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Why do many pregnant women always feel nauseous andVomit？

About 50% to 90% of pregnant women will encounter this problem, and 35% of them will also experience severe vomiting. These symptoms usually begin in the early stages of pregnancy and reach their peak at 9 weeks of pregnancy. Then, around 20 weeks of pregnancy, more than 90% of pregnant women will be relieved.

Although these reactions may seem common during pregnancy, nausea and vomiting are more than simple physiological reactions and cannot be simply classified as hyperemesis gravidarum.

Next, Rolando G. Valenzuela, director of the emergency department at Renaissance School of Medicine at Stonebrook University in New York, will take us through why pregnancyNausea and vomiting, and how to handle it correctly:

What harm can hyperemesis gravidarum bring to pregnant women?

Hyperemesis gravidarum is an extreme case of nausea and vomiting during pregnancy, but it is not common, affecting only about 0.5% to 2% of pregnant women. Before you diagnose a patient with hyperemesis gravidarum, you as a doctor need to rule out other possible causes of vomiting.

Hyperemesis gravidarum usually makes pregnant women feel very hungry, usually manifested as large amounts of ketonuria, accompanied by electrolyte imbalance and dehydration, and sometimes causes weight loss. If not treated in time, this severe vomiting will not only affect the pregnant woman, but also cause harm to the fetus.

In addition, hyperemesis gravidarum may also cause some seriouscomplication, such as spleen rupture, esophageal rupture,pneumothorax, acute tubular necrosis, Wernicke's encephalopathy, and central pontine demyelination.

How to identify and diagnose?

A physical examination and a thorough medical history, including documentation of chronic medical conditions, performed before pregnancy are very helpful in identifying possible serious risk factors.

It is important to note that nausea and vomiting during pregnancy are not usually accompanied by other symptoms, such as fever, headache, neurological dysfunction, abdominal pain,Proteinuria, difficulty urinating,hematuriaOr side abdominal pain, etc. If a pregnant woman has these symptoms, further examination is needed to find out the cause.

The following table lists the differential diagnosis of nausea and vomiting during pregnancy, which can help you as a physician better judge the situation.

Evaluation of nausea and vomiting during pregnancy should include several tests: blood tests to check forElectrolytesIn addition, a pelvic B-ultrasound is needed to rule out the possibility of molar pregnancy.

Once serious illness has been ruled out, the basic treatment measure is to adjust lifestyle and eating habits to control symptoms. For example, avoid exposure to factors that easily cause nausea, such as strong smells, greasy or spicy foods, and iron supplements. Switching to small and frequent meals and eating light, low-fat, high-protein foods can also help reduce nausea.

In addition, ginger andVitaminsB can also effectively relieve symptoms, and it is a safe over-the-counter drug that is easily available.

How is treatment carried out?

If lifestyle adjustments, dietary changes, and over-the-counter medications don't relieve your symptoms, you may need to consider prescription medications.

The initial treatment recommended by the American College of Obstetricians and Gynecologists (ACOG) includes oral vitamin B6 10-25 mg, 3-4 times a day; and the antihistamine doxylamine 12.5 mg, 3-4 times a day. These drugs are safe for both mother and fetus.

If this doesn't work, consider a second-line medication such as diphenhydramine or promethazine. These are also antihistamines and should be avoided with doxylamine.

For drug-resistant patients, 5-HT3 receptor antagonists such as ondansetron can be used for treatment.

Although these drugs are generally safe for pregnant women, they may increaseCardiovascular diseaserisk.

Finally, to summarize briefly, here are three things you need to know about the correct way to deal with nausea and vomiting during pregnancy:

(1) While nausea and vomiting are common during pregnancy, it is important to be aware of other possible causes of these symptoms.

(2) Improving nausea symptoms by adjusting lifestyle and dietary habits is the preferred treatment option without medication.

(3) Vitamin B6 and doxylamine are both relatively safe, and there is usually no problem using these medications.

References:

[1]Amal Mattu, Arjun S. Chanmugam, Stuart P. Swadron et al. Avoiding common errors in the emergency department[M]. Wolters Kluwer, 2020.