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I am in the first trimester and have nausea. What can I do and when should I be worried?

Fifty to ninety percent of pregnant patients experience nausea and vomiting. A list of home and over-the-counter remedies is available in the section on medications in pregnancy. We certainly advocate the use of electrolyte containing fluids if vomiting is persistent.

Less than 1 percent of patients develop a severe variant called hyperemesis gravidarum. These patients have intractable nausea and vomiting and experience weight loss, dehydration and electrolyte abnormalities. Go to the emergency room if you are unable to keep any fluid down and have signs of dehydration such as dry mouth, low or concentrated urine output and the conservative interventions have not helped. There you may be hydrated and evaluated for hyperemesis gravidarum.

There are some important things to remember about pregnancy-associated nausea and vomiting. These symptoms should not start after the first trimester. If they do, other potential causes should be explored. Also, pregnancy should not be accompanied by fever, burning with urination, headache and abdominal pain beyond what can be explained by sore abdominal muscles.

Nausea and vomiting*:

  • Strategies
    • Avoid odors and triggers
    • Avoid spicy and fatty foods
    • Omit iron supplement
    • Eat bland, dry high protein foods
    • Eat small frequent meals with fluids between
    • Avoid an empty stomach
    • Keep crackers at bedside; eat before rising
  • Alternative therapies
    • Ginger: ginger ale or capsules (250mg 4 times per day taken orally)
    • Vitamin B6
    • P6 elastic wristband (acupuncture point)
  • Antihistamines available without a script
    • Dramamine (dimenhydrinate) 50mg 4 times per day
    • Antivert (meclizine) 25mg 3 times per day
    • Vistaril (hydroxyzine) 25-50mg 4 times per day
    • Benadryl (diphenhydramine) 25mg 3 times per day
  • Prescription medicines available if indicated
* adapted from Niebyl. "Management of Nausea and Vomiting in Pregnancy: A Clinical Perspective". Academy for Healthcare Education. Nov. 2002 pp.6-9.

Alert! Patients should take medicines during pregnancy only as a last alternative. Many medicines are considered "safe" when taken during pregnancy, and are described as such here; however, these declarations are usually made via observational studies of populations. They are rarely made as the result of rigorous study. Thus, caution and restraint should be exercised in starting any medication, prescription or over the counter, during pregnancy.

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