attributed to the smaller placental volumes in these women.

Although nausea and vomiting are common early pregnancy symptoms, they can lead to dehydration and poor nutrition. NVPs also can have a negative impact on a woman's ability to conduct daily household duties, social life, spouse relationship, ability to take care of children, and employment capability. Moreover, NVP also affects the physical and emotions resulting in feelings of anxiety and worry about the effects of the symptoms to the baby.

These are some advice on dietary modifications that can relieve the symptom of NVP such as:

• Taking small but frequent diet and fluids instead of having 3 or 4 full courses of meals. This is to ensure mother to consume adequate nutrition and hydration.
• Eat a few crackers before rising from bed is usually helpful, then rest for 15 minutes before getting out of bed.
• Eat whenever the women want and immediately when feel like eating certain.
• Avoid oily, spicy, and fried food that can stimulate nausea and vomiting.
• Avoid eating known food or stimulants that can trigger nausea and vomiting.
• Avoid taking lots of fluids during eating or immediately before or after meals to prevent a fullness sensation that causes nausea and vomiting.
• Taking ginger teas, preserves, or ginger ale. This can be effective in reducing NVP.
• Get adequate rest, a lot of fresh air, and enough support from friends and family members.

 

Women are advised to report signs and symptoms of dehydration, unrelieved NVP, or inability to take orally for more than 24 hours. Thus, women with severe and unrelenting NVP should seek medical advice as soon as possible. Depending on the severity of the NVP, medical treatment focuses on reducing symptoms while minimizing risks to the mother and baby. Dietary adjustments, medication treatment, or hospitalization with intravenous fluid replacement and nutrition therapy are all possible treatments. In conclusion, women are encouraged to be aware of the physiology and nature of NVP and to eat as much as possible during the duration of the symptom.

 

Prepared by:

• Khairunnisa Binti Ismail, Clinical Instructor, Nursing Department, FMHS, UPM
• Nurul Asyikin Binti Mohamad, Clinical Instructor, Nursing Department, FMHS, UPM
• Wan Nor Anis Binti Wan Ali, Clinical Instructor, Nursing Department, FMHS, UPM

 

 

 

 

                                                                        

 

 

REFERENCES

 

Annama Jacob. (2017). Hyperremesis Gravidarum. In Manual of Midwifery and Gynecological Nursing (3rd ed., pp. 330–333). essay, The Health sciences Publisher.

Jordan, R. G., Farley, C. L., & Grace, T. K. (2018). Prenatal and Postnatal Care: A Woman-Centered Approach (2nd ed.) [E-book]. Wiley-Blackwell.

American College Obstetric & Genecology. (2020, May). Morning sickness: Nausea and vomiting of pregnancy. ACOG. Retrieved May 19, 2022, from https://www.acog.org/womens-health/faqs/morning-sickness-nausea-and-vomiting-of-pregnancy

Ben-Joseph, E. P. (Ed.). (2020). Severe morning sickness (hyperemesis gravidarum) (for parents) - nemours kidshealth. KidsHealth. Retrieved from https://kidshealth.org/en/parents/hyperemesis-gravidarum.html

Bunce, E. E., & Heine, R. P. (2022). Nausea and vomiting during early pregnancy - gynecology and Obstetrics. MSD Manual Professional Edition. Retrieved from https://www.msdmanuals.com/professional/gynecology-and-obstetrics/symptoms-during-pregnancy/nausea-and-vomiting-during-early-pregnancy

Bustos, M., Venkataramanan, R., & Caritis, S. (2017). Nausea and vomiting of pregnancy - What’s new? Autonomic Neuroscience, 202, 62–72. https://doi.org/10.1016/j.autneu.2016.05.002

 

Tarikh Input: 01/06/2023 | Kemaskini: 01/06/2023 | mukhriz